title: Relationship between leukocytes recruitment and risk of rebleeding in patients with peptic ulcers.
abstract: OBJECTIVE
  The aim of this study was to assess the impact of leukocytes reaction on rebleeding development among patients with peptic ulcers.
  
  
  METHODS
  This was a single-center cohort study enrolling 232 patients with a diagnosis of gastroduodenal ulcer bleeding. The end point was the in-hospital rebleeding rate during the three days after admission. The impact of clinical, demographic, endoscopic and laboratory data at the time of admission, as well as macrophages (CD68) and neutrophils count in ulcer margin, on bleeding outcome was assessed. In addition, impact of the leukocytes on the platelets aggregation induced with ADP (5μM) and collagen (1μM) was measured in vitro.
  
  
  RESULTS
  Acute ulcer bleeding was accompanied with an acute inflammatory response to damage and hemorrhage. Despite the increase of neutrophil count (P=0.031) in peripheral blood of bleeders, there were not significant influence of this parameter on the outcome. It was shown that the most significant predicting factors were an increased neutrophils (OR 1.4; 95% CI 1.1-1.8) and macrophages count in the ulcer margin (OR 3.5; 95% CI 1.9-4.87); an endoscopically diagnosed active bleeding (OR 3.0; 95% CI 1.4-6.3); an enhanced level of plasma fibrinogen (OR 1.04; 95% CI 1.0-1.08). Co-incubation of platelets with leukocytes significantly decreased the collagen induced aggregation (P=0.008) that could indicate either alteration of mechanisms of platelets adhesion, or inhibition of stabilization phase of thrombogenesis.
  
  
  CONCLUSIONS
  The severity of the local acute inflammatory reaction promotes progressive tissue damage of ulcer margin, and increases the risk of rebleeding.
authors.affiliation: Department of Histology, Cytology and Embryology, Zaporozhye State Medical University, Ukraine. Electronic address: Oksana.sulaieva@gmail.com.
authors.forename: Oksana
authors.initials: O
authors.lastname: Sulaieva
authors.affiliation: Department of Histology, Cytology and Embryology, Zaporozhye State Medical University, Ukraine.
authors.forename: Victoriia
authors.initials: V
authors.lastname: Deliy
authors.affiliation: Department of Surgery and Endoscopy, M. Gorky Donetsk National Medical University, Ukraine.
authors.forename: Stanislav
authors.initials: S
authors.lastname: Zharikov
keywords: Bleeding; Inflammation; Macrophages; Platelets; Ulcer