Mustafa KEÇECİ, CAN SEVİNÇ, Kadir KAYATAŞ, Koray KOÇHAN, Arif ŞAHİN, Zeynep Ece DEMİRTAŞ, Ferhat FERHATOĞLU, Ezgi YEŞİL ERSOY, Refik DEMİRTAŞ

Varis dışı akut üst gastrointestinal sistem kanamalı hastalarda lökositoz ile kanama ciddiyeti arasındaki ilişki

Giriş ve Amaç: Varis dışı üst gastrointestinal sistem kanamalı hastala- rın, hastaneye başvuru sırasında bakılan laboratuvar parametreleri ile kanamanın ciddiyeti arasındaki ilişkiyi araştıran birçok çalışma vardır. Biz de bu çalışmamızda hastaların başvuru sırasında tespit edilen lökosito- zun kanama ciddiyetini gösterme açısından prediktif değerini araştırdık. Gereç ve Yöntem: Çalışmaya 2006-2010 yılları arasında hastanemiz Haydarpaşa Numune Eğitim ve Araştırma Hastanesi acil polikliniğine hematemez ve/veya melena şikayeti ile başvuran, melena ve/veya he- matemezi saptanıp, üst gastrointestinal sistem kanama nedeniyle İç Hastalıkları kliniğine yatırılan hastalar alındı. Bu hastaların demografik bilgileri, üst gastrointestinal sistem endoskopi bulguları ve endoskopi sırasında alınan biyopsilerin patoloji sonuçları retrospektif olarak topla- narak kaydedildi. Hastaların yalnızca acil polikliniğe başvuru sırasındaki lökosit değerleri dikkate alındı. Bulgular: Gruplar arasında lökosit sayı- ları açısından istatistiki olarak anlamlı fark saptandı (p:0,007). Gruplar arasında platelet sayıları açısından (p:0,039), kan üre nitrojen düzeyleri açısından (p:0,000), albumin düzeyleri açısından (p:0,006), eritrosit süs- pansiyonu replasman ihtiyaçları açısından (p:0,040), taze donmuş plaz- ma replasman ihtiyaçları açısından istatistiki olarak anlamlı fark saptandı (p:0,045). Sonuç: Lökositoz ile ciddi kanama göstergeleri olan kan üre nitrojeni, eritrosit süspansiyonu ve taze donmuş plazma tarnsfüzyonu ihtiyacı ve hipoalbuminemi ile yakın ilişkili olması; lökositozun başvuru sırasında klinik seyrin ciddiyetini öngörmeye yardımcı olacak bir para- metre olarak kullanılabileceğini göstermekte iken hastane yatış sürele- ri arasında anlamlı fark tespit edilememiş olması hasta sayımızın kısıtlı olması ile ilişkilendirilebilir. Geniş hasta serilerinde yapılacak çalışmalar, lökositozun üst gastrointestinal sistem kanamalarında kullanılan klinik skorlamalarda yerini almasını sağlayabilecek gibi görünmektedir

The correlation between leukocytosis and the severity of bleeding in patients with acute non-variceal upper gastrointestinal system bleeding

Background and Aims: Many studies have investigated the correla- tion between laboratory parameters checked at presentation to the hospital and the severity of bleeding in patients with acute non-variceal upper gastrointestinal system bleeding. In this study, we investigated the predictive value of leukocytosis determined at presentation to the hospital in predicting the severity of bleeding. Materials and Meth- ods: Patients presenting to the emergency polyclinic of Haydarpaşa Numune Training and Research Hospital between 2006 and 2010 with the complaint of hematemesis and/or melena and admitted to the In- ternal Medicine Clinic due to upper gastrointestinal system bleeding with the detection of melena and/or hematemesis were included in the study. Collection of demographic data, upper gastrointestinal en- doscopy findings, and pathological results of biopsies taken during the endoscopy was performed retrospectively. Only leukocyte values de- termined at presentation to the emergency polyclinic were taken into consideration. Results: Statistically significant differences were deter- mined between the groups regarding the number of leukocytes (p: 0,007), number of platelets (p: 0,039), blood urea nitrogen levels (p: 0,000), albumin levels (p: 0,006), requirement for erythrocyte suspen- sion replacement (p: 0,040), and requirement for fresh frozen plasma replacement (p: 0,045). Conclusions: The close association between leukocytosis and the markers of severe bleeding, such as blood urea nitrogen, requirement for erythrocyte suspension and fresh frozen plas- ma and hypoalbuminemia, shows that leukocytosis can be used as a parameter to help predict the severity of the clinical course at presenta- tion to the emergency polyclinic. The inability to determine a significant difference between the hospitalization periods can be attributed to the small numbers of patients in our study. It seems that future studies performed in large patient series will facilitate leukocytosis taking its place among the clinical scoring systems used for upper gastrointestinal system bleedings.

