Glasgow blatchford skorunun üst gastrointestinal sistem kanamalarında prognozu öngörmedeki etkinliğinin değerlendirilmesi
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Tarih
2024
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Hitit Üniversitesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Amaç: Akut üst gastrointestinal sistem kanaması, acil başvuruların ciddi sonuçları olabilen yaygın nedenlerinden biridir. Bu kapsamda, hastaları erken dönemde değerlendirmek morbidite, kanama tekrarı, mortalite olasılığını öngörmek ve risk analizi yapmak önemlidir. Glasgow Blatchford skoru, tıbbi müdahale (kan transfüzyonu, endoskopi, cerrahi) gereksinimini öngörmek için geliştirilen bir skorlama sistemidir. Bu çalışmadaki amacımız, Glasgow Blatchford skorunun üst gastrointestinal sistem kanamalarında prognoz belirteçleri ile ilişkilerini araştırmaktır. Gereç ve Yöntem: Çalışmaya Hitit Üniversitesi Erol Olçok Eğitim ve Araştırma Hastanesinde, Aralık 2022-Mayıs 2023 tarihleri arasında üst gastrointestinal sistem kanaması ile başvuran hastalar dahil edildi. Hastaların demografik verileri, başvuru şikâyetleri, kronik hastalıkları, kullandığı ilaçlar, yatış anında yoğun bakım/servis yatış durumu, vital bulguları, melena varlığı, senkop durumu, kan transfüzyon ihtiyacı olup olmadığı, endoskopik girişim zamanı, endoskopi sırasında aktif kanama bulgusu olup olmadığı, müdahale yapıldı ise yöntemi, cerrahi ihtiyacı, yeniden kanama durumu, yatışın taburculuk veya exitus ile sonlanım durumu ve yatış süreleri kaydedildi. Glasgow Blatchford skorları hesaplanarak prognoz belirteçleri ve mortalite ile olan ilişkileri araştırıldı. Bulgular: Çalışmaya toplam 140 hasta dahil edildi. Hastaların yaş ortalaması 69,7±18 yıl idi. Hastaların % 41,4'ü (n=58) kadın, %58,6'sı (n=82) erkek idi. Glasgow Blatchford skoru ortalaması 9,5±4 idi. Hastaların yatış süresi ortalama 5,1±6,3 gün iken, %15,7'si (n=21) exitus oldu. Glasgow Blachford Skoru ile yaş (r=0,470, p<0,001), Charlson komorbidite indeksi (r=0,518, p<0,001) ve yatış süresi (r=0,272, p=0,001) arasında, orta düzeyde pozitif korelasyon saptandı. Mortaliteyi predikte etmek amacıyla yapılan logistik regresyon analizinde Charlson Komorbidite indeksi (OR:1,023, %95 CI:1,008-1,437, p=0,046) anlamlı iken GBS mortalite prediktörü değildi (p=0,582). GBS; kan transfüzyon ihtiyacında (OR:1,493, %95 CI:1,297-1,719, p<0,001), endoskopik girişim ihtiyacında v (OR:1,248, %95 CI:1,089-1,430, p=0,001) ve yoğun bakım yatışında (OR:1,153, %95 CI:1,049-1,266, p=0,003) anlamlı öngördürücü idi. ROC analizinde mortalite için GBS için 9,5 sınır değeri ile AUC 0,64 (%95 CI: 0,513-0,775, p=0,032), sensitivite %68,2 ve spesivite %52,5; kan transfüzyon ihtiyacında GBS 8,5 sınır değeri ile AUC 0,853 (%95 CI: 0,782-0,924, p<0,001), sensitivite %84,9 ve spesivite %75,9; endoskopik müdahale ihtiyacında GBS 9,5 sınır değeri ile AUC 0,752 (%95 CI: 0,653-0,851, p<0,001), sensitivite %90 ve spesivite %50,8; yoğun bakıma yatış ihtiyacında GBS 9,5 sınır değeri ile AUC 0,72 (%95 CI: 0,646-0,812, p<0,001), sensitivite %70,1 ve spesivite %58,9 idi. Sonuç: Glasgow Blachford skoru mortalitede öngördürücü değil iken, Charlson Komorbidite indeksi mortalite öngördürücüsüdür. Glasgow Blachford skoru; kan transfüzyon ihtiyacının tespitinde, endoskopik girişim ihtiyacının tespitinde ve servis/yoğun bakım tercihinde öngördürücüdür. Anahtar kelimeler: Gastrointestinal sistem kanaması, Glasgow Blatchford Skoru, mortalite, prognoz.
Aim: Acute upper gastrointestinal bleeding is one of the common causes of emergency admissions that can have serious consequences. Therefore, it is important to evaluate patients in the early period, predict morbidity, bleeding recurrence, mortality. Glasgow Blatchford score is a scoring system developed to predict the need for medikal intervention (blood transfusion, endoscopy, surgery). The aim of the study was to investigate the relationship of Glasgow Blatchford score with prognostic markers in patients with upper gastrointestinal bleeding. Materials and Methods: Patients admitted to Hitit Üniversity Erol Olçok Training and Research Hospital with upper gastrointestinal tract bleeding between December 2022 and May 2023 were included in the study. Demographic data of the patients, complaints at the time of admission, chronic disease, medications used, intensive care/ward admission status, vital signs, presence of melena, syncope status, whether there is a need for blood transfussion, time of endoscopic intervention, whether there are signs of active bleeding endoscopy, intervention method, need for surgery, rebleeding status, outcome of hospitalization and length of stay were recorded. Glasgow Blatchford score of the patients were calculated and their relationship with prognostic markers and mortality were investigated. Result: A total of 140 patients were included included in the study. The average age of the patients was 69.7±18 years. 41.4% (n=58) of the patients were female and 58.6% (n=82) were male. The average Glasgow Blatchford score was 9.5±4. While the average length of stay of the patient was 5.1±6.3 days, 15.7% (n=21) died. There was a moderate positive correlation between Glasgow Blatchford Score and age (r=0.470, p<0,001), Charlson comorbity index (r=0.518, p<0.001) and length of stay (r=0.272, p=0.001). In the logistic regression analysis performed to predict mortality, the Charlson Comorbidity index (OR: 1.023, CI= 1.008-1.437, p=0.046) was significant, while the Glasgow Blatchford score was not a predictor of mortality (p=0.582). Glasgow Blatchford score; in determining the need for blood transfusion (OR: 1.493, 95% CI:1.297-1.719, p<0.001), in the need for endoscopic intervention (OR:1.248, 95% CI:1.089-1.430, p=0.001) and in ward/intensive care vii preference (OR:0.869, %95 CI:0.790-0.953, p=0.003) was a significant predıctor. In ROC analysis, with a cut off value of 9.5 for Glasgow Blatchford Scorefor mortality, AUC was 0.64 (%95 CI:0.513-0.775, p=0.032), sensivity was 68.2% and specifity was 52.5%. With a Glasgow Blatchford Score 8.5, cut off value for blood transfusion requirement, AUC was 0.853 (95% CI:0.782-0.924, p<0.001), sensivity was 84.9% and specificity was 75.9%. With a Glasgow Blatchford Score 9.5 cut off value for the need for endoscopıc intervention, AUC was 0.752(95% CI:0.653-0.812, p<0.001), sensitivity was 90% and specificity was 50.8%. With a Glasgow Blatchford Score cut off value of 9.5 for the need for intensive care unit admission, AUC was 0.72 (95%CI:0.646-0.812, p<0.001), sensitivity was 70.1% and specificity was 58.9%. Conclusion: Glasgow Blatchford score was not predictive for mortality, but Charlson Comorbidity index was predictive for mortality. Glasgow Blatchford score was predictive in determining the need for blood transfussion, the need for endoscopic intervention and the need for intensive care. Key Words: Glasgow Blatchford scale, prognosis, upper gastrointestinal bleeding.
Aim: Acute upper gastrointestinal bleeding is one of the common causes of emergency admissions that can have serious consequences. Therefore, it is important to evaluate patients in the early period, predict morbidity, bleeding recurrence, mortality. Glasgow Blatchford score is a scoring system developed to predict the need for medikal intervention (blood transfusion, endoscopy, surgery). The aim of the study was to investigate the relationship of Glasgow Blatchford score with prognostic markers in patients with upper gastrointestinal bleeding. Materials and Methods: Patients admitted to Hitit Üniversity Erol Olçok Training and Research Hospital with upper gastrointestinal tract bleeding between December 2022 and May 2023 were included in the study. Demographic data of the patients, complaints at the time of admission, chronic disease, medications used, intensive care/ward admission status, vital signs, presence of melena, syncope status, whether there is a need for blood transfussion, time of endoscopic intervention, whether there are signs of active bleeding endoscopy, intervention method, need for surgery, rebleeding status, outcome of hospitalization and length of stay were recorded. Glasgow Blatchford score of the patients were calculated and their relationship with prognostic markers and mortality were investigated. Result: A total of 140 patients were included included in the study. The average age of the patients was 69.7±18 years. 41.4% (n=58) of the patients were female and 58.6% (n=82) were male. The average Glasgow Blatchford score was 9.5±4. While the average length of stay of the patient was 5.1±6.3 days, 15.7% (n=21) died. There was a moderate positive correlation between Glasgow Blatchford Score and age (r=0.470, p<0,001), Charlson comorbity index (r=0.518, p<0.001) and length of stay (r=0.272, p=0.001). In the logistic regression analysis performed to predict mortality, the Charlson Comorbidity index (OR: 1.023, CI= 1.008-1.437, p=0.046) was significant, while the Glasgow Blatchford score was not a predictor of mortality (p=0.582). Glasgow Blatchford score; in determining the need for blood transfusion (OR: 1.493, 95% CI:1.297-1.719, p<0.001), in the need for endoscopic intervention (OR:1.248, 95% CI:1.089-1.430, p=0.001) and in ward/intensive care vii preference (OR:0.869, %95 CI:0.790-0.953, p=0.003) was a significant predıctor. In ROC analysis, with a cut off value of 9.5 for Glasgow Blatchford Scorefor mortality, AUC was 0.64 (%95 CI:0.513-0.775, p=0.032), sensivity was 68.2% and specifity was 52.5%. With a Glasgow Blatchford Score 8.5, cut off value for blood transfusion requirement, AUC was 0.853 (95% CI:0.782-0.924, p<0.001), sensivity was 84.9% and specificity was 75.9%. With a Glasgow Blatchford Score 9.5 cut off value for the need for endoscopıc intervention, AUC was 0.752(95% CI:0.653-0.812, p<0.001), sensitivity was 90% and specificity was 50.8%. With a Glasgow Blatchford Score cut off value of 9.5 for the need for intensive care unit admission, AUC was 0.72 (95%CI:0.646-0.812, p<0.001), sensitivity was 70.1% and specificity was 58.9%. Conclusion: Glasgow Blatchford score was not predictive for mortality, but Charlson Comorbidity index was predictive for mortality. Glasgow Blatchford score was predictive in determining the need for blood transfussion, the need for endoscopic intervention and the need for intensive care. Key Words: Glasgow Blatchford scale, prognosis, upper gastrointestinal bleeding.
Açıklama
Hitit Üniversitesi, Tıp Fakültesi
