Clinical impact of endoscopy in severely thrombocytopenic patients with hematologic malignancy experiencing gastrointestinal bleeding

Table 1 Baseline demographics and characteristics, mean ± SD or n (%)

Variable	No endoscopy, n = 38	Endoscopy, n = 38	P value
Age	62.7 ± 10.5	58.5 ± 15.6	0.17
Gender
Male	24 (63.2)	27 (71.1)	0.46
Female	14 (36.8)	11 (28.9)
BMI	30.8(12.7)	27.2(8.9)	0.15
Ethnicity
White	32 (84.2)	26 (68.4)	0.24
Black	5 (13.2)	11 (28.9)
Asian	1 (2.6)	1 (2.7)
Comorbidities
Hypertension	25 (65.8)	21 (55.3)	0.35
Cardiac	7 (18.4)	13 (34.2)	0.12
Pulmonary	8 (21.1)	3 (7.9)	0.1
CKD	8 (21.1)	7 (8.4)	0.77
Presentation of GI bleeding
Melena	22 (57.9)	30 (78.9)	0.08
Hematemesis	8(21.1)	2 (5.3)	0.09
Hematochezia	8(21.1)	6 (15.8)	0.77
Hematologic disease/malignancy
MDS	7 (18.4)	6 (15.8)	0.76
AML	11 (28.9)	12 (31.6)	0.8
CML	1 (2.6)	3 (7.9)	0.3
ALL	6 (15.8)	5 (13.2)	0.74
Multiple myeloma	7 (18.4)	7 (18.4)	1.0
NHL	2 (5.3)	2 (5.3)	1.0
CLL	1 (2.6)	0 (0)	0.31
Aplastic anemia	2 (5.3)	2 (5.3)	1.0
Myelofibrosis	1 (2.6)	1 (2.6)	1.0

BMI: Body mass index; CKD: Chronic kidney disease; GI: Gastrointestinal; MDS: Myelodysplastic syndrome; AML: Acute myeloid leukemia; CML: Chronic myeloid leukemia; ALL: Acute lymphoblastic leukemia; NHL: Non-Hodgkin lymphoma; CLL: Chronic lymphocytic leukemia.

Table 2 Basic clinical and laboratory characteristics of patients

Variable	No Endoscopy, n = 38	Endoscopy, n = 38	P value
SBP	109.6 ± 19.7	116.3 ± 23.3	0.18
DBP	62.9 ± 13.3	66.6 ± 14.7	0.25
HR	105.2 ± 20.7	98.4 ± 17.2	0.12
HGB	7.1 ± 1	6.3 ± 1.6	0.01a
WBC	6.4 ± 16.6	6.2 ± 9.6	0.97
PLT	14.6 ± 13.3	24.3 ± 13.7	0.01a
INR	1.3 ± 0.3	1.5 ± 1.3	0.46
PTT	32 ± 12.4	34.4 ± 16.4	0.48

^aP < 0.05.

SBP: Systolic blood pressure; DBP: Diastolic blood pressure; HR: Heart rate; HGB: Hemoglobin; WBC: White blood count; PLT: Platelet; INR: International normalized ratio; PTT: Partial thromboplastin time.

Table 3 Outcomes of patients treated with medical management vs endoscopy, mean ± SD or n (%)

Variable	No endoscopy, n = 38	Endoscopy, n = 38	P value
Mortality at 30 days	8 (21.0)	14 (36.8)	0.13
Mortality at 1 year	27 (71.1)	28 (73.7)	0.78
ICU admission	12 (31.6)	14 (36.8)	0.63
PRBC transfusion	31 (81.6)	34 (89.5)	0.47
PLT transfusion	38 (100)	37 (97.4)	0.31
Recurrent bleeding	13 (34.2)	14 (36.8)	0.68
Length of stay (day)	18.2 ± 14.9	17.8 ± 25.7	0.94

ICU: Intensive care unit; PRBC: Packed red blood cells; PLT: Platelet.

Table 4 Basic clinical and laboratory characteristics of patients treated with endoscopic intervention urgently vs non-urgently

Variable	Endoscopy < 24 hours, n = 19	Endoscopy > 24 hours, n = 19	P value
SBP	107.4 ± 21.8	125.3 ± 21.6	0.02a
DBP	62.6 ± 15.4	70.6 ± 13.2	0.1
HR	104.8 ± 15.8	92 ± 16.4	0.02a
HGB	6.1 ± 1.4	6.5 ± 1.7	0.41
WBC	9.2 ± 12.8	3.3 ± 2.8	0.06
PLT	25.7 ± 14	22.8 ± 13.7	0.52
INR	1.7 ± 1.8	1.3 ± 0.3	0.32
PTT	36.4 ± 18.8	32.4 ± 13.7	0.46

^aP < 0.05.

SBP: Systolic blood pressure; DBP: Diastolic blood pressure; HR: Heart rate; HGB: Hemoglobin; WBC: White blood count; PLT: Platelet; INR: International normalized ratio; PTT: Partial thromboplastin time; SD: Standard deviation.

Table 5 Outcome of patients treated with endoscopy urgently vs non-urgently, mean ± SD or n (%)

	Endoscopy < 24 hours, n = 19	Endoscopy > 24 hours, n = 19	P value
Mortality at 30 days	6 (31.6)	2 (10.5)	0.11
Mortality at 1 year	4 (21.1)	6 (31.6)	0.46
ICU admission	9 (47)	5 (26.3)	0.18
PRBC transfusion	17 (89.5)	17 (89.5)	1.0
PLT transfusion	19 (100)	18 (94.7)	0.31
Recurrent bleeding	3 (15.8)	11 (57.9)	0.01a
Length of stay (days)	13.5 ± 13	22.1± 33.9	0.31

^aP < 0.05.

ICU: Intensive care unit; PRBC: Packed red blood cells; PLT: Platelet.

Table 6 Type of endoscopic intervention, n (%)

Variable	Endoscopy < 24 hours, n = 19	Endoscopy > 24 hours, n = 19	P value
No intervention	14 (73.7)	15 (78.9)	0.72
Intervention	5 (26.3)	4 (21.1)	0.7
Thermal	1	3
Mechanical	3	0
Dual	0	1
Banding	1	0

Table 7 Findings on endoscopy, n (%)

Variable	Endoscopy < 24 hours	Endoscopy > 24 hours
EGD findings	n = 16	n = 17
Normal	1 (6.3)	6 (35.3)
PUD	3 (18.8)	2 (11.8)
AVM	1 (6.3)	2 (11.8)
Mucosal inflammation	5 (31.3)	3 (17.6)
PHG	2 (12.5)	0
Solid tumor	1 (6.3)	0
Dieulafoy	2 (12.5)	0
Mallory Weiss	0	1 (5.9)
Cameron lesion	0	2 (11.8)
Esophagitis	1 (6.3)	1 (5.9)
Colonoscopy findings	n = 6	n = 5
Normal	2 (33.3)	2 (40)
Blood with no source	1 (16.7)	2 (40)
Radiation proctitis	0	1 (20)
Mucosal ulcer	1 (16.7)	0
Mucosal inflammation	2 (33.3)	0

PUD: Peptic ulcer disease; AVM: Arteriovenous malformation; PHG: Portal hypertensive gastropathy.