Upper GI bleeding: Causes, morbidity and mortality in admitted patients at Tertiary Care Hospital of Karachi.

摘要

Objectives: Acute upper gastrointestinal bleed is one of the most commonemergencies. Despite advancement in the medical field, gastrointestinal bleeding still carriessignificant mortality and fiscal burden on healthcare system. At present, limited data is availableon the predictors of morbidity and mortality associated with acute upper gastrointestinalbleeding in our part of the country. Study Design: Descriptive analytical study. Setting:Medical wards of Civil Hospital Karachi. Period: From January 2018 to June 2018. Materialand Methods: 260 patients of 12 years and above with complaint of upper gastrointestinalbleeding. After hemodynamic stabilization, patients were referred to undergo esophago-gastroduodenoscopyat the endoscopy suite of the hospital. Their personal data and endoscopicfindings were recorded after obtaining a written consent. The patients were followed for 2weeks to document the factors leading to their morbidity and mortality. We used Rockall scoringsystem to identify risk of patient mortality. Data collected was analyzed using SPSS 22·0.Results: The survey included 260 patients having males (62·3%) more than females (37·7%)with age ranging from 12 to 85 years. Among all, variceal bleed was accounted in 186 (71·5%)patients while remaining 74 (28·4%) patients had non-variceal bleed; peptic ulcer disease beingthe most common etiology. The overall mortality rate of our study was 5·76%. Some factorsinfluencing mortality of the patients were age 60 years, comorbid, use of NSAIDS, rebleeding,deranged laboratory tests at the time of presentation- anemia (hemoglobin of 10 gdl), grade3 thrombocytopenia (platelet count of 50 cellsdl), serum creatinine 1·5 and serum INR of 1·6. Additionally, a direct proportion was seen in between Rockall scoring system and patientmortality with a significant p-value (0·000). Conclusion: In this study, variceal bleeding wasfound as the predominant lesion of upper gastro-intestinal bleeding followed by peptic ulcerdisease. Certain factors are found that are strongly related in deteriorating patient’s outcome.Along with it, Rockall score is also a good predictor of outcome of patients.