Serum Laktat Akut Üst Gastrointestinal Sistem Kanamalı Hastalarda 30 Günlük Mortaliteyi Belirlemede Belirteç Olabilir
Abstract
Amaç: Üst gastrointestinal sistem kanamalı (GİSK) hastalarda serum laktat düzeyinin 30 günlük mortaliteyi öngörmedeki yerini incelemeyi amaçladık.
Gereç ve Yöntem: Çalışmaya 377 üst GİSK’lı hasta dahil edildi. Hastaların yaş, cinsiyet, semptom ve bulgular, komorbidite ve ilaçlar, hemoglobin, verilen eritrosit miktarı, laktat düzeyi, mortalite oranları kaydedildi. Hastalar GIS kanama sonrası ölen ve yaşayanlar olarak 2 gruba ayrıldı. Grupların klinik ve laboratuar değişkenleri karşılaştırıldı. Grupların karşılaştırılmasında Ki-kare testi ve Mann-Witney U testi kullanıldı. 30 günlük mortaliteyi belirlemede serum laktat düzeyinin sensitivite ve spesifitesini belirlemek için ROC eğrisi çizdirildi. P<0,05 değeri istatistiksel olarak anlamlı kabul edildi.
Bulgular: Eksitus olan 42 hastanın (%11.1) laktat düzeyi ortancası 3 mmol/L (QR:3.3 mmol/L), yaşayan hastaların laktat düzeyi ortancası 1.7 mmol/L (QR:1.3 mmol/L) olduğu saptandı. Eksitus olan hastaların laktat düzeyi anlamlı olarak yüksek saptandı (p<0.001). 30 günlük Mortaliteyi belirlemede serum laktatın sensitivite ve spesifitesini belirlemek için ROC eğrisi çizdirildi. 3 mmol/L için; sensitivite %79.5 ve spesifite 53.8 olarak saptandı
Sonuç: Serum Laktat düzeyi yüksek olan hastaların daha mortal seyrettiğini tespit edildi.
Keywords
References
- Jaka H, Koy M, Liwa A, Kabangila R, Mirambo M, Scheppach W, et al. A fibreoptic endoscopic study of upper gastrointestinal bleeding at Bugando Medical Centre in northwestern Tanzania: a retrospective review of 240 cases. BMC research notes. 2012;5:200. doi: 10.1186/1756-0500-5-200
- Konyar Z, Guneysel O, Dogan FS, Gokdag E. Modification of Glasgow-Blatchford scoring with lactate in predicting the mortality of patients with upper gastrointestinal bleeding in emergency department. Hong Kong Journal of Emergency Medicine. 2019;26(1):31-38.
- Sayhan MB, S. Oğuz, H. Ümit, E. Secgin Sayhan, MO. Eralp, G. Akdur, C. Kavalcı, T. Sagiroglu. Akut üst gastrointestinal kanama şikâyeti ile başvuran yaşlı hastaların klinik özellikleri ve risk faktörlerinin değerlendirilmesi. Türkiye Acil Tıp Dergisi. 2012;12(4):157-162
- Shrestha MP, Borgstrom M, Trowers EA. Elevated lactate level predicts intensive care unit admissions, endoscopies and transfusions in patients with acute gastrointestinal bleeding. Clinical and experimental gastroenterology. 2018;11:185-192.
- Lee SH, Min YW, Bae J, Lee H, Min BH, Lee JH, et al. Lactate parameters predict clinical outcomes in patients with nonvariceal upper gastrointestinal bleeding. Journal of Korean medical science. 2017;32(11):1820-1827.
- Contenti J, Occelli C, Lemoel F, Ferrari P, Levraut J. Blood lactate measurement within the emergency department: A two-year retrospective analysis. The American journal of emergency medicine. 2019;37(3):401-406.
- Musikatavorn K, Thepnimitra S, Komindr A, Puttaphaisan P, Rojanasarntikul D. Venous lactate in predicting the need for intensive care unit and mortality among nonelderly sepsis patients with stable hemodynamic. The American journal of emergency medicine. 2015;33(7):925-930.
- Alegria L, Vera M, Dreyse J, Castro R, Carpio D, Henriquez C, et al. A hypoperfusion context may aid to interpret hyperlactatemia in sepsis-3 septic shock patients: a proof-of-concept study. Annals of intensive care. 2017;7(1):29.
- Hernandez G, Bellomo R, Bakker J. The ten pitfalls of lactate clearance in sepsis. Intensive care medicine. 2019;45(1):82-85.
- Shah A, Chisolm-Straker M, Alexander A, Rattu M, Dikdan S, Manini AF. Prognostic use of lactate to predict inpatient mortality in acute gastrointestinal hemorrhage. The American journal of emergency medicine. 2014;32(7):752-755.
- Shapiro NI, Howell MD, Talmor D, Nathanson LA, Lisbon A, Wolfe RE, et al. Serum lactate as a predictor of mortality in emergency department patients with infection. Annals of emergency medicine. 2005;45(5):524-528.
