Abstract
Upper gastrointestinal bleeding (UGIB) is one of the most common emergencies. Risk stratification is essential in patients with this potentially life-threatening condition. The aim of this prospective study was to evaluate the usefulness of the admission venous lactate level in predicting clinical outcomes in patients with UGIB. All consecutive adult patients hospitalized due to UGIB were included in the study. The clinical data included the demographic characteristics of the observed population, etiology of UGIB, need for surgical intervention and intensive care, bleeding recurrence, and mortality rates. Venous lactate was measured in all patients on admission. Logistic regression analyses were used to calculate the odds ratios (OR) of lactate levels for all outcomes. The receiver operating characteristic (ROC) curve was used to determine the accuracy of lactate levels in measuring clinical outcomes, while Youden index was used to calculate the best cut-off points. A total of 221 patients were included in the study (151M; 70F). There were 24 cases of UGIB recurrence (10.8%), 19 patients (8.6%) required surgery, and 37 individuals (16.7%) required intensive care. Mortality rate was 11.3% (25 cases). The logistic regression analysis showed statistically significant association between admission venous lactate and all clinical outcomes: mortality (OR = 1.39, 95%CI: 1.22–1.58, p < 0.001), recurrence of bleeding (OR = 1.16, 95%CI: 1.06; 1.28, p = 0.002), surgical intervention (OR = 1.17, 95%CI: 1.06–1.3, p = 0.002) and intensive care (OR = 1.33, 95%CI: 1.19–1.5, p < 0.001). The ROC curve analysis showed a high predictive value of lactate levels for all outcomes, especially mortality: cut-off point 4.3 (AUC = 0.82, 95%CI: 0.72–0.92, p < 0.001) and intensive care: cut-off point 4.2 (AUC = 0.76, 95%CI: 0.66–0.85, p < 0.001). Admission venous lactate level may be a useful predictive factor of clinical outcomes in patients with UGIB.
Highlights
Acute upper gastrointestinal bleeding (UGIB) is considered as one of the most common emergencies and reasons of urgent hospitalization
The clinical data was collected prospectively during the study period. It included the demographic characteristics of the observed population, etiology of UGIB, endoscopic treatment, need for surgical intervention, and intensive care unit (ICU) therapy, bleeding recurrence rates and in-hospital mortality rates
The logistic regression models showed that there was a statistically significant association between admission venous lactate level and recurrence of bleeding (OR = 1.16, 95%confidence intervals (CIs): 1.06–1.28, p = 0.002)
Summary
Acute upper gastrointestinal bleeding (UGIB) is considered as one of the most common emergencies and reasons of urgent hospitalization. The incidence of acute upper gastrointestinal hemorrhage ranges from 40 up to 150 cases a year in 100,000 population. Proper risk evaluation and prediction of therapy results are essential in patients with UGIB. Several scoring systems have been created to predict clinical outcomes associated with UGIB, but none of these scoring systems used admission venous lactate level as a predictive factor of treatment results [1,2]. Existing scores with proven predictive value in patients with UGIB such as Rockall, Glasgow-Blatchford, or AIMS65 are often difficult to calculate at the patient’s bed, and not practical [1,2]
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