PDF

___

1. Current Diagnosis & Treatment in Gastroenterology. Scott L Fre - idman, Keneth R McQuaid. Lange Medical Books/McGraw-Hill. Güneş Kitabevi, çeviri editörü Sivri B.
2. Longstreth GF. Epidemiology and outcome of patients hospitalized with acute lower gastrointestinal hemorrhage: A population- based study. Am J Gastroenterol 1997; 92:419-24.
3. Hasselgren G, Carlsson J, Lind T, et al. Risk factors for rebleeding and fatal outcome in elderly patients with acute peptic ulcer bleed - ing. Eur J Gastroenterol Hepatol 1998; 10:667-72.
4. Sonnenberg A. Peptic Ulcer. In: Everhart JE, Washington DC, eds. Digestive Disease in the United States: Epidemiology and Impact. US Dept of Health and Human Services. 1994, 357-408.
5. Sleisenger & Fordtrans Gastrointestinal and Liver Disease: Patho - physiology, diagnosis, management /( edited by) Mark Feldman, Lawrence S. Friedman, Marvin H. Sleisenger. 8th ed. 2006 Vol - ume1 Chapter 13: 258.
6. Memisoğlu K. Akut üst gastrointestinal sistem kanamaları. Türkiye Klinikleri J Surg Med Sci 2005; 1:1-6.
7. Alkım H, Şaşmaz N. Akut üst gastrointestinal sistem kanaması. Öz- den A, Şahin B, Yılmaz U, Soykan İ (eds). Gastroenteroloji. 1. Baskı. Ankara: TGV Yayınları 2002; 141-8.
8. Conrad SA. Acute upper gastrointestinal bleeding in critically ill patients: Causes and treatment modalities. Crit Care Med 2002; 30:365-8.
9. Tung CF, Chow WK, Chang CS, et al. The prevalence and signifi - cance of hypoalbuminemia in non-variceal upper gastrointestinal bleeding. Hepatogastroenterology 2007; 54:1153-6.
10. Chalasani N, Patel K, Clark WS, Wilcox CM. The prevalence and significance of leukocytosis in upper gastrointestinal bleeding. Am J Med Sci 1998; 315:233-6.
11. Rockall TA, Logan RF, Devlin HB, Northfield FC. Risk assessment af- ter acute upper gastrointestinal hemorrage. Gut 1996; 38:316-21.
12. Coskun F, Topeli A, Sivri B. Patients admitted to the emergency room with upper gastrointestinal bleeding: factors influencing re - currence or death. Adv Ther 2005; 22:453-61.
13. Kopaniak MM, Issekutz AC, Movat HZ. Kinetics of acute inflam- mation induced by E coli in rabbits. Quantitation of blood flow, enhanced vascular permeability, hemorrhage, and leukocyte accu - mulation. Am J Pathol 1980; 98:485-98.
14. Kopaniak MM, Movat HZ. Kinetics of acute inflammation induced by Escherichia coli in rabbits. II. The effect of hyperimmunization, complement depletion, and depletion of leukocytes. Am J Pathol 1983; 110:13-29.
15. Gaylor MS, Chervenick PA, Boggs DR. Neutrophil kinetics after acute hemorrhage. Proc Soc Exp Bio Med 1969; 131:1332-6.
16. Crawford JP, Movat HZ, Minta JO, Opas M. Acute inflammation induced by immune complexes in the microcirculation. Exp Mol Pathol 1985; 42:175-93.
17. Kollef MH, OBrien JD, Zuckerman GR, Shannon W. BLEED: a clas- sification tool to predict outcomes in patients with acute upper and lower gastrointestinal hemorrhage. Crit Care Med 1997; 25:1125-32.
18. Almeida D, Lopes AA, Santos-Jesus R, et al. Comparative study of bacterial infection prevalence between cirrhotic patients with and without upper gastrointestinal bleeding. Braz J Infect Dis 2001; 5:136-42.
19. Sung JJY. The role of acid suppression in the management and prevention of gastrointestinal hemorrhage associated with gastro- duodenal ulcers. Gastroenterol Clin North Am 2003; 32:11-23.
