PhD Scientific Days 2022

Clinical Medicine III.

One in Four Patients with Gastrointestinal Bleeding develops Shock or Haemodynamic Instability: A Systematic Review and Meta-analysis

Text of the abstract

INTRODUCTION
Gastrointestinal bleeding (GIB) is one of the most common medical emergencies with an estimated mortality rate between 2-15%. Data from several studies showed that haemodynamic instability was significantly associated with mortality in patients with GIB. We aimed to assess the proportion of haemodynamic instability and/or shock among patients with gastrointestinal bleeding.

AIMS
We aimed to quantify the proportion of patients affected by haemodynamic instability or shock in the published data and specify it according to the type of bleeding source.

METHODS
The protocol was registered on PROSPERO in advance (CRD42021283258). A systematic search was performed in three main databases (Pubmed, Embase, CENTRAL) on the 14th of October, 2021, for studies reporting the number of patients with shock and/or haemodynamic instability in the GIB population. No restrictions were applied. Pooled proportions with 95% confidence intervals (CIs) were calculated with the random-effects model. Heterogeneity was tested with the I² and the Cochrane Q tests. The Joanna Briggs Institute Critical Appraisal checklist for use in JBI Systematic Reviews was used for risk of bias assessment.

RESULTS
With our systematic search we identified 11,589 articles, out of which 220 studies were eligible for data extraction, resulting in more than 6 million patient data. The overall proportion of shock and hemodynamic instability in GIB patients was 0.25 (CI: 0.17–0.36), in non-variceal upper GIB 0.20 (CI: 0.13–0.28) while in variceal bleeders it was 0.25 (CI: 0.19–0.33). The highest proportion of shock and haemodynamic instability in the upper GIB patients was found among the peptic ulcer bleeders, 0.27 (CI: 0.22–0.32). In the lower GIB group the overall proportion was 0.27 (CI: 0.14–0.47) while in the colonic diverticular bleeding (CDB) group it was 0.12 (CI: 0.06–0.22). Heterogeneity was high in almost all analyses.

CONCLUSION
To conclude, haemodynamic instability and shock are common complications of GIB. A high majority of patients; 1 in 5 with non-variceal GIB, 1 in 4 with variceal GIB and 1 in 10 with CDB will develop shock or hemodynamic instability on admission or during hospital stay.

Funding
None to declare.