Factores asociados a mal pronóstico en pacientes con sangrado digestivo bajo en un hospital público / Poor outcome factors associated to patients with lower digestive bleeding in a public hospital

Introducción: El sangrado digestivo bajo (SDB) es una entidad cuyas tasas de complicaciones y mortalidad se han incrementado en las últimas décadas. Si bien se han identificado algunos factores relacionados a mal pronóstico, aún quedan variables por evaluar. Objetivo: Identificar factores de mal pronóstico en pacientes que presentaron SDB en el Hospital Nacional Edgardo Rebagliati Martins de Lima, Perú. Materiales y métodos: Se realizó un estudio observacional analítico de tipo cohorte retrospectivo. Se realizó un censo de todos los pacientes que presentaron SDB agudo entre enero 2010 y diciembre 2013. Las variables principales a evaluar fueron frecuencia cardiaca ≥100/min, presión arterial sistólica <100 mmHg y hematocrito bajo (≤35%) al ingreso. Se definió mal pronóstico como cualquiera de los siguientes criterios: muerte durante la hospitalización, sangrado que requiera transfusión de ≥4 unidades de sangre, reingreso dentro del primer mes, o necesidad de cirugía de hemostasia. Resultados: Se incluyó un total de 341 pacientes con SDB, de los cuales el 27% tuvo mal pronóstico y 2% fallecieron. Se encontró como variables asociadas a mal pronóstico: frecuencia cardiaca ≥100/min al ingreso (RR: 1,75, IC 95% 1,23-2,50), presión arterial sistólica <100 mmHg al ingreso (RR: 2,18, IC 95% 1,49-3,19), hematocrito ≤35% al ingreso (RR: 1,98, IC 95% 1,23-3,18) y sangrado de origen no determinado (RR: 2,74, IC 95% 1,73-4,36). Conclusiones: Frecuencia cardiaca elevada al ingreso, hipotensión sistólica al ingreso, hematocrito bajo al ingreso y presentar un sangrado en el cual no se encuentra el punto de origen son factores que incrementan el riesgo de presentar mal pronóstico, por lo que se recomienda un monitoreo más estricto en estos pacientes

Background: Lower gastrointestinal bleeding (LGIB) is an event that has shown an increase in complications and mortality rates in the last decades. Although some factors associated with poor outcome have been identified, there are several yet to be evaluated. Objective: To identify risk factors for poor outcome in patients with LGIB in the Hospital Edgardo Rebagliati Martins of Lima, Peru. Material and methods: A prospective analytic observational cohort study was made, and a census was conducted with all patients with acute LGIB between January 2010 and December 2013. The main variables were heart rate ≥100/min, systolic blood pressure <100 mmHg and low hematocrit (≤35%) at admission. Poor outcome was defined as any of the following: death during hospital stay, bleeding requiring transfusion of ≥4 blood packs, readmission within one month of hospital discharge, or the need for hemostatic surgery. Results: A total of 341 patients with LGIB were included, of which 27% developed poor outcome and 2% died. Variables found to be statistically related to poor outcome were: heart rate ≥ 100/min at admission (RR: 1.75, IC 95% 1.23-2.50), systolic blood pressure <100 mmHg at admission (RR: 2.18, IC 95% 1.49-3.19), hematocrit ≤35% at admission (RR: 1.98, IC 95% 1.23-3.18) and LGIB of unknown origin (RR: 2.74, IC 95% 1.73-4.36). Conclusions: Elevated heart rate at admission, systolic hypotension at admission, low hematocrit at admission and having a LGIB of unknown origin are factors that increase the risk of developing poor outcome, and these patients should be monitored closely due to their higher risk of complications

[Poor outcome factors associated to patients with lower digestive bleeding in a public hospital]. / Factores asociados a mal pronóstico en pacientes con sangrado digestivo bajo en un hospital público.