20. Blatchford O, Murray WR, Blatchford M. A risk score to predict need for treatment for upper gastrointestinal hemorrhage. Lancet 2000; 356:1318-21.
21. Mino Fugarolas G, Jaramillo Esteban JL, Galvez Calderon C, et al. An analysis of a general prospective series of 3270 upper digestive hemorrhages. Rev Esp Enferm Dig 1992; 82:7-15.
22. Codina Cazador A, Codina Barreras A, Olivet Pujol F, et al. Descrip- tive analysis of 660 cases of upper digestive hemorrhage: relation of emergency endoscopy and mortality. Rev Esp Enferm Apar Dig 1989; 75:665-70.
23. Zimmerman J, Arnon R, Liqumski M, et al. Acute upper gastrointes- tinal bleeding in Jerusalem 1988-91: causes, characteristics and re - lation to nonsteroidal antiinflammatory drugs. Isr J Med Sci 1993; 29:292-7.
24. Ndjitoyap Ndam EC, Koki Ndombo PO, Fouda OA, et al. Upper digestive system hemorrhages in Cameroon (apropos of 172 cases examined via endoscopy). Med Trop (Mars) 1990; 50:181-4.
25. Thomopoulos KC, Katsakoulis EC, Margaritis VG, et al. Seasonality in the prevalence of acute upper gastrointestinal bleeding. J Clin Gastroenterol 1997; 25:576-9.
26. Bendanhan J, Gilboa S, Paran H, et al. Seasonal pattern in the inci - dence of bleeding caused by peptic ulcer in Israel. Am J Gastroen - terol 1992; 87:733-5.
27. Kashyap R, Mahajan S, Sharma B, et al. A clinical profile of acute upper gastrointestinal bleeding at moderate altitude. Journal of Indian Academy of Clinical Medicine (JIACM) 2005; 6:224-8.
28. Sezgin O, Altıntaş E, Tombak A. Effects of seasonal variations on acute upper gastrointestinal bleeding and etiology, Turk J Gastro - enterol 2007; 18:172-6.
29. Nur N, Yılmaz A, Yıldız G. GİS kanamalı hastaların özellikleri endos- kopik ve biyopsi sonuçlarının değerlendirilmesi, C.Ü. Tıp Fakültesi Dergisi 2007; 29:42-6.
30. Bayır A, Okumuş M, Köstekçi ŞK, Şahin TK. Üst GİS kanama risk faktörlerinin prognoz üzerine etkisi Genel Tıp Dergisi 2003; 13:157- 61.
31. Paspatis GA, Matrella E, Kapsoritakis A, et al. An epidemiological study of acute upper gastrointestinal bleeding in Crete, Greece. Eur J Gastroenterol Hepatol 2000; 12:1215-20.
32. Thomopoulos KC, Vagenas KA, Vagianos CE, et al. Changes in ae - tiology and clinical outcome of upper gastointestinal bleeding dur- ing the last 15 years. Eur J Gastroenterol Hepatol 2004; 16:177-82.
33. Sarı O, Tanoğlu A, İnal V, et al. GATA Acil Dahiliye Kliniğinde üst gastrointestinal sistem kanaması nedeniyle 1998-2005 yılları arasında takip edilen hastaların sosyodemografik özelliklerinin ince - lenmesi. Gülhane Tıp Dergisi 2007; 49: 226-31.
34. Chung L, Chakravarty EF, Kearns P, et al. Bleeding complications in patients on celecoxib and warfarin. J Clin Pharm Ther 2005; 30:471-7.
35. Johnsen SP, Sørensen HT, Mellemkjoer L, et al. Hospitalisation for upper gastrointestinal bleeding associated with use of oral antico - agulants. Thromb Haemost 2001; 86:563-8.
36. Younossi ZM, Strum WB, Schatz RA, et al. Effect of combined anti - coagulation and low-dose aspirin treatment on upper gastrointesti - nal bleeding. Dig Dis Sci 1997; 42:79-82.
37. Theocharis GJ, Thomopoulos KC, George Sakellaropoulos, et al. Changing trends in the epidemiology and clinical outcome of acute upper gastrointestinal bleeding in a defined geographical area in Greece. J Clin Gastroenterol 2008; 42:128-33.