马达加斯加外科重症监护病房中静脉曲张性上消化道出血的临床死亡风险因素

Clinical mortality risk factors of variceal upper gastrointestinal bleeding in a Malagasy surgical intensive care unit.

作者信息

Rakotondrainibe Aurélia, Rahanitriniaina Nadia M P, Randriamizao Harifetra M R, Raelison Jasper G, Ramanampamonjy Rado M, Rajaonera Andriambelo T, Sztark François

机构信息

Unité de Soins, de Formation et de Recherche, Réanimation Chirurgicale, Antananarivo - Faculté de Médecine d'Antananarivo, Université d'Antananarivo, Madagascar.

Unité de Soins, de Formation et de Recherche, Hépato-gastro-entérologie, Antananarivo, Madagascar - Faculté de Médecine d'Antananarivo, Université d'Antananarivo, Madagascar.

出版信息

Afr J Emerg Med. 2020 Dec;10(4):188-192. doi: 10.1016/j.afjem.2020.06.004. Epub 2020 Jul 21.

DOI:10.1016/j.afjem.2020.06.004

PMID:33299747

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7700958/

Abstract

BACKGROUND

Variceal upper gastrointestinal bleeding is a dreadful complication of portal hypertension with a significant morbidity and mortality. Different prognostic scores can be used. However, in the local context of Madagascar, the completion of paraclinical investigations can be delayed by the limited financial means of patients. Hence, determining clinical mortality risk factors of variceal upper gastrointestinal bleeding could be interesting. The aim of the study was to evaluate the clinical mortality risk factors of variceal gastrointestinal bleeding (VUGIB).

METHOD

An observational, cohort retrospective study was conducted over an 8-year period (2010-2017), at the surgical intensive care unit of the J.R. Andrianavalona University Hospital, Antananarivo, in patients admitted for VUGIB confirmed by upper gastrointestinal endoscopy and whose clinical examination was performed at admission. The primary endpoint was intensive care unit (ICU) mortality. Univariate analysis and multivariate logistic regression analysis were performed to identify risk factors for ICU mortality, with OR defining odds ratio. A value <0.05 was considered significant.

RESULTS

1920 patients were admitted for gastrointestinal bleeding of any digestive causes; the source of bleeding was variceal in 269 patients (14%). The predominantly male population (sex ratio = 2.5), aged 47.1 ± 13.7 years was mostly American Society of Anesthesiologists (ASA) 1 classification (58.4%). In 56.5% of patients, the gastrointestinal bleeding had not occurred before. The mortality rate was 16.0%. Three major clinical factors of mortality were identified: previous endoscopic band variceal ligation (OR = 12.57 [2.18-72.58], = 0.005), tachycardia >120 bpm (OR = 2.91 [1.04-8.14], = 0.041), and ascites (OR = 3.80 [1.85-7.81], < 0.001).

CONCLUSION

Upper gastrointestinal bleeding may be life-threatening. The mortality scores are certainly useful; however, the identification of clinical factors is interesting in countries like Madagascar, pending the results of paraclinical investigations.

摘要

背景

静脉曲张性上消化道出血是门静脉高压症的一种严重并发症，具有较高的发病率和死亡率。可使用不同的预后评分。然而，在马达加斯加当地，由于患者经济条件有限，辅助检查的完成可能会延迟。因此，确定静脉曲张性上消化道出血的临床死亡危险因素可能会很有意义。本研究的目的是评估静脉曲张性胃肠道出血（VUGIB）的临床死亡危险因素。

方法

在塔那那利佛J.R.安德里亚纳瓦洛纳大学医院的外科重症监护病房，对2010年至2017年这8年期间因VUGIB入院且经上消化道内镜检查确诊、入院时进行了临床检查的患者进行了一项观察性队列回顾性研究。主要终点是重症监护病房（ICU）死亡率。进行单因素分析和多因素逻辑回归分析以确定ICU死亡率的危险因素，OR定义比值比。P值<0.05被认为具有统计学意义。

结果

1920例患者因任何消化系统原因导致的胃肠道出血入院；其中269例（14%）出血源为静脉曲张。患者以男性为主（性别比=2.5），年龄47.1±13.7岁，大多为美国麻醉医师协会（ASA）1级分类（58.4%）。56.5%的患者之前未发生过胃肠道出血。死亡率为16.0%。确定了三个主要的死亡临床因素：既往内镜下静脉曲张套扎术（OR=12.57[2.18-72.58]，P=0.005）、心率>120次/分（OR=2.91[1.04-8.14]，P=0.041）和腹水（OR=3.80[1.85-7.81]，P<0.001）。