BACKGROUND: Lower gastrointestinal bleeding (LGIB) is an event that has shown an increase in complications and mortality rates in the last decades. Although some factors associated with poor outcome have been identified, there are several yet to be evaluated. OBJECTIVE: To identify risk factors for poor outcome in patients with LGIB in the Hospital Edgardo Rebagliati Martins of Lima, Peru. MATERIAL AND METHODS: A prospective analytic observational cohort study was made, and a census was conducted with all patients with acute LGIB between January 2010 and December 2013. The main variables were heart rate ≥100/min, systolic blood pressure <100 mmHg and low hematocrit (≤35%) at admission. Poor outcome was defined as any of the following: death during hospital stay, bleeding requiring transfusion of ≥4 blood packs, readmission within one month of hospital discharge, or the need for hemostatic surgery. RESULTS: A total of 341 patients with LGIB were included, of which 27% developed poor outcome and 2% died. Variables found to be statistically related to poor outcome were: heart rate ≥ 100/min at admission (RR: 1.75, IC 95% 1.23- 2.50), systolic blood pressure <100 mmHg at admission (RR: 2.18, IC 95% 1.49-3.19), hematocrit ≤35% at admission (RR: 1.98, IC 95% 1.23-3.18) and LGIB of unknown origin (RR: 2.74, IC 95% 1.73-4.36). CONCLUSIONS: Elevated heart rate at admission, systolic hypotension at admission, low hematocrit at admission and having a LGIB of unknown origin are factors that increase the risk of developing poor outcome, and these patients should be monitored closely due to their higher risk of complications.

Lesiones vasculares del tracto gastrointestinal altoen el Hospital Nacional Daniel A. Carrión (2007-2008) / Vascular lesions of the upper gastrointestinal tract in the National Hospital Daniel A. Carrión (2007-2008)

OBJETIVO: presentar la experiencia en lesiones vasculares del tracto digestivo superior en los años 2007-2008 en el Hospital Daniel Alcides Carrion. METODOLOGíA: Estudio descriptivo transversal. Se revisaron todas las endoscopias realizadas en el periodo señalado. Se consignaron las lesiones vasculares encontradas. Se utilizo la Clasificación de la OMED para lesiones vasculares. RESULTADOS: Se revisaron 1,979 exámenes. Se encontraron 26 lesiones vasculares (Prevalencia=13.13/1,000 endoscopias). La localización mas frecuente (65,4 por ciento) en estomago. El tipo de lesión más común fue la angiectasia vascular (57,7 por ciento). CONCLUSIóN: Las lesiones vasculares del tracto digestivo superior son poco frecuentes, son mas comunes en estomago y las angiectasias vasculares son las mas frecuentemente reportadas.

To display the experience of vascular lesions in the upper digestive tract in 2007-2008 at Daniel Alcides Carrión Hospital. METHODOLOGY: Transverse study. All endoscopies performed in the indicated period were reviewed. Vascular lesions found were record. The OMED classification for vascular lesions was used in this research. RESULTS: 1.979 examinations were reviewed. 26 vascular injuries were found (prevalence= 13.13/1000 endoscopies). The most frequent location was in stomach (65.4 per cent). The most common type of injury was vascular angiectasia(57.7 per cent). CONCLUSION: Vascular lesions in the upper digestive tract were rare; these lesions were more common in the stomach. Vascular angiectasias were the most frequently reported.

[Vascular lesions of the upper gastrointestinal tract in the national hospital Daniel A. Carrion (2007-2008)]. / Lesiones vasculares del tracto gastrointestinal alto en el Hospital Nacional Daniel Carrion 2007-2008.

UNLABELLED: To display the experience of vascular lesions in the upper digestive tract in 2007-2008 at Daniel Alcides Carrión Hospital. METHODOLOGY: Transverse study. All endoscopies performed in the indicated period were reviewed. Vascular lesions found were record. The OMED classification for vascular lesions was used in this research. RESULTS: 1.979 examinations were reviewed. 26 vascular injuries were found (prevalence = 13.13/1000 endoscopies). The most frequent location was in stomach (65.4%). The most common type of injury was vascular angiectasia(57.7%). CONCLUSION: Vascular lesions in the upper digestive tract were rare; these lesions were more common in the stomach. Vascular angiectasias were the most frequently reported.