S3304 A Retrospective Analysis of Orthostatic Hypotension and Risk Stratification in Patients Presenting With Acute Gastrointestinal Bleeds

Abstract

Introduction: Gastrointestinal bleeding (GIB) is a common presentation occurring in 150 per 100,000 patients with a mortality rate of 2-15%. The timely assessment of patients and accurate risk stratification is of the utmost importance. Physicians have adopted several risk stratification tools to help assess risk and guide medical management. One parameter that is ill-defined in risk stratification of acute GIBs is orthostatic hypotension (OH). The presence of OH in GIB is widely utilized as a surrogate for intravascular volume depletion and hemodynamic instability as a marker of increased mortality. Through retrospective analysis we assessed the proposed link between OH and disposition, intervention, and mortality and its ability to risk stratify patients with GIB. Methods: We conducted an IRB-approved, retrospective study in all patients from a single tertiary referral center with an ICD-10 diagnosis for GIB and OH between the years of 2018-2020. Our cohort consisted of 77 patients in whom we assessed timing of endoscopic intervention, intensive care unit (ICU) admission, and mortality using chi-square analyses. Results: Upon review of the 77 patients selected with GIB and OH, 46 (59.7%) were ultimately admitted to the ICU. Of the 46 patients in the ICU, 34 (74%) required endoscopic intervention with 7 (15%) requiring emergent intervention, defined as occurring within 6 hours of evaluation by gastroenterology. Of the 77 patients, 8 (10.4%) required emergent intervention, 24 (31.2%) required intervention within 24 hours of evaluation, and 19 (24.7%) intervention beyond 24 hours. There were 26 (33.8%) that required no intervention prior to discharge. Overall, 75 (97.4%) were discharged, while 2 (2.6%) passed away. Based on our initial data with chi-square analyses, there were no statistically significant associations between OH, intervention, disposition, and mortality. Conclusion: Acute GI bleeding require swift evaluation and risk stratification. It is taught that 1000cc (20% of body volume) of blood loss can induce orthostasis. This argues that OH upon presentation may represent significant hemodynamic instability and increase overall mortality. There are other etiologies of OH that may need to be considered independent of intravascular volume loss. Our initial data suggest that OH alone in the setting of GIB is insufficient in assessment for disposition, intervention, and mortality. Future studies are warranted to better risk stratify patients presenting with acute GIBs and the association with OH.Table 1.: Crosstab analysis comparing the intervention group with ICU admission and discharge status. Following the crosstab analysis, a chi-square test was used to compare the intervention groups on the categorical variables. The P-value for the intervention groups compared to admission was P = .21 while the P-value for discharge status was P = .08. There were no statistically significant associations to report.