Comparison of Lactate Clearance with Established Risk Assessment Tools in Predicting Outcomes in Acute Upper Gastrointestinal Bleeding
Abstract
:1. Introduction
2. Materials and Methods
3. Results
3.1. Baseline Characteristics and Outcomes
3.2. Performance of Risk Assessment Tools in Predicting Intervention, Mortality and Rebleeding
3.3. Performance of Bleeding Risk Scoring Systems at Optimal Cutoffs
3.4. Factors Associated with the Need for Hemostatic Intervention
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Total | Non-Intervention | Intervention | p-Value | |
---|---|---|---|---|
Age (median (IQR)) | 70 (56–77) | 68 (51–76) | 73 (61–81) | 0.027 |
Women, n (%) | 48 (44.9) | 32 (44.4) | 16 (45.7) | 0.901 |
Coronary heart disease | 13 (12.1) | 10 (13.9) | 3 (8.6) | 0.43 |
Congestive heart failure | 15 (14.0) | 8 (11.1) | 7 (20.0) | 0.214 |
Cerebrovascular disease | 18 (16.8) | 9 (12.5) | 9 (25.7) | 0.086 |
Peripheral vascular disease | 19 (17.7) | 11 (15.3) | 8 (22.9) | 0.336 |
Chronic pulmonary disease | 12 (11.2) | 11 (15.3) | 1 (2.9) | 0.056 |
Peptic ulcer disease | 27 (25.2) | 20 (27.8) | 7 (20.0) | 0.385 |
Diabetes without end-organ damage | 23 (21.5) | 13 (12.1) | 10 (9.3) | 0.214 |
Diabetes with end-organ damage | 6 (5.6) | 4 (5.6) | 2 (5.7) | 0.973 |
Moderate/severe renal disease | 25 (23.4) | 20 (27.8) | 5 (14.3) | 0.122 |
Non-metastatic tumor | 14 (13.1) | 8 (11.1) | 6 (17.1) | 0.385 |
Moderate/severe liver disease | 20 (18.7) | 15 (20.8) | 5 (14.3) | 0.415 |
Metastatic solid tumor | 13 (12.1) | 5 (6.9) | 8 (22.9) | 0.018 |
CCI median, (IQR) | 6 (4–8) | 6 (3–8) | 7 (4–8) | 0.09 |
Antithrombotic drug, n(%) | 34 (32.1) | 27 (37.5) | 7 (20.6) | 0.082 |
Anticoagulants, n (%) | 26 (24.8) | 14 (19.7) | 12 (35.3) | 0.084 |
Signs of bleeding, n (%) | ||||
Hematemesis | 39 (36.4) | 24 (33.3) | 15 (42.9) | 0.922 |
Melaena | 71 (66.4) | 48 (66.7) | 23 (65.7) | 0.922 |
Hematochezia | 13 (12.1) | 9 (12.5) | 4 (11.4) | 0.874 |
Syncope | 12 (11.2) | 9 (12.5) | 3 (8.6) | 0.546 |
Pulse rate, median (IQR), beats per minute | 83 (75–102) | 82 (76–102) | 86 (71–102) | 0.718 |
Tachycardia | 30 (28.0) | 20 (27.8) | 10 (28.6) | 0.932 |
Systolic blood pressure, median (IQR), mmHg | 120 (95–138) | 125 (96–140) | 117 (93–130) | 0.16 |
Signs of shock | 46 (43.0) | 30 (41.7) | 16 (45.7) | 0.692 |
Bleeding etiologies, n (%) | ||||
Peptic ulcers | 40 (38.1) | 21 (29.2) | 19 (54.2) | 0.012 |
Neoplasms | 12 (11.4) | 4 (5.6) | 8 (22.9) | 0.008 |
Others | 41 (39.1) | 33 (45.8) | 8 (22.9) | 0.022 |
Laboratory parameters, median (IQR) | ||||
Urea (mg/dL) | 79 (47–120) | 76 (41–108) | 88 (61–185) | 0.023 |
Hemoglobin (g/dL) | 8.4 (6.7–9.9) | 8.6 (6.7–10.1) | 7.9 (6.1–8.8) | 0.057 |
Initial Lactate (mmol/L) | 2.7 (1.6–5.4) | 2.7 (1.6–5.0) | 3.1 (1.7–6.0) | 0.195 |
