Causes, management, and prognosis of severe gastrointestinal bleedings in critically ill patients with pancreatic cancer: A retrospective multicenter study.

IF 4 3区 医学 Q1 GASTROENTEROLOGY & HEPATOLOGY
B Picard, E Weiss, V Bonny, C Vigneron, A Goury, G Kemoun, O Caliez, M Rudler, R Rhaiem, V Rebours, J Mayaux, C Fron, F Pène, J B Bachet, A Demoule, M Decavèle
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引用次数: 0

Abstract

Background: Gastrointestinal (GI) bleeding is a leading cause of intensive care unit (ICU) admission in pancreatic cancer patients.

Aims: To analyze causes, ICU mortality and hemostatic treatment success rates of GI bleeding in pancreatic cancer patients requiring ICU admission.

Methods: Retrospective multicenter cohort study between 2009 and 2021. Patients with a recent pancreatic resection surgery were excluded.

Results: Ninety-five patients were included (62 % males, 67 years-old). Fifty-one percent presented hemorrhagic shock, 41 % required mechanical ventilation. Main GI bleeding causes were gastroduodenal tumor invasion (32 %), gastroesophageal varices (21 %) and arterial aneurysm (12 %). Arterial aneurysms were more frequent in patients with previous pancreatic resection (36 % vs 2 %, p < 0.001). Hemostatic procedures included gastroduodenal endoscopy in 81 % patients and arterial embolization in 28 % patients. ICU mortality was 19 %. Multivariate analysis identified four variables associated with mortality: performance status >2 (OR 9.34, p = 0.026), mechanical ventilation (OR 14.14, p = 0.003), treatment success (OR 0.09, p = 0.010), hemorrhagic shock (OR 11.24, p = 0.010). Treatment success was 46 % and was associated with aneurysmal bleeding (OR 29.89, p = 0.005), ongoing chemotherapy (OR 0.22, p = 0.016), and prothrombin time ratio (OR 1.05, p = 0.001).

Conclusion: In pancreatic cancer patients with severe GI bleeding, early identification of aneurysmal bleeding (particularly in case of previous resection surgery) and coagulopathy management may increase the treatment success and reduce mortality.

胰腺癌重症患者严重消化道出血的原因、处理和预后:一项多中心回顾性研究。
背景:胃肠道出血是胰腺癌患者入住重症监护病房(ICU)的主要原因:目的:分析需要入住重症监护室的胰腺癌患者消化道出血的原因、重症监护室死亡率和止血治疗成功率:方法:2009年至2021年间的回顾性多中心队列研究。方法:2009 年至 2021 年期间的回顾性多中心队列研究,排除近期接受过胰腺切除手术的患者:结果:共纳入 95 名患者(62% 为男性,67 岁)。51%的患者出现失血性休克,41%的患者需要机械通气。消化道出血的主要原因是胃十二指肠肿瘤侵犯(32%)、胃食管静脉曲张(21%)和动脉瘤(12%)。动脉瘤在曾接受胰腺切除术的患者中更为常见(36% 对 2%,P < 0.001)。81%的患者接受过胃十二指肠内窥镜检查,28%的患者接受过动脉栓塞治疗。重症监护室死亡率为 19%。多变量分析确定了与死亡率相关的四个变量:表现状态>2(OR 9.34,p = 0.026)、机械通气(OR 14.14,p = 0.003)、治疗成功(OR 0.09,p = 0.010)、失血性休克(OR 11.24,p = 0.010)。治疗成功率为46%,与动脉瘤出血(OR 29.89,P = 0.005)、正在进行的化疗(OR 0.22,P = 0.016)和凝血酶原时间比(OR 1.05,P = 0.001)有关:结论:对于严重消化道出血的胰腺癌患者,早期发现动脉瘤出血(尤其是既往接受过切除手术的患者)并进行凝血病管理可提高治疗成功率并降低死亡率。
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来源期刊
Digestive and Liver Disease
Digestive and Liver Disease 医学-胃肠肝病学
CiteScore
6.10
自引率
2.20%
发文量
632
审稿时长
19 days
期刊介绍: Digestive and Liver Disease is an international journal of Gastroenterology and Hepatology. It is the official journal of Italian Association for the Study of the Liver (AISF); Italian Association for the Study of the Pancreas (AISP); Italian Association for Digestive Endoscopy (SIED); Italian Association for Hospital Gastroenterologists and Digestive Endoscopists (AIGO); Italian Society of Gastroenterology (SIGE); Italian Society of Pediatric Gastroenterology and Hepatology (SIGENP) and Italian Group for the Study of Inflammatory Bowel Disease (IG-IBD). Digestive and Liver Disease publishes papers on basic and clinical research in the field of gastroenterology and hepatology. Contributions consist of: Original Papers Correspondence to the Editor Editorials, Reviews and Special Articles Progress Reports Image of the Month Congress Proceedings Symposia and Mini-symposia.
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