P1320 - GI Bleeding, Risk Factors and Predictors of Endoscopic Evaluation and Severe Complicated Course

Presenting Author(s)

• 

  Saif Bella, MD

  Chief Resident
  UHS Wilson Hospital
  Johnson City, New York

Saif Bella, MD¹, Judie Hoilat², Md S. Alom, MD³, Atif Saleem, MD¹, Amine Hila, MD¹

¹United Health Services Wilson Hospital, Johnson City, NY; ²College of Medicine, Alfaisal University, Vestal, NY; ³United Health Services, Johnson City, NY

Introduction: Acute gastrointestinal (GI) bleeding is a common worldwide clinical problem and continues to be associated with significant morbidity, hospital admission, and mortality. Overall, for patients hospitalized for GI bleeding, 40% occurred in the UGI tract, 25% in the LGI tract and 35% in an undefined location (1). Clinical presentation and outcomes vary. Bleeding from the GI tract is usually mild, self-limited, and the majority heal spontaneously. However, massive hemorrhage can happen. We aim to identify risk factors that predict the need for endoscopy or a complicated hospital course.

Methods: This is a retrospective study. We reviewed adult patients who were admitted with GI bleeding diagnosis from 10/2017-10/2018. We looked for risks and predictors of primary and secondary outcomes.  The primary outcome was defined as the need for endoscopic evaluation (EGD or colonoscopy) within 14 days of admission. Secondary outcomes: 30-day hospital readmission and complicated course. A complicated course was defined with any of the following: ICU admission; Blood transfusion; increase the length of stay (7 days or more) and need for surgical intervention or death.

Results: Preliminary analysis was performed. A total of 148 patients were reviewed with a mean age of 70 years old. 56% of patients were females.  Hemoglobin < 8g/dl, melena and bright red blood per rectum were significantly associated with an increasing need for endoscopic evaluation (table). No significant association between patient age, gender, Obesity, and abnormal systemic inflammatory response indicators and the need for endoscopic evaluation. History of CHF, history of blood thinner use (Aspirin, Plavix, Ticagrelor, Warfarin or NOACs), presentation of exertional dyspnea, weakness, hemoglobin < 8g/dl, PT >15 sec, WBC >12K, Albumin < 3 g/dl, SBP< 90 mmHg and CRP >1 mg/L were significantly associated with an increase in the length of stay and complicated course (Figure).

Discussion: A comprehensive triage is important in evaluating patients presenting with GI bleeding. Predictors of poor outcome in such patients can be extracted from history, physical examination, vital signs, and initial lab workup. This may help to give priority to high-risk patients and planning for safe discharge and follow up.   

Reference:

- Laine L, Yang H, Chang S-C, Datto C. Trends for incidence of hospitalization and death due to GI complications in the United States from 2001 to 2009. Am J Gastroenterol. 2012; 107: 1190-95.

Citation: Saif Bella, MD; Judie Hoilat; Md S. Alom, MD; Atif Saleem, MD; Amine Hila, MD. P1320 - GI BLEEDING, RISK FACTORS AND PREDICTORS OF ENDOSCOPIC EVALUATION AND SEVERE COMPLICATED COURSE. Program No. P1320. ACG 2019 Annual Scientific Meeting Abstracts. San Antonio, Texas: American College of Gastroenterology.