RESUMO
BACKGROUND: Massive gastrointestinal bleeding is a life-threatening condition without a well-established definition. We aimed to analyze the characteristics, risk factors, and outcomes of patients with massive upper gastrointestinal bleeding. METHODS: Our study analyzed a prospective registry of patients admitted between 2013 and 2020 with variceal and non-variceal causes. Severe bleeding was defined as ongoing bleeding requiring transfusion of more than 2 units of packed red blood cells within 24 hours, accompanied by signs of shock. The main outcomes were 30-day and 6-month mortality, rebleeding within 7 days, persistent bleeding, and severe complications during admission. RESULTS: Out of 1213 patients, 171 had massive gastrointestinal bleeding, with a predominance of males. The massive bleeding group had higher rates of chronic kidney disease, cirrhosis, in-patient status, disseminated malignancy, alcoholism, and ASA score ≥3. All major outcomes, including 30-day mortality, 6-month mortality, rebleeding, persistent bleeding, and severe complications, were more common in the massive bleeding group. Multivariate logistic regression identified inpatient status, systemic diseases, malignancy, active bleeding in endoscopy, and severe complications as risk factors for massive bleeding and mortality. CONCLUSIONS: Inpatient status and comorbidities, especially systemic diseases, and malignancies, were associated with a higher risk of massive bleeding. Mortality was linked to chronic kidney disease, cirrhosis, severe comorbidities, and alcohol consumption. We observed increased 6-months mortality, probably related to a health status in which gastrointestinal bleeding heralded poor outcomes, some of them potentially preventable. Innovative healthcare interventions, such as Emergency Department-based intermediate care areas or Intensive Care Units, and multidisciplinary follow-up, could potentially improve survival.
Assuntos
Varizes Esofágicas e Gástricas , Neoplasias , Insuficiência Renal Crônica , Masculino , Humanos , Feminino , Hemorragia Gastrointestinal/epidemiologia , Hemorragia Gastrointestinal/etiologia , Hemorragia Gastrointestinal/diagnóstico , Fatores de Risco , Cirrose Hepática/complicações , Endoscopia Gastrointestinal , Insuficiência Renal Crônica/complicaçõesRESUMO
BACKGROUND: By high resolution consultation (HRC) we mean an ambulatory process of assistance fulfilled in a single day, by which treatment and diagnosis are established and recorded. OBJECTIVE: To assess to which extent patients with digestive conditions may benefit from a single consultation system. MATERIAL: A descriptive study of 179 first visit events, randomly selected as high-resolution consultations in gastroenterology. We discuss the percentage of patients who benefited from HRC and the complementary tests performed. RESULTS: Most common conditions included dyspepsia (16%), a family history of colon cancer (16%) and gastroesophageal reflux disease (GERD) (16%). Seventy-nine (44%) of all first visits became HRCs and 80 (45%) required a diagnostic test (100% abdominal ultrasound) that was reviewed on the same day. Performing a test on the same day significantly increased the percentage of HRCs (57% vs. 34%, p < 0.002). GERD, dyspepsia, cholelithiasis and chronic liver disease were the subjects most commonly leading to HRC. CONCLUSIONS: Gastroenterology consultations may largely benefit from an HRC system with only organizational changes and no additional costs.