Upper Gastrointestinal Bleeding at The National University Hospital of Iceland 2019-2023

Abstract

Inngangur: Efri meltingarvegsblæðingar (EMVB) eru algeng orsök komu á bráðamóttöku og geta leitt til dauða.Markmið: Athuga nýgengi bráðra EMVB sem leiða til komu á bráðamóttöku og horfur sjúklinganna.Efni og aðferðir: Afturskyggn þýðisbundin rannsókn sem náði til þeirra sem komu á bráðamóttöku Landspítalans með grun um EMVB 2019-2023. Gagna var aflað um einkenni, speglunarniðurstöður, blóðgjafir, aðrar sjúkdómsgreiningar og lyfjanotkun. Cox og Kaplan-Meier voru notuð til að reikna lifun og kí-kvaðrat próf og ANOVA til að ákvarða mun milli hópa.Niðurstöður: Meðalnýgengi EMVB var 66,4/100.000 á ári á 5-ára tímabilinu. Alls voru 886 komur á bráðamóttöku með grun um EMVB eftir fyrstu uppvinnslu, af þeim voru 87,2% (n=773) með lokagreiningu EMVB. Af einstaklingum sem voru grunaðir um EMVB (n=886) voru 54,1% (n=479) 60 ára eða eldri og 63,1% (n=559) karlar. Af þeim sem grunaðir voru um EMVB voru 60,2% (n=533) lagðir inn og af þeim 12,4% (n=66) á gjörgæslu. Speglun var framkvæmd á 77,5% (n=687) þeirra sem komu, þar af var inngrip framkvæmt hjá 28,7% (n=197). Þrjátíu daga dánartíðni af öllum orsökum var 3,1%. Þegar COVID-19 barst til Íslands árið 2020 voru færri komur á bráðamóttöku með grun um EMVB en hin árin. Ekki var marktækur munur á útkomum þegar bornir voru saman mars og apríl 2019 við sömu mánuði 2020.Ályktun: Nýgