Utilidad de escalas pronósticas en hemorragia digestiva proximal secundaria a úlcera péptica

Introduction

Upper gastrointestinal bleeding (UGIB) is the most common gastrointestinal emergency, and a frequent cause of admission to the emergency services. It has a high mortality and morbidity, and is also one of the main indications for conducting an upper gastrointestinal endoscopy. Early risk stratification is made using prognostic scales that evaluate patients with high and low risk, and help make initial decisions, for the appropriate therapies that can save the lives of patients. The validated scales include Blatchford, Rockall, AIMS-65, and Forrest, are useful in predicting mortality, recurrence of the UGIB, cost, length of hospital stay, use of blood and endoscopic haemostasis.

Objective

To assess the usefulness of the Blatchford, Rockall, AIMS-65, and Forrest prognostic scales in patients with UGIB secondary to a peptic ulcer as predictors of mortality, recurrence of bleeding, hospital stay, use of blood, and endoscopic haemostasis.

Material and methods

The study included patients with a diagnosis of UGIB secondary to peptic ulcer admitted to the emergency department of the Juarez Hospital of Mexico during the period March 2013 to March 2015. The prognosis was estimated using the Rockall, Blatchford, AIMS-65, and Forrest scales.

Results

A total of 70 patients with UGIB secondary to peptic ulcer were included. Descriptive analysis of quantitative variables and analysis of variance using Fisher test were performed using Statistics Software 8. Using the Forrest classification, the endoscopic findings included, 1 a (4.28%), lb (12.85%), lla (10%), llb (14.2%), llc (8.57%), and III (50%) were observed in the endoscopic findings. Of the 40% (28) that received endoscopic therapy, there was re-bleeding in 3 (4.2%) patients during hospitalisation, and 1.42% died. The mean hospital stay was 3.74 days and a mean number of 1.11 packed red cells were transfused. Statistically significant relationships were observed in the Rockall scale to predict recurrence of UGIB (P=.019), in the Blatchford scale for UGIB recurrence (P=.063), mortality (P=.00004), need for transfusion (P=.0094), length of hospital stay (P=.0070), and in the Forrest scale as a predictor of a need for endoscopic treatment (P=.0000).

Conclusions

In our study Blatchford scale is the most useful for assessing recurrent bleeding, hospital stay, need for transfusion, and mortality. The Forrest scale is the only one that assesses the need for endoscopic therapy in patients with upper gastrointestinal bleeding secondary to peptic ulcer.