Are Short-Stay Units Safe and Effective in the Treatment of Non-Variceal Upper Gastrointestinal Bleeding?
Abstract
1. Introduction
2. Materials and Methods
3. Results
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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All Patients (N = 120) | SSU (N = 60) | Medical Ward (N = 60) | p | |
---|---|---|---|---|
Demographic data | ||||
Age (years, M ± SD) | 69.6 ± 16 | 66.4 ± 16 | 72.6 ± 16 | 0.03 |
Males N (%) | 65 (54) | 29 (48) | 36 (60) | 0.2 |
RCFS (Median and IQR) | 4 (2–5) | 4 (3–5) | 4 (2–4) | 0.83 |
Clinical presentation at ED | ||||
Melena N (%) | 110 (91.6) | 55 (91.6) | 55 (91.6) | 1 |
Hematemesis N (%) | 8 (6.7) | 4 (6.7) | 4 (6.7) | 1 |
Rectal bleeding + UGIB N (%) | 2 (1.7) | 1 (1.7) | 1 (1.7) | 1 |
Duration of symptoms at admission (M ± SD) | 34 ± 23 | 32 ± 25 | 35 ± 22 | 0.09 |
Comorbidities N (%) | ||||
Diabetes | 25 (21) | 10 (17) | 15 (25) | 0.26 |
Hypertension | 48 (40) | 34 (57) | 22 (37) | 0.46 |
Coronary Heart Disease | 21 (17) | 9 (15) | 12 (20) | 0.52 |
Congestive Heart Failure | 10 (8) | 5 (8) | 5 (8) | 1 |
Chronic Liver Disease | 6 (5) | 2 (3) | 4 (7) | 0.7 |
Atrial Fibrillation | 32 (27) | 12 (20) | 20 (33) | 0.1 |
COPD | 15 (12) | 5 (8) | 10 (17) | 0.17 |
Active cancer | 22 (18) | 4 (7) | 18 (30) | 0.002 |
History of stroke | 9 (7) | 1 (2) | 8 (13) | 0.03 |
Chronic Kidney Disease | 11 (9) | 4 (7) | 7 (12) | 0.53 |
Previous bariatric surgery | 6 (5) | 4 (7) | 2 (3) | 0.7 |
Autoimmune diseases | 6 (5) | 3 (5) | 3 (5) | 1 |
VTE | 6 (5) | 3 (5) | 3 (5) | 1 |
N. of comorbidities >1 | 54 (45) | 21 (35) | 33 (55) | 0.03 |
RCFS > 4 | 32 (27) | 14 (23) | 18 (30) | 0.68 |
At-home treatment N (%) | ||||
Anticoagulants | 33 (27) | 12 (20) | 21 (35) | 0.07 |
VKA | 5 (4) | 0 (0) | 5 (4) | 0.21 |
DOAC | 22 (18) | 10 (17) | 12 (20) | 0.64 |
Dabigatran | 4 (3) | 3 (5) | 1 (2) | 0.62 |
Apixaban | 4 (3) | 1 (2) | 3 (5) | 0.62 |
Rivaroxaban | 4 (3) | 0 (0) | 4 (7) | 0.36 |
Edoxaban | 12 (10) | 6 (10) | 4 (7) | 0.74 |
LMWH | 5 (7) | 1 (2) | 4 (7) | 0.36 |
Fondaparinux | 1 (2) | 1 (3) | 0 (0) | 0.81 |
Antiplatelets | 29 (24) | 13 (22) | 16 (27) | 0.52 |
ASA | 23 (27) | 11 (18) | 12 (20) | 0.82 |
Clopidogrel | 10 (8) | 5 (8) | 5 (8) | 1 |
Others antiplatelets | 4 (3) | 0 (0) | 4 (7) | 0.36 |
Dual antiplatelets therapy | 8 ((7) | 3 (5) | 5 (8) | 0.77 |
Anticoagulant + Antiplatelets | 3 (2) | 1 (2) | 2 (3) | 1 |
NSAIDs | 12 (10) | 5 (8) | 7 (12) | 0.54 |
Corticosteroids | 8 (7) | 2 (3) | 6 (10) | 0.27 |
PPI | 33 (27) | 15 (25) | 28 (47) | 0.01 |
Laboratory and vital signs (M ± DS) | ||||
Hemoglobin (g/dL) | 8.7 ± 2 | 9.0 ± 2 | 8.3 ± 2 | 0.11 |
WBC (×109/L) | 8794 ± 3350 | 8960 ± 3270 | 8629 ± 3447 | 0.62 |
Neutrophils (×107/L) | 7040 ± 6564 | 6450 ± 2900 | 7633 ± 8819 | 0.31 |
Plt (×109/L) | 260 ± 97 | 273 ± 104 | 247 ± 90 | 0.15 |
INR | 1.2 ± 1 | 1.1 ± 1 | 1.3 ± 1 | 0.04 |
Na+ (mmol/L) | 139 ± 3 | 139 ± 3 | 138 ± 4 | 0.43 |
K+ (mmol/L) | 4.2 ± 1 | 4.3 ± 1 | 4.1 ± 1 | 0.15 |
Creatinine (mg/dL) | 1.2 ± 1 | 1.1 ± 1 | 1.4 ± 1 | 0.06 |
SBP (mm/Hg) | 110 ± 18 | 109 ± 16 | 112 ± 17 | 0.34 |
Heart Rate (beats/min) | 94 ± 12 | 95 ± 14 | 93 ± 10 | 0.62 |
BUN (mmol/L) | 9.6 ± 7 | 9.6 ± 6 | 9.7 ± 7 | 0.98 |
Glasgow-Blatchford Score * | 10 (7–12) | 10 (7–13) | 10 (8–12) | 0.89 |