- El-Kersh K, Chaddha U, Sinha RS, Saad M, Guardiola J, Cavallazzi R. Predictive role of admission lactate level in critically ill patients with acute upper gastrointestinal bleeding. The Journal of emergency medicine. 2015;49(3):318-325.
- Christensen S, Riis A, Norgaard M, Sorensen HT, Omsen RW. Short-term mortality a&er perforated or bleeding peptic ulcer among elderly patients: a population-based cohort study. BMC Geriatr 2007;7:8.
- Marmo R, Koch M, Cipolletta L, Bianco MA, Grossi E, Rotondano G, et al. Predicting mortality in patients with in-hospital nonvariceal upper GI bleeding: a prospective, multicenter database study. Gastrointest Endosc 2014;79(5):741-9 e1.
- Altınbilek E, Ozturk D, Kavalci C. Neutrophil/lymphocyte ratio and Red blood cell distribution width are independent risk factors for 30-day mortality in Gastrointestinal system bleeding patients. Signa Vitae 2019;15(2):59-64
- Crooks C, Card T, West J. Reductions in 28-day mortality following hospital admission for upper gastrointestinal hemorrhage. Gastroenterology 2011;141(1):62-70.
- Lee YJ, Min BR, Kim ES, Park KS, Cho KB, Jang BK, et al. Predictive factors of mortality within 30 days in patients with nonvariceal upper gastrointestinal bleeding. Korean J Intern Med 2016;31(1):54-64.
- Sung JJ, Tsoi KK, Ma TK, Yung M-Y, Lau JY, Chiu PW. Causes of mortality in patients with peptic ulcer bleeding: a prospective cohort study of 10,428 cases. The American journal of gastroenterology. 2010;105(1):84.
- Siddique SM, Mehta SJ, Lewis JD, Neuman MD, Werner RM. Rates of hospital readmission among Medicare beneficiaries with gastrointestinal bleeding vary based on etiology and comorbidities. Clinical Gastroenterology and Hepatology. 2019;17(1):90-97. e3.
- Gölgeli H, Ecirli Ş, Kutlu O, Başer H, Karasoy D. Evaluation of the patients that followed up for upper gastrointestinal system bleeding. Dicle Med J. 2014;41:495-501.
- Baradaran F, Norouzi A, Tavassoli S, Baradaran A, Roshandel G. Factors associated with outcome in patients with acute upper gastrointestinal bleeding in a tertiary referral center in Northern Iran. Middle East journal of digestive diseases. 2016;8(3):201.
- Sayhan MB, Oğuz S, Yüksel V, Hüseyin S, Seçgin Sayhan E, Yağcı G. The analysis of patients admitted to the emergency department due to complications related to Warfarin treatment. JAEM 2014; 13: 194-198.
Serum Lactate may be a Marker for Determining 30-Day Mortality in Patients with Acute Upper Gastrointestinal System Bleeding
Abstract
Ojective: We aimed to examine the role of serum lactate level in predicting 30-day mortality in patients with upper gastrointestinal bleeding (GIB).
Matarial and Method: 377 upper GIB cases included in the study. Age, gender, symptoms and signs, comorbidity and drugs, hemoglobin, amount of red blood cells administered, lactate level, mortality rates were recorded. The patients were divided into 2 groups as those who died and those who survived after GI bleeding. The clinical and laboratory variables of the groups were compared. Chi-square test and Mann-Witney U test were used to compare the groups. The ROC curve was plotted to determine the sensitivity and specificity of serum lactate level in determining 30-day mortality. A p value of <0.05 was considered statistically significant.
Results: The median lactate level of 42 (11.1%) deceased patients was 3 mmol/L (QR: 3.3 mmol/L), and the median lactate level of the surviving patients was 1.7 mmol/L (QR: 1.3 mmol/L). The lactate level of the patients who died was found to be significantly higher (p<0.001). The ROC curve was plotted to determine the sensitivity and specificity of serum lactate in determining 30-day Mortality. for 3 mmol/L; sensitivity was 79.5% and specificity was 53.8%.
Conclusion: It was determined that patients with high serum lactate levels were more mortal.
References
- Jaka H, Koy M, Liwa A, Kabangila R, Mirambo M, Scheppach W, et al. A fibreoptic endoscopic study of upper gastrointestinal bleeding at Bugando Medical Centre in northwestern Tanzania: a retrospective review of 240 cases. BMC research notes. 2012;5:200. doi: 10.1186/1756-0500-5-200
- Konyar Z, Guneysel O, Dogan FS, Gokdag E. Modification of Glasgow-Blatchford scoring with lactate in predicting the mortality of patients with upper gastrointestinal bleeding in emergency department. Hong Kong Journal of Emergency Medicine. 2019;26(1):31-38.
- Sayhan MB, S. Oğuz, H. Ümit, E. Secgin Sayhan, MO. Eralp, G. Akdur, C. Kavalcı, T. Sagiroglu. Akut üst gastrointestinal kanama şikâyeti ile başvuran yaşlı hastaların klinik özellikleri ve risk faktörlerinin değerlendirilmesi. Türkiye Acil Tıp Dergisi. 2012;12(4):157-162
- Shrestha MP, Borgstrom M, Trowers EA. Elevated lactate level predicts intensive care unit admissions, endoscopies and transfusions in patients with acute gastrointestinal bleeding. Clinical and experimental gastroenterology. 2018;11:185-192.
