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- Title
At admission hemodynamic instability is associated with increased mortality and rebleeding rate in acute gastrointestinal bleeding: a systematic review and meta-analysis.
- Authors
Tari, Edina; Frim, Levente; Stolcz, Tünde; Teutsch, Brigitta; Veres, Dániel Sándor; Hegyi, Péter; Erőss, Bálint
- Abstract
Background: Acute gastrointestinal bleeding (GIB) is a life-threatening event. Around 20–30% of patients with GIB will develop hemodynamic instability (HI). Objectives: We aimed to quantify HI as a risk factor for the development of relevant end points in acute GIB. Design: A systematic search was conducted in three medical databases in October 2021. Data sources and methods: Studies of GIB patients detailing HI as a risk factor for the investigated outcomes were selected. For the overall results, pooled odds ratios (ORs) with 95% confidence intervals (CIs) were calculated based on a random-effects model. Subgroups were formed based on the source of bleeding. The Quality of Prognostic Studies tool was used to assess the risk of bias. Results: A total of 62 studies were eligible, and 39 were included in the quantitative synthesis. HI was found to be a risk factor for both in-hospital (OR: 5.48; CI: 3.99–7.52) and 30-day mortality (OR: 3.99; CI: 3.08–5.17) in upper GIB (UGIB). HI was also associated with higher in-hospital (OR: 3.68; CI: 2.24–6.05) and 30-day rebleeding rates (OR: 4.12; 1.83–9.31) among patients with UGIB. The need for surgery was also more frequent in hemodynamically compromised UGIB patients (OR: 3.65; CI: 2.84–4.68). In the case of in-hospital mortality, the risk of bias was high for 1 (4%), medium for 13 (48%), and low for 13 (48%) of the 27 included studies. Conclusion: Hemodynamically compromised patients have increased odds of all relevant untoward end points in GIB. Therefore, to improve the outcomes, adequate emergency care is crucial in HI. Registration: PROSPERO registration number: CRD42021285727.
- Subjects
GASTROINTESTINAL hemorrhage; ENDOSCOPIC hemostasis; HEMODYNAMICS; DEATH rate; MEDICAL databases; HOSPITAL mortality; PROGNOSTIC tests
- Publication
Therapeutic Advances in Gastroenterology, 2023, p1
- ISSN
1756-283X
- Publication type
Article
- DOI
10.1177/17562848231190970