Predictor for Endoscopic Intervention in Patient with Upper Gastrointestinal Bleeding in Trat Hospital
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Abstract
BACKGROUND: Upper gastrointestinal bleeding (UGIB) is an urgent medical condition. Endoscopic intervention is one type of management for patients with high-risk stigmata. However, sometimes it can be difficult to evaluate. Therefore, predicting which patients require endoscopic intervention is important.
OBJECTIVES: To determine the predictors for endoscopic intervention and to assess the clinical presentations, endoscopic findings, endoscopic interventions and outcomes of upper gastrointestinal bleeding patients.
METHODS: We conducted a retrospective cohort study in patients diagnosed with upper gastrointestinal bleeding from August 2022 to February 2024. Medical records and endoscopic results were reviewed. Data were obtained using descriptive statistics, the Chi-square or Fisher’s exact test, the Independent t-test or Mann-Whitney U test, and multiple logistic regression analysis.
RESULTS: A total of 269 patients were enrolled, with a mean age of 64 years, and 60.2% were male. Among the 97 patients (36%) who underwent endoscopic intervention compared to those who did not, it was found that they were more likely to present with melena and have fresh blood NG, higher NSAIDS use, more instances of systolic blood pressure (SBP) <100 mmHg, lower hemoglobin levels, and a drop in hematocrit greater than 20% from baseline. Peptic ulcer was the leading cause of UGIB (60.6%), and the most common intervention was combined epinephrine injection with coaptive thermocoagulation (61.9%). Both groups had similar lengths of hospital stay, re-bleeding rates, and mortality rates. The multivariate analysis indicated that significant predictors for endoscopic intervention were NSAIDS use (OR 2.42; 95% CI, 1.23-4.76; p=0.01), Hb level <7 g/dL (OR 4.02; 95% CI, 1.93-8.40; p<0.001), Hct drop >20% from baseline (OR 3.93; 95% CI, 1.97-7.88; p<0.001), SBP <100 mmHg (OR 5.44; 95% CI, 1.69-17.51; p=0.005) and fresh blood NG (OR 9.48; 95% CI, 2.40-37.39; p<0.001).
CONCLUSIONS: Significant predictors for endoscopic intervention in patients with upper gastrointestinal bleeding include NSAIDS use, hemoglobin level <7 g/dL, hematocrit drop >20% from baseline, systolic blood pressure <100 mmHg, and fresh blood NG.
Thaiclinicaltrials.org number, TCTR20240806005
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