Öz
Amaç: Bu çalışmada yoğun bakım ünitesinde (YBÜ) izlenen akut gastrointestinal sistem (GİS) kanamalı hastaların genel klinik özelliklerini ve mortalite için risk faktörlerini değerlendirilmesi amaçlanmıştır.
Gereç ve Yöntem: Ekim 2016-Mart 2019 tarihleri arasında medikal YBÜ’de izlenen akut GİS kanamalı hastalar çalışmaya dahil edildi. Hastalar demografik, klinik ve laboratuvar verileri (kabul sırasında ve 24 saat sonra) açısından değerlendirildi ve mortalite durumuna (sağ kalan ve ölen) göre karşılaştırıldı.
Bulgular: Medyan yaşı 73,5 (31-93) yıl olan toplam 64 hasta (37 erkek/27 kadın) değerlendirildi. Tüm hastaların üst GİS kanaması vardı ve ölüm oranı %29,7 olarak saptandı. Sağ kalan ve ölen gruplar arasında cinsiyet, yaş ve kronik yandaş hastalıklar açısından malignite dışında fark yoktu. Takipte 24 saat sonra bakılan BUN, kreatinin, INR ve laktat düzeylerinin yüksek seviyeleri mortalite ile ilişkili bulundu. Lojistik regresyon analizinde akut solunum yetmezliği varlığı, YBÜ'den önce hastanede kalma süresinin uzun olması, yüksek SOFA skoru ve 24 saat sonra bakılan yüksek laktat seviyeleri YBÜ mortalitesinin bağımsız belirleyicileri olarak saptandı
Sonuç: Bu çalışmada hastaların YBÜ'ye yatıştaki değerlerinden ziyade 24 saat sonra bakılan ve yüksek seyreden BUN, kreatinin, INR ve laktat düzeyleri artmış mortalite ile ilişkili olduğunu saptadık. Bu nedenle bu değerlerin yakın takibi ve uygun tedaviler ile hızlıca normalleştirilmesinin önemli olduğunu düşünmekteyiz.
Anahtar Kelimeler
Gastrointestinal kanama yoğun bakım ünitesi risk faktörleri mortalite
Kaynakça
- 1. Wilkins T, Khan N, Nabh A, Schade RR. Diagnosis and management of upper gastrointestinal bleeding. Am Fam Physician. 2012;85(5):469–76.
- 2. Turkoğlu M, Altıntaş ND, Topeli İskit A. Comparison Between the Patients Admitted to the Intensive Care Unit with Gastrointestinal Bleeding and the Patients who Had Gastrointestinal Bleeding in the Intensive Care Unit Due to Stress Ulcer. Yoğun Bakım Derg. 2010; 3: 63–9.
- 3. Cook DJ, Griffith LE, Walter SD et al. The attributable mortality and length of intensive care unit stay of clinically important gastrointestinal bleeding in critically ill patients. Crit Care Med. 2001;5:368–75.
- 4. Alhazzani W, Guyatt G, Alshahrani M, et al. Withholding pantoprazole for stres ulcer prophylaxis in critically ill patients: a pilot randomized clinical trial and meta-analysis. Crit Care Med. 2017; 45, 1121–9.
- 5. Kuşcu ÖÖ, Elmas D, Erdoğan M, et al. Retrospective Evaluation of Critical Care Patients with Upper Gastrointestinal System Bleeding. Yoğun Bakım Derg. 2019;10(3):80–4.
- 6. Moledina SM, Komba E. Risk factors for mortality among patients admitted with upper gastrointestinal bleeding at a tertiary hospital: a prospective cohort study. BMC Gastroenterol. 2017;17(1):165.
- 7. Abaylı B, Akkan A, Avcı BŞ. Demographic Analysis of Non-variceal Upper Gastrointestinal Hemorrhagic Patients. Med J of Bakırköy.2019;15:222–6.
- 8. Yalçın MS, Kara B, Öztürk NA, Ölmez Ş, Taşdoğan BE, Taş A. Evaluation of the patients that followed up for upper gastrointestinal system bleeding. Dicle Med J. 2016;43:73–6.
- 9. Yenigün EC, Pirpir A, Aytan P, Ulusal G, Yıldırım İS. Evaluation of the characteristics of patients with upper gastrointestinal system bleeding. Akad Gastroent Derg. 2006;5:116–22.
- 10. Okutur SK, Alkım C, Bes C, et al. Acute upper gastrointestinal bleeding: Analysis of 230 cases. Akad Gastroent Derg. 2007;6:30–6.
