Title: Predictors of Outcome in Patients with Upper Non Variceal Gastrointestinal Bleeding in Emergency Department

Authors: Yasmin Nouh Shereif, Abeer Mahmoud Ali Ibrahim, Asmaa Mohamed Alkafafy, Yehia Mostafa Ghanem

 DOI: https://dx.doi.org/10.18535/jmscr/v8i8.14

Abstract

Acute upper gastrointestinal bleeding is a life threatening emergency. Modified Glasgow Blatchford score is the current scoring system to evaluate patients with acute UGIB. The purpose of this study was to confirm value of Modified Blatchford scoring system as a predictor of outcome as regard patient’s mortality, their need for ICU, duration of hospitalization and need for endoscopic intervention and compare its sensitivity and specificity with and without adding serum lactate level in patients presenting with upper non variceal gastrointestinal bleeding upon admission to the emergency department.

At presentation,51% of patients with low lactate level were classified as high risk Blatchford score while 87.8% of patients with high lactate level were classified as high risk score

2 hours after resuscitation, all patients with high lactate level were classified as high risk.

After 48 hours, mortality rate and ICU admission were significantly higher in group 2 than in group 1.

Keywords: Upper Non Variceal Gastrointestinal Bleeding, Modified Glasgow Blatchford Scoring System, lactate.

References

  1. Lam KL, Wong JC, Lau JY. Pharmacological treatment in upper gastrointestinal bleeding. Curr Treat Options Gastroenterol 2015; 4:369-76.
  2. Curdia Goncalves T, Rosa B, Cotter J. New insights on an old medical emergency: non-portal hypertension related upper gastrointestinal bleeding. Rev Esp Enferm Dig2016; 108(10):648-56.
  3. Blatchford O, Davidson LA, Murray WR, Blatchford M, Pell J. Acute upper gastrointestinal haemorrhage in west of Scotland: case ascertainment study. BMJ1997; 315:510-4.
  4. Zhang Z, Xu X (2014) Lactate clearance is a useful biomarker for the prediction of all-cause mortality in critically Ill patients. Crit Care Med 42:2118–2125.
  5. Wada, T., Hagiwara, A., Uemura, T., Yahagi, N., & Kimura, A. (2016). Early lactate clearance for predicting active bleeding in critically ill patients with acute upper gastrointestinal bleeding: a retrospective study. Internal and Emergency Medicine, 11(5), 737–743. doi:10.1007/s11739-016-1392-z.
  6. El-Kersh K, Chaddha U, Sinha RS, Saad M, Guardiola J, Cavallazzi R. Predictive role of admission lactate level in critically ill patients with acute upper gastrointestinal bleeding. J Emerg Med 2015; 49(3):318–25.

Corresponding Author

Yasmin Nouh Shereif

Asmaa Mohamed Alkafafy

Emergency Department, Faculty of Medicine University of Alexandria, Egypt