Predictors of poor outcome in gastrointestinal bleeding in emergency department.
OBJECTIVE
To determine the prognostic risk factors of gastrointestinal bleeding in emergency department cases.


METHODS
The trial was a retrospective single-center study involving 600 patients over 18-years-old and carried out with approval by the Institutional Ethics Committee. Patient data included demographic characteristics, symptoms at admission, past medical history, vital signs, laboratory results, endoscopy and colonoscopy results, length of hospital stay, need of intensive care unit (ICU) admission, and mortality. Mortality rate was the principal endpoint of the study, while duration of hospital stay, required interventional treatment, and admission to the ICU were secondary endpoints.


RESULTS
The mean age of patients was 61.92-years-old. Among the 600 total patients, 363 (60.5%) underwent upper gastrointestinal endoscopy and the most frequent diagnoses were duodenal ulcer (19.2%) and gastric ulcer (12.8%). One-hundred-and-fifteen (19.2%) patients required endoscopic treatment, 20 (3.3%) required surgical treatment, and 5 (0.8%) required angiographic embolization. The mean length of hospital stay was 5.21 ± 5.85 d. The mortality rate was 6.3%. The ICU admission rate was 5.3%. Patients with syncope, higher blood glucose levels, and coronary artery disease had significantly higher ICU admission rates (P = 0.029, P = 0.043, and P = 0.002, respectively). Patients with low thrombocyte levels, high creatinine, high international normalized ratio, and high serum transaminase levels had significantly longer hospital stay (P = 0.02, P = 0.001, P = 0.019, and P = 0.005, respectively). Patients who died had significantly higher serum blood urea nitrogen and creatinine levels (P = 0.016 and P = 0.038), and significantly lower mean blood pressure and oxygen saturation (P = 0.004 and P = 0.049). Malignancy and low Glasgow coma scale (GCS) were independent predictive factors of mortality.


CONCLUSIONS
Prognostic factors for gastrointestinal bleeding in emergency room cases are malignancy, hypotension on admission, low GCS, and impaired kidney function.
Ender Kaya, Dr. Nafiz Korez State Hospital, Sincan 06932, Ankara, Turkey.
Ender
E
Kaya
Ender Kaya, Dr. Nafiz Korez State Hospital, Sincan 06932, Ankara, Turkey.
Mehmet Ali
MA
Karaca
Ender Kaya, Dr. Nafiz Korez State Hospital, Sincan 06932, Ankara, Turkey.
Deniz
D
Aldemir
Ender Kaya, Dr. Nafiz Korez State Hospital, Sincan 06932, Ankara, Turkey.
M Mahir
MM
Ozmen
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004381:Duodenal Ulcer / Q000401:mortality / Q000628:therapy; D004621:Embolization, Therapeutic / Q000009:adverse effects / Q000401:mortality; D004636:Emergency Service, Hospital; D016099:Endoscopy, Gastrointestinal; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D015600:Glasgow Coma Scale; D016558:Hemostasis, Endoscopic / Q000009:adverse effects / Q000401:mortality; D017052:Hospital Mortality; D006801:Humans; D007022:Hypotension / Q000401:mortality / Q000503:physiopathology; D007362:Intensive Care Units; D007674:Kidney Diseases / Q000401:mortality / Q000503:physiopathology; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000401:mortality; D010438:Peptic Ulcer Hemorrhage / Q000401:mortality / Q000628:therapy; D012189:Retrospective Studies; D012307:Risk Factors; D013276:Stomach Ulcer / Q000401:mortality / Q000628:therapy; D013997:Time Factors; D016896:Treatment Outcome; D014421:Turkey; D055815:Young Adult
Emergency department; Gastrointestinal bleeding; Kidney function; Malignancy; Mortality; Poor prognosis