- Lee SH, Min YW, Bae J, Lee H, Min BH, Lee JH, et al. Lactate parameters predict clinical outcomes in patients with nonvariceal upper gastrointestinal bleeding. Journal of Korean medical science. 2017;32(11):1820-1827.
- Contenti J, Occelli C, Lemoel F, Ferrari P, Levraut J. Blood lactate measurement within the emergency department: A two-year retrospective analysis. The American journal of emergency medicine. 2019;37(3):401-406.
- Musikatavorn K, Thepnimitra S, Komindr A, Puttaphaisan P, Rojanasarntikul D. Venous lactate in predicting the need for intensive care unit and mortality among nonelderly sepsis patients with stable hemodynamic. The American journal of emergency medicine. 2015;33(7):925-930.
- Alegria L, Vera M, Dreyse J, Castro R, Carpio D, Henriquez C, et al. A hypoperfusion context may aid to interpret hyperlactatemia in sepsis-3 septic shock patients: a proof-of-concept study. Annals of intensive care. 2017;7(1):29.
- Hernandez G, Bellomo R, Bakker J. The ten pitfalls of lactate clearance in sepsis. Intensive care medicine. 2019;45(1):82-85.
- Shah A, Chisolm-Straker M, Alexander A, Rattu M, Dikdan S, Manini AF. Prognostic use of lactate to predict inpatient mortality in acute gastrointestinal hemorrhage. The American journal of emergency medicine. 2014;32(7):752-755.
- Shapiro NI, Howell MD, Talmor D, Nathanson LA, Lisbon A, Wolfe RE, et al. Serum lactate as a predictor of mortality in emergency department patients with infection. Annals of emergency medicine. 2005;45(5):524-528.
- El-Kersh K, Chaddha U, Sinha RS, Saad M, Guardiola J, Cavallazzi R. Predictive role of admission lactate level in critically ill patients with acute upper gastrointestinal bleeding. The Journal of emergency medicine. 2015;49(3):318-325.
- Christensen S, Riis A, Norgaard M, Sorensen HT, Omsen RW. Short-term mortality a&er perforated or bleeding peptic ulcer among elderly patients: a population-based cohort study. BMC Geriatr 2007;7:8.
- Marmo R, Koch M, Cipolletta L, Bianco MA, Grossi E, Rotondano G, et al. Predicting mortality in patients with in-hospital nonvariceal upper GI bleeding: a prospective, multicenter database study. Gastrointest Endosc 2014;79(5):741-9 e1.
- Altınbilek E, Ozturk D, Kavalci C. Neutrophil/lymphocyte ratio and Red blood cell distribution width are independent risk factors for 30-day mortality in Gastrointestinal system bleeding patients. Signa Vitae 2019;15(2):59-64
- Crooks C, Card T, West J. Reductions in 28-day mortality following hospital admission for upper gastrointestinal hemorrhage. Gastroenterology 2011;141(1):62-70.
- Lee YJ, Min BR, Kim ES, Park KS, Cho KB, Jang BK, et al. Predictive factors of mortality within 30 days in patients with nonvariceal upper gastrointestinal bleeding. Korean J Intern Med 2016;31(1):54-64.
- Sung JJ, Tsoi KK, Ma TK, Yung M-Y, Lau JY, Chiu PW. Causes of mortality in patients with peptic ulcer bleeding: a prospective cohort study of 10,428 cases. The American journal of gastroenterology. 2010;105(1):84.
- Siddique SM, Mehta SJ, Lewis JD, Neuman MD, Werner RM. Rates of hospital readmission among Medicare beneficiaries with gastrointestinal bleeding vary based on etiology and comorbidities. Clinical Gastroenterology and Hepatology. 2019;17(1):90-97. e3.
- Gölgeli H, Ecirli Ş, Kutlu O, Başer H, Karasoy D. Evaluation of the patients that followed up for upper gastrointestinal system bleeding. Dicle Med J. 2014;41:495-501.
- Baradaran F, Norouzi A, Tavassoli S, Baradaran A, Roshandel G. Factors associated with outcome in patients with acute upper gastrointestinal bleeding in a tertiary referral center in Northern Iran. Middle East journal of digestive diseases. 2016;8(3):201.
- Sayhan MB, Oğuz S, Yüksel V, Hüseyin S, Seçgin Sayhan E, Yağcı G. The analysis of patients admitted to the emergency department due to complications related to Warfarin treatment. JAEM 2014; 13: 194-198.
Details
| Primary Language | Turkish |
|---|---|
| Subjects | Emergency Medicine |
| Journal Section | Research Articles |
| Authors | |
| Publication Date | March 1, 2022 |
| Submission Date | January 31, 2022 |
| Acceptance Date | February 20, 2022 |
| Published in Issue | Year 2022 Volume: 4 Issue: 1 |
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