Centre for Translational Medicine, Semmelweis University, Budapest 1085, Hungary.
Institute for Translational Medicine, Medical School, University of Pécs, Pécs 7623, Hungary.
World J Gastroenterol. 2023 Jul 28;29(28):4466-4480. doi: 10.3748/wjg.v29.i28.4466.
Hemodynamic instability and shock are associated with untoward outcomes in gastrointestinal bleeding. However, there are no studies in the existing literature on the proportion of patients who developed these outcomes after gastrointestinal bleeding.
To determine the pooled event rates in the available literature and specify them based on the bleeding source.
The protocol was registered on PROSPERO in advance (CRD42021283258). A systematic search was performed in three databases (PubMed, EMBASE, and CENTRAL) on 14 October 2021. Pooled proportions with 95%CI were calculated with a random-effects model. A subgroup analysis was carried out based on the time of assessment (on admission or during hospital stay). Heterogeneity was assessed by Higgins and Thompson's statistics. The Joanna Briggs Institute Prevalence Critical Appraisal Tool was used for the risk of bias assessment. The Reference Citation Analysis (https://www.referencecitationanalysis.com/) tool was applied to obtain the latest highlight articles.
We identified 11589 records, of which 220 studies were eligible for data extraction. The overall proportion of shock and hemodynamic instability in general gastrointestinal bleeding patients was 0.25 (95%CI: 0.17-0.36, = 100%). In non-variceal bleeding, the proportion was 0.22 (95%CI: 0.14-0.31, = 100%), whereas it was 0.25 (95%CI: 0.19-0.32, = 100%) in variceal bleeding. The proportion of patients with colonic diverticular bleeding who developed shock or hemodynamic instability was 0.12 (95%CI: 0.06-0.22, = 90%). The risk of bias was low, and heterogeneity was high in all analyses.
One in five, one in four, and one in eight patients develops shock or hemodynamic instability on admission or during hospitalization in the case of non-variceal, variceal, and colonic diverticular bleeding, respectively.
血流动力学不稳定和休克与胃肠道出血的不良结局相关。然而，现有的文献中没有关于胃肠道出血后出现这些结局的患者比例的研究。
确定现有文献中汇总的事件发生率，并根据出血源进行具体说明。
该方案已提前在 PROSPERO 上注册（CRD42021283258）。2021 年 10 月 14 日，我们在三个数据库（PubMed、EMBASE 和 CENTRAL）中进行了系统检索。使用随机效应模型计算汇总比例及其 95%CI。根据评估时间（入院时或住院期间）进行亚组分析。采用 Higgins 和 Thompson 的 统计量评估异质性。使用 Joanna Briggs 研究所流行率关键性评估工具进行偏倚风险评估。应用参考文献分析（https://www.referencecitationanalysis.com/）工具获取最新的高引文章。
我们共检索到 11589 条记录，其中 220 项研究符合数据提取标准。一般胃肠道出血患者中休克和血流动力学不稳定的总体比例为 0.25（95%CI：0.17-0.36， = 100%）。非静脉曲张性出血的比例为 0.22（95%CI：0.14-0.31， = 100%），静脉曲张性出血的比例为 0.25（95%CI：0.19-0.32， = 100%）。发生结肠憩室出血的患者中，出现休克或血流动力学不稳定的比例为 0.12（95%CI：0.06-0.22， = 90%）。所有分析的偏倚风险均较低，但异质性较高。
非静脉曲张性、静脉曲张性和结肠憩室性出血患者中，分别有五分之一、四分之一和八分之一的患者在入院时或住院期间发生休克或血流动力学不稳定。