- 11. Öcal O, Kaya B, Demirhan R, Özüçelik DN. The Evaluation of 342 Cases Jith upper Gastrointestinal Bleeding Diagnosis in Emergency Department. Acad Emerg Med. 2011;10:69–72.
- 12 Özen E, Tekin F, Oruç N, et al. Review of 412 patients with non-variceal upper gastrointestinal bleeding. Akad Gastroent Derg. 2007; 6:62–7.
- 13. Ateş F, Karıncaoğlu M, Aladağ M. Evaluation of 524 Cases With Non-Variceal Gastrointestinal System Bleeding. İnönü Üniv Tıp Fak Derg. 2008;15:93–8.
- 14. Ayık İC, Değerli V, Yılmaz G, Sevim E. Prognostic Usage of Lactate Levels in Patients with Upper Gastrointestinal Bleeding. Kafkas J Med Sci. 2018; 8(2):115–20.
- 15. Krag M, Perner A, Wetterslev J, et al. Prevalence and outcome of gastrointestinal bleeding and use of acid suppressants in acutely ill adult intensive care patients. Intensive Care Med. 2015;41:833–45.
- 16. Cook DJ, Fuller HD, Guyatt GH, et al. Risk factors for gastrointestinal bleeding in critically ill patients. Canadian Critical CareTrials Group. N Engl J Med. 1994; 330:377–81.
- 17. Fuchs L, Chronaki CE, Park S, et al. ICU admission characteristics and mortality rates among elderly and very elderly patients. Intensive Care Med. 2012; 38, 1654–61.
- 18. Balaban DV, Strambu V, Florea BG, Cazan AR, Bratucu M, Jinga M. Predictors for in-hospital mortality and need for clinical intervention in upper GI bleeding: a 5- year observational study. Chirurgia (Bucharest, Romania:1990). 2014;109(1):48–54.
- 19. Jimenez-Rosales R, Valverde-Lopez F, Vadillo-Calles F, Martinez-Cara JG, Lopez de Hierro M, Redondo-Cerezo E. Inhospital and delayed mortality after upper gastrointestinal bleeding: an analysis ofrisk factors in a prospective series.Scand. J. Gastroenterol.2018;53:714–20.
- 20. Roberts SE, Button LA, Williams JG. Prognosis following upper gastrointestinal bleeding. PLoS One. 2012;7(12):e49507.
- 21. Skok P, Sinkovic A. Upper gastrointestinal haemorrhage: predictive factors of in-hospital mortality in patients treated in the medical intensive care unit. The Journal of international medical research. 2011;39(3):1016–127.
- 22. Klebl F, Bregenzer N, Schöfer L et al. Risk factors for mortality in severe upper gastrointestinal bleeding. Int J Colorectal Dis 2005; 20: 49–56.
- 23. MacLaren R, Allen R, Reynolds P. Risk Factors for Gastrointestinal Hemorrhage, Pneumonia, and Clostridium Difficile Infection. Crit Care Med. 2013;41: 179–80.
- 24. Holzman NL, Schirmer CM, Nasraway SA. Gastrointestinal hemorrhage. Fink MP, Abraham E, Vincevt J-L, Kochanek PM. Textbook of Critical Care. Elsevier Saunders 5th ed. 2005: 973–83.
- 25. Sezgin O, Altintaş E, Tombak A. Effects of seasonal varia¬tions on acute upper gastrointestinal bleeding and its etiol¬ogy. Turk J Gastroenterol 2007;18:172–6.
- 26. Thomopoulos KC, Vagenas KA, Vagianos CE, et al. Chang¬es in etiology and clinical outcome of upper gastointestinal bleeding during the last 15 years. Eur J Gastroenterol Hepa¬tol. 2004;16:177–82.
- 27. Shah A, Chisolm-Straker M, Alexander A, Ratu M, Dikdan S, Manini AFD. Prognostic use of lactate to predict inpatient mortality in acute gastrointestinal hemorrhage. Am J Emerg Med. 2014;32:752–5.
- 28. Neville AL, Nemtsev D, Manasrah R, Bricker SD, Putnam BA. Mortality risk stratification in elderly trauma patients based on initial arterial lactate and base deficit levels. Am Surg. 2011;77:1337–41.
- 29. Shapiro NI, Howell MD, Talmor D, et al. Serum lactate as a predictor of mortality in emergency department patients with infection. Ann Emerg Med. 2005;45(5):524–8.
- 30. El-Kersh K, Chaddha U, Sinha RS, Saad M, Guardiola J, Cavallazzi R. Predictive role of admission lactate level in criticaly ill patients with acute upper gastrointestinal bleeding. J Emerg Med. 2015;49(3):318–25.
Mortality risk factors in patients with upper gastrointestinal bleeding in a medical intensive care unit
Öz
Purpose: The aim of this study was to evaluate the general clinical characteristics of acute gastrointestinal system (GIS) bleeding patients who were followed-up in the intensive care unit (ICU) and the risk factors for mortality.
Materials and Methods: The GIS bleeding patients followed up in a medical ICU between October 2016 and March 2019 were included. Patients were evaluated for demographic, clinical and laboratory data (on admission and after 24-hours) and compared according to the mortality status (surviving vs. non-surviving).
Results: A total of 64 patients (37 males and 27 females) with a median age of 73.5 (31-93) years were evaluated. All patients had upper GIS bleeding and the mortality rate was 29.7%. There was no difference between the mortality groups for gender, age and chronic co-morbid diseases except malignancy. High BUN, creatinine, INR, and lactate levels after 24 hours were significantly associated with mortality. All patients had a diagnosis of upper GIS bleeding. In the logistic regression analysis, the presence of acute respiratory insufficiency, long hospital stays before ICU, high SOFA score and high lactate levels after 24 hours were the independent predictors of ICU mortality).
Conclusion: In this study, we found that high levels of BUN, creatinine, INR, and lactate levels in the first 24 hours of follow-up, rather than the values on admission to ICU, were associated with increased mortality. Therefore, we suggest that close monitoring and rapid normalization of these values with appropriate treatments is important.
Anahtar Kelimeler
Gastrointestinal bleeding intensive care unit risk factors mortality
Kaynakça
- 1. Wilkins T, Khan N, Nabh A, Schade RR. Diagnosis and management of upper gastrointestinal bleeding. Am Fam Physician. 2012;85(5):469–76.
- 2. Turkoğlu M, Altıntaş ND, Topeli İskit A. Comparison Between the Patients Admitted to the Intensive Care Unit with Gastrointestinal Bleeding and the Patients who Had Gastrointestinal Bleeding in the Intensive Care Unit Due to Stress Ulcer. Yoğun Bakım Derg. 2010; 3: 63–9.
- 3. Cook DJ, Griffith LE, Walter SD et al. The attributable mortality and length of intensive care unit stay of clinically important gastrointestinal bleeding in critically ill patients. Crit Care Med. 2001;5:368–75.
- 4. Alhazzani W, Guyatt G, Alshahrani M, et al. Withholding pantoprazole for stres ulcer prophylaxis in critically ill patients: a pilot randomized clinical trial and meta-analysis. Crit Care Med. 2017; 45, 1121–9.
- 5. Kuşcu ÖÖ, Elmas D, Erdoğan M, et al. Retrospective Evaluation of Critical Care Patients with Upper Gastrointestinal System Bleeding. Yoğun Bakım Derg. 2019;10(3):80–4.
- 6. Moledina SM, Komba E. Risk factors for mortality among patients admitted with upper gastrointestinal bleeding at a tertiary hospital: a prospective cohort study. BMC Gastroenterol. 2017;17(1):165.
- 7. Abaylı B, Akkan A, Avcı BŞ. Demographic Analysis of Non-variceal Upper Gastrointestinal Hemorrhagic Patients. Med J of Bakırköy.2019;15:222–6.
- 8. Yalçın MS, Kara B, Öztürk NA, Ölmez Ş, Taşdoğan BE, Taş A. Evaluation of the patients that followed up for upper gastrointestinal system bleeding. Dicle Med J. 2016;43:73–6.
- 9. Yenigün EC, Pirpir A, Aytan P, Ulusal G, Yıldırım İS. Evaluation of the characteristics of patients with upper gastrointestinal system bleeding. Akad Gastroent Derg. 2006;5:116–22.
- 10. Okutur SK, Alkım C, Bes C, et al. Acute upper gastrointestinal bleeding: Analysis of 230 cases. Akad Gastroent Derg. 2007;6:30–6.
- 11. Öcal O, Kaya B, Demirhan R, Özüçelik DN. The Evaluation of 342 Cases Jith upper Gastrointestinal Bleeding Diagnosis in Emergency Department. Acad Emerg Med. 2011;10:69–72.
- 12 Özen E, Tekin F, Oruç N, et al. Review of 412 patients with non-variceal upper gastrointestinal bleeding. Akad Gastroent Derg. 2007; 6:62–7.
- 13. Ateş F, Karıncaoğlu M, Aladağ M. Evaluation of 524 Cases With Non-Variceal Gastrointestinal System Bleeding. İnönü Üniv Tıp Fak Derg. 2008;15:93–8.
- 14. Ayık İC, Değerli V, Yılmaz G, Sevim E. Prognostic Usage of Lactate Levels in Patients with Upper Gastrointestinal Bleeding. Kafkas J Med Sci. 2018; 8(2):115–20.
- 15. Krag M, Perner A, Wetterslev J, et al. Prevalence and outcome of gastrointestinal bleeding and use of acid suppressants in acutely ill adult intensive care patients. Intensive Care Med. 2015;41:833–45.
- 16. Cook DJ, Fuller HD, Guyatt GH, et al. Risk factors for gastrointestinal bleeding in critically ill patients. Canadian Critical CareTrials Group. N Engl J Med. 1994; 330:377–81.
- 17. Fuchs L, Chronaki CE, Park S, et al. ICU admission characteristics and mortality rates among elderly and very elderly patients. Intensive Care Med. 2012; 38, 1654–61.
- 18. Balaban DV, Strambu V, Florea BG, Cazan AR, Bratucu M, Jinga M. Predictors for in-hospital mortality and need for clinical intervention in upper GI bleeding: a 5- year observational study. Chirurgia (Bucharest, Romania:1990). 2014;109(1):48–54.
- 19. Jimenez-Rosales R, Valverde-Lopez F, Vadillo-Calles F, Martinez-Cara JG, Lopez de Hierro M, Redondo-Cerezo E. Inhospital and delayed mortality after upper gastrointestinal bleeding: an analysis ofrisk factors in a prospective series.Scand. J. Gastroenterol.2018;53:714–20.
- 20. Roberts SE, Button LA, Williams JG. Prognosis following upper gastrointestinal bleeding. PLoS One. 2012;7(12):e49507.
- 21. Skok P, Sinkovic A. Upper gastrointestinal haemorrhage: predictive factors of in-hospital mortality in patients treated in the medical intensive care unit. The Journal of international medical research. 2011;39(3):1016–127.
- 22. Klebl F, Bregenzer N, Schöfer L et al. Risk factors for mortality in severe upper gastrointestinal bleeding. Int J Colorectal Dis 2005; 20: 49–56.
- 23. MacLaren R, Allen R, Reynolds P. Risk Factors for Gastrointestinal Hemorrhage, Pneumonia, and Clostridium Difficile Infection. Crit Care Med. 2013;41: 179–80.
- 24. Holzman NL, Schirmer CM, Nasraway SA. Gastrointestinal hemorrhage. Fink MP, Abraham E, Vincevt J-L, Kochanek PM. Textbook of Critical Care. Elsevier Saunders 5th ed. 2005: 973–83.
- 25. Sezgin O, Altintaş E, Tombak A. Effects of seasonal varia¬tions on acute upper gastrointestinal bleeding and its etiol¬ogy. Turk J Gastroenterol 2007;18:172–6.
- 26. Thomopoulos KC, Vagenas KA, Vagianos CE, et al. Chang¬es in etiology and clinical outcome of upper gastointestinal bleeding during the last 15 years. Eur J Gastroenterol Hepa¬tol. 2004;16:177–82.
- 27. Shah A, Chisolm-Straker M, Alexander A, Ratu M, Dikdan S, Manini AFD. Prognostic use of lactate to predict inpatient mortality in acute gastrointestinal hemorrhage. Am J Emerg Med. 2014;32:752–5.
- 28. Neville AL, Nemtsev D, Manasrah R, Bricker SD, Putnam BA. Mortality risk stratification in elderly trauma patients based on initial arterial lactate and base deficit levels. Am Surg. 2011;77:1337–41.
- 29. Shapiro NI, Howell MD, Talmor D, et al. Serum lactate as a predictor of mortality in emergency department patients with infection. Ann Emerg Med. 2005;45(5):524–8.
- 30. El-Kersh K, Chaddha U, Sinha RS, Saad M, Guardiola J, Cavallazzi R. Predictive role of admission lactate level in criticaly ill patients with acute upper gastrointestinal bleeding. J Emerg Med. 2015;49(3):318–25.
Ayrıntılar
| Birincil Dil | İngilizce |
|---|---|
| Konular | Klinik Tıp Bilimleri |
| Bölüm | Araştırma |
| Yazarlar | |
| Yayımlanma Tarihi | 30 Eylül 2021 |
| Kabul Tarihi | 7 Temmuz 2021 |
| Yayımlandığı Sayı | Yıl 2021 Cilt: 46 Sayı: 3 |
