Modification of Glasgow-Blatchford scoring with lactate in predicting the mortality of patients with upper gastrointestinal bleeding in emergency department
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Background: Gastrointestinal bleeding is a commonly seen multidisciplinary clinical condition in emergency departments which has high treatment cost and mortality in company with hospital admission. Risk evaluation before endoscopy is based on clinical and laboratory findings at patient's emergency visit. Objective: The purpose of this study is to investigate the efficacy of "Glasgow-Blatchford scale + lactate levels" to predict the mortality of patients detected with gastrointestinal bleeding in the emergency department. Methods: A total of 107 patients with preliminary diagnosis of upper gastrointestinal bleeding included in the study after approval of the ethics committee were prospectively evaluated. Glasgow-Blatchford scale scores were calculated and venous blood lactate levels were assessed. Need for blood transfusion in the follow-up, the amount of transfusion, and mortality in the next 6 months were evaluated. Results: A statistically significant difference was found in mortality rates between the lactate and Glasgow-Blatchford scale cohorts in our study (p = 0.001 and p < 0.01, respectively). The mortality rate was significantly higher in the lactate(+) GBS(+) cases compared to the lactate(-) GBS(+), lactate(+) GBS(-), and lactate(-) GBS(-) cases compared to the bilateral comparisons (p = 0.004, p = 0.001, p = 0.001, and p < 0.01, respectively). There was a statistically significant relationship between the rate of erythrocyte suspension replacement in the cases according to Glasgow-Blatchford scale levels (p = 0.001 and p < 0.01, respectively). The incidence of erythrocyte suspension replacement was 7.393 times greater in patients with Glasgow-Blatchford scale score of 12 and above. Conclusion: Glasgow-Blatchford scale is highly sensitive to the determination of mortality risk and the need for blood transfusion in upper gastrointestinal bleeding. Glasgow-Blatchford scale with lactate evaluation is more sensitive and more significant than Glasgow-Blatchford scale alone. This significance provides us to establish "modified Glasgow-Blatchford scale." In the future, studies which will use Glasgow-Blatchford scale supported by lactate could be increased and the results should be supported more.