Outcome N (%) | ||||
Patients who need transfusion | 69 (57) | 28 (47) | 41 (68) | 0.02 |
Blood unit transfused * | 1 (0–2) | 0 (0–2) | 2 (0–2) | 0.04 |
Readmission at 30 days | 3 (3) | 1 (2) | 2 (3) | 1 |
In-hospital death | 2 (2) | 0 (0) | 2 (3) | 0.76 |
Admission to hospital | 67 (56) | 7 (12) | 60 (100) | <0.0001 |
Outcome (M ± SD) | ||||
Length of Hospital stay (h) | 214 ± 209 | 126 ± 133 | 298 ± 212 | <0.0001 |
Time to endoscopy (h) | 66 ± 14 | 31 ± 39 | 104 ± 119 | <0.0001 |
Time to admission (h) | 45 ± 26 | 33 ± 21 | 67 ± 30 | <0.001 |
Time from endoscopy to discharge | 145 ± 181 | 99 ± 131 | 199 ± 207 | <0.0001 |
Type of NVUGIB N (%) | All Patients (120) | SSU (60) | Medical Ward (60) | p |
---|---|---|---|---|
Peptic Ulcer | 66 (55) | 42 (70) | 24 (40) | 0.001 |
Gastric Ulcer | 35 (29) | 23 (38) | 12 (20) | 0.03 |
Duodenal Ulcer | 31 (26) | 19 (32) | 12 (20) | 0.14 |
Erosive hemorrhagic gastritis | 15 (12) | 4 (7) | 11 (18) | 0.1 |
Angiodysplasia | 8 (7) | 3 (5) | 5 (8) | 0.72 |
Obscure gastrointestinal bleeding | 10 (8) | 4 (7) | 6 (10) | 0.51 |
Esophagitis | 11 (9) | 3 (5) | 8 (13) | 0.20 |
Other sources | 10 (8) | 4 (7) | 6 (10) | 0.74 |
Forrest Classification | All Patients (66) | SSU (42) | Medical Ward (24) | p |
---|---|---|---|---|
III | 40 (61) | 25 (60) | 15 (62) | 0.90 |
IIc | 7 (11) | 5 (12) | 2 (8) | 1.00 |
IIb | 3 (4.5) | 1 (2) | 2 (8) | 0.55 |
IIa | 11 (17) | 9 (21) | 2 (8) | 0.30 |
I | 5 (7) | 2 (5) | 3 (12) | 0.34 |
Hemostasis N (%) | All Patients (120) | SSU (60) | Medical Ward (60) | p |
---|---|---|---|---|
Any techniques | 35 (29) | 17 (28) | 18 (30) | 0.84 |
Endoscopic clip | 23 (19) | 11 (18) | 12 (20) | 0.81 |
Epinephrine injection | 9 (8) | 5 (8) | 4 (7) | 0.99 |
Thermocoagulation | 8 (7) | 5 (8) | 3 (5) | 0.72 |
Fibrin glue | 7 (7) | 5 (8) | 2 (3) | 0.44 |
2 or more combined tool | s15 (13) | 10 (17) | 5 (8) | 0.27 |
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Candelli, M.; Lumare, M.; Riccioni, M.E.; Mestice, A.; Ojetti, V.; Pignataro, G.; Merra, G.; Piccioni, A.; Gabrielli, M.; Gasbarrini, A.; et al. Are Short-Stay Units Safe and Effective in the Treatment of Non-Variceal Upper Gastrointestinal Bleeding? Medicina 2023, 59, 1021. https://doi.org/10.3390/medicina59061021
Candelli M, Lumare M, Riccioni ME, Mestice A, Ojetti V, Pignataro G, Merra G, Piccioni A, Gabrielli M, Gasbarrini A, et al. Are Short-Stay Units Safe and Effective in the Treatment of Non-Variceal Upper Gastrointestinal Bleeding? Medicina. 2023; 59(6):1021. https://doi.org/10.3390/medicina59061021
Chicago/Turabian StyleCandelli, Marcello, Maria Lumare, Maria Elena Riccioni, Antonio Mestice, Veronica Ojetti, Giulia Pignataro, Giuseppe Merra, Andrea Piccioni, Maurizio Gabrielli, Antonio Gasbarrini, and et al. 2023. "Are Short-Stay Units Safe and Effective in the Treatment of Non-Variceal Upper Gastrointestinal Bleeding?" Medicina 59, no. 6: 1021. https://doi.org/10.3390/medicina59061021
APA StyleCandelli, M., Lumare, M., Riccioni, M. E., Mestice, A., Ojetti, V., Pignataro, G., Merra, G., Piccioni, A., Gabrielli, M., Gasbarrini, A., & Franceschi, F. (2023). Are Short-Stay Units Safe and Effective in the Treatment of Non-Variceal Upper Gastrointestinal Bleeding? Medicina, 59(6), 1021. https://doi.org/10.3390/medicina59061021