Subsequent Lactate (mmol/L) | 1.8 (1.2–3.9) | 2.0 (1.1–3.5) | 1.6 (1.4–4.0) | 0.87 |
Hours between lactate measurement, | 2.9 (1.7–4.5) | 2.9 (1.6–4.4) | 3.2 (1.8–4.9) | 0.450 |
Lactate clearance (%) | 18.7 (2.7–48.2) | 16.8 (−0.6–41.2) | 28.9 (8.7–51) | 0.376 |
Initial lactate elevated (%) | 64 (59.8) | 42 (58.3) | 22 (62.9) | 0.654 |
Risk scores median, (IQR) | ||||
GBS | 12 (9–14) | 11 (8–14) | 13 (11–15) | 0.004 |
p-RS | 4 (3–5) | 4 (3–5) | 4 (3–5) | 0.123 |
f-RS | 6 (4–7) | 5 (4–6) | 7 (6–9) | <0.001 |
Outcome | Number of Patients (%) |
---|---|
Active Bleeding at Endoscopy | 27 (25.2) |
Endoscopic intervention | 30 (29.1) |
Radiological intervention | 6 (5.6) |
Surgical intervention | 2 (1.9) |
Any interventions | 35 (32.7) |
Patients received transfusions | 63 (60) |
Number of packed red-blood-cells transfused (median (range)) | 2 (0–4) |
30-day mortality | 12 (11.2) |
30-day rebleeding rate | 16 (15.0) |
Cutoff Value | Identified Patients | Need for Intervention | Sensitivity % | Specificity % | PPV % | NPV % | |
---|---|---|---|---|---|---|---|
Initial lactate | ≤3.8 mmol/L | 68 (64.5%) | 18 (26.1%) | 48.6 | 70.8 | 44.7 | 73.9 |
Lactate clearance | ≤23.8% | 60 (56.1%) | 15 (25.0%) | 57.1 | 63.9 | 42.6 | 75.0 |
GBS | ≤10 | 42 (39.3%) | 8 (19%) | 22.9 | 52.8 | 41.5 | 81.0 |
pRS | ≤4 | 71 (66.4%) | 20 (28.2%) | 42.9 | 70.8 | 41.7 | 71.8 |
Odds Ratio | Confidence Interval | p-Value | |
---|---|---|---|
Age | 1.031 | 0.993–1.071 | |
Cerebrovascular disease | 1.763 | 0.468–6.646 | 0.402 |
Chronic pulmonary disease | 0.184 | 0.018–1.89 | 0.154 |
Metastatic solid tumor | 4.007 | 1.018–15.775 | 0.047 |
Antithrombotic drugs | 0.361 | 0.115–1.138 | 0.082 |
Anticoagulants | 0.855 | 0.267–2.735 | 0.792 |
Urea (mg/dL) | 1.006 | 1.000–1.013 | 0.047 |
Hemoglobin (g/dL) | 0.831 | 0.66–1.046 | 0.114 |
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Allo, G.; Gillessen, J.; Gülcicegi, D.; Kasper, P.; Chon, S.-H.; Goeser, T.; Bürger, M. Comparison of Lactate Clearance with Established Risk Assessment Tools in Predicting Outcomes in Acute Upper Gastrointestinal Bleeding. J. Clin. Med. 2023, 12, 2716. https://doi.org/10.3390/jcm12072716
Allo G, Gillessen J, Gülcicegi D, Kasper P, Chon S-H, Goeser T, Bürger M. Comparison of Lactate Clearance with Established Risk Assessment Tools in Predicting Outcomes in Acute Upper Gastrointestinal Bleeding. Journal of Clinical Medicine. 2023; 12(7):2716. https://doi.org/10.3390/jcm12072716
Chicago/Turabian StyleAllo, Gabriel, Johannes Gillessen, Dilan Gülcicegi, Philipp Kasper, Seung-Hun Chon, Tobias Goeser, and Martin Bürger. 2023. "Comparison of Lactate Clearance with Established Risk Assessment Tools in Predicting Outcomes in Acute Upper Gastrointestinal Bleeding" Journal of Clinical Medicine 12, no. 7: 2716. https://doi.org/10.3390/jcm12072716