Predictors of poor outcome in gastrointestinal bleeding in emergency department

Table 1 Demographic and clinical characteristics of patients

Characteristic	n
Sex
Male	369
Female	231
Admission symptoms
Melena	423
Hematemesis	142
Hematochezia	76
Syncope	34
Systolic blood pressure (mmHg)
< 90	26
90-139	546
≥ 140	28
Diastolic blood pressure (mmHg)
< 60	55
60-89	539
≥ 90	6
Heart rate (bpm)
< 60	2
60-100	448
> 100	150
Respiratory rate (rpm)
12-20	545
> 20	55
Oxygen saturation (%)
< 92	14
≥ 92	586
Glasgow coma score
< 15	21
15	579

Mean values: Blood pressure, 82.8 ± 13.1 mmHg; Systolic blood pressure, 110.2 ± 18.2 mmHg; Diastolic blood pressure, 69.2 ± 11.8 mmHg; Heart rate, 92.7 ± 18.37 bpm; Respiratory rate, 18.2 ± 2.6 rpm; SaO₂, 95.15% ± 1.66%; Glasgow coma score, 14.93 ± 0.45.

Table 2 Upper endoscopy results, treatment modalities and mortality rates

Forrest classification[4]	n (%)	Medical treatment	Endoscopic treatment1	Surgery	Angiographic embolization	Exitus
Spurting hemorrhage (1a)	41 (12.2)	0	39	0	2	0
Oozing hemorrhage (1b)	41 (12.2)	0	39	2	0	2
Visible vessel (2a)	16 (4.8)	2	13	1	0	1
Adherent clot (2b)	16 (4.8)	5	9	2	0	1
Flat pigmented hematin on ulcer base (2c)	3 (0.9)	3	0	0	0	0
Lesions without signs of recent hemorrhage/fibrin-covered clean ulcer base (3)	218 (65.1)	216	0	22	0	23
Total	335 (100)	226	100	7	2	6

¹Sclerotherapy, laser, argon plasma coagulation, mechanical modalities;

²Patients who underwent surgery due to gastric malignancy;

³Causes of mortality include septic shock and pneumonia; Forrest classification is a classification that attempt to standardize the characterization of peptic ulcers.

Table 3 Colonoscopy findings, treatment modality, and mortality rates

Colonoscopic findings	n (%)	Active bleeding- +		Medical treatment	Endoscopic treatment	Surgery	Angiographic embolization	Exitus
Normal findings	20 (44.4)	20	0	19	0	0	0	11
Anal pathologies	9 (20.0)	9	0	7	0	2	0	0
Recto-sigmoid pathologies	7 (15.6)	5	2	5	0	1	1	0
Other colon pathologies	4 (8.9)	3	1	3	1	0	1	0
Other pathologies	5 (11.1)	5	0	4	1	0	0	0
Total	45 (100)	42	3	38	2	3	2	1

¹Cause of mortality was septic shock.

Table 4 Laboratory results and treatment modalities

	Medical treatment	Endoscopic treatment	Angiographic embolization	Surgery	P value
Hb (g/dL)	9.92	9.74	8.32	8.85	0.283
Htc (g/dL)	29.12	28.61	24.82	25.85	0.273
Thrombocytes (103/L)	251.59	272.61	282.40	291.95	0.162
BUN (mg/dL)	38.57	37.73	33.60	35.06	0.177
Creatinine (mg/dL)	1.15	1.07	1.17	1.07	0.864
Glucose, (mg/dL)	144.25	148.50	173.40	164.05	0.539
AST (IU/L)	33.59	24.33	66.20	59.75	0.635
ALT (IU/L)	26.10	20.21	62.80	29.25	0.825
aPTT (s)	31.36	26.92	31.80	26.83	0.818
INR (s)	2.22	1.59	2.40	2.25	0.831
Mean blood pressure (mmHg)	83.74	81.47	75.33	72.83	0.001
Pulse (bpm)	91.81	95.04	108.00	98.05	0.043

Data represent mean values. Hb: Hemoglobin; Htc: Hematocrit; BUN: Blood urea nitrogen; AST: Aspartate aminotransferase; ALT: Alanine aminotransferase; aPTT: Active partial thromboplastin; INR: International normalization ratio.

Table 5 Comparison of laboratory results according to departments of admission

	General wards/ED	ICU	P value
Hb (g/dL)	9.89	8.82	0.051
Htc (g/dL)	29.04	25.96	0.054
Thrombocytes (103/L)	254.87	298.88	0.086
BUN (mg/dL)	36.86	37.38	0.909
Creatinine (mg/dL)	1.13	1.18	0.787
Glucose (mg/dL)	144.53	171.47	0.050
AST (IU/L)	33.21	106.59	0.131
ALT (IU/L)	24.63	88.81	0.238
aPTT (s)	30.57	28.36	0.402
INR (s)	2.11	2.61	0.370
Mean blood pressure (mmHg)	83.09	79.11	0.097
Pulse (bpm)	92.73	93.56	0.803
SpO2 (%)	95.16	94.96	0.467

Data represent mean values. Hb: Hemoglobin; Htc: Hematocrit; BUN: Blood urea nitrogen; AST: Aspartate aminotransferase; ALT: Alanine aminotransferase; aPTT: Active partial thromboplastin; INR: International normalization ratio; ICU: Intensive care unit; ED: Emergency medicine department.

Table 6 Comparison of laboratory results for surviving and exitus patients

	Surviving	Exitus	P value
Hb (g/dL)	9.85	9.63	0.072
Htc (g/dL)	28.90	28.54	0.085
Thrombocytes (103/L)	259.06	230.05	0.280
BUN (mg/dL)	36.24	46.39	0.016
Creatinine (mg/dL)	1.10	1.65	0.038
Glucose (mg/dL)	144.56	166.76	0.268
AST (IU/L)	33.06	97.29	0.150
ALT (IU/L)	26.53	50.58	0.061
aPTT (s)	30.45	30.43	0.991
INR (s)	2.18	1.99	0.072
Mean blood pressure (mmHg)	83.28	76.92	0.004
Pulse (bpm)	92.51	96.68	0.175
SpO2 (%)	95.18	94.63	0.049

Data represent mean values. Hb: Hemoglobin; Htc: Hematocrit; BUN: Blood urea nitrogen; AST: Aspartate aminotransferase; ALT: Alanine aminotransferase; aPTT: Active partial thromboplastin; INR: International normalization ratio.

Table 7 Comparison of surviving and exitus patient history, need for transfusion, and mortality n (%)

	Surviving	Exitus	P value
Medical history	562 (93.7)	38 (6.3)
Liver disease
+	42 (87.5)	6 (12.5)	0.730
-	520 (94.2)	32 (5.8)
Peptic ulcer
+	62 (100)	0 (0.0)	0.014
-	500 (92.9)	38 (7.1)
Malignancy
+	64 (84.2)	12 (15.8)	0.001
-	498 (95.0)	26 (5.0)
Bleeding diathesis
+	7 (100)	0 (0.0)	0.631
-	555 (93.6)	38 (6.4)
Anal disease
+	9 (100)	0 (0.0)	0.553
-	553 (93.6)	38 (6.4)
Hypertension
+	164 (96.5)	6 (3.5)	0.051
-	398 (92.6)	32 (7.4)
Diabetes mellitus
+	86 (92.5)	7 (7.5)	0.373
-	476 (93.9)	31 (6.1)
Coronary artery disease
+	85 (93.4)	6 (6.6)	0.530
-	477 (93.7)	32 (6.3)
Comorbid disease
+	77 (96.3)	3 (3.8)	0.227
-	485 (93.3)	35 (6.7)
ES replacement
+	291 (93.3)	21 (6.7)	0.400
-	271 (94.1)	17 (5.9)
FFP replacement
+	106 (92.2)	456 (94)	0.290
-	9 (7.8)	29 (6.0)
GCS
15	549 (94.8)	30 (5.2)	0.000
< 15	13 (61.9)	8 (38.1)

ES: Erythrocyte suspension; FFP: Fresh frozen plasma; GCS: Glasgow coma score.

Table 8 Causes of mortality

Causes of mortality	n (%)
Malignancy1	14 (36.8)
Esophageal varices bleeding	8 (21.1)
Sepsis/septic shock	6 (15.8)
Renal failure	4 (10.5)
Multi organ failure	3 (7.9)
Others2	3 (7.9)
Total	38 (100)

¹Gastric cancer, esophageal adenocancer, hepatocellular carcinoma;

²Anticoagulant therapy for venous thromboembolism, mesenteric ischemia.