The relationship between clinical and laboratory data with prognosis in upper gastrointestinal system bleeding

ABSTRACT The Relationship Between Clinical and Laboratory Data with Prognosis in Upper Gastrointestinal System Bleeding Dr. Hazan TOPRAK Upper gastrointestinal (GI) bleeding, which is one of the common causes of emergency department (ED) visits, is a serious clinical entity with mortality rates of 2-10% despite advanced diagnostic and therapeutic methods. This disease has high costs due to rebleeding, prolonged hospitalization, the need for endoscopic/surgical intervention and transfusions. Advanced age, male gender and low socioeconomic status are defined risk factors for upper GI bleeding. Identification of risk factors of poor outcome is critical in these patients. The aim of this study is to determine the value of clinical and laboratory values at admission in determining hospitalization, readmission within thirty days and thirty-day mortality in patients admitted to the ED with upper GI bleeding symptoms. This prospective, cross-sectional and descriptive study was conducted in the adult ED of Pamukkale University Hospital during the one-year period (July 1, 2022-June 30, 2023). After revision of inclusion and exclusion criteria 184 patients' data were analyzed for endpoints. One hundred and seventeen patients (64%) were male. The mean age was 67.42±17.29 years. When patients diagnosed with upper GI bleeding were compared in terms of mortality, no significant difference was found between the two groups in all parameters such as age, gender, vital signs, shock index (SI), transfusion amounts, laboratory data and Glasgow-Blatchford Score (GBS) (all p >0.05). In the readmitted group, the SI was higher (0.87±0.22); the hemoglobin (HGB) (8.18±2.61 g/dl), hematocrit (HTC) (25.66±7.66%) and plateletcrit (PLC) (40.81±19.58%) was lower than in the non-readmitted group (all p <0.05). Of these values, lower HGB and PLC increased readmission (O.R.=0.793; p=0.041, O.R.=0.965; p=0.008). In terms of hospitalization and discharge status, the SI (0.78), prothrombin time (PT) (21.36±27.23 seconds) and blood urea nitrogen (BUN) (39.6±30.77 mg/dl) were higher in readmission group, while in the hospitalized group mean arterial pressure (MAP) (89.11±16.48 mmHg), platelet (PLT) of 253000±134282 /µl and international normalized ratio (INR) (1.85±2.6) values were lower (all p <0.05). Only BUN value increased hospitalization (O.R.=1.025; p=0.018). Among the parameters we examined in patients with upper GI bleeding, we did not find any factor affecting 30-day mortality. Patients who were readmitted within 30 days with symptoms of upper GI bleeding had a higher SI value than those who were not readmitted, while HGB, HTC and PLC values were lower. Among these, lower HGB and PLC values affect readmission. In hospitalized patients with upper GI bleeding, the values of SI, PT and BUN were higher, while the values of MAP, PLT and INR were lower than those who were discharged. Of these, only higher BUN values increase hospitalization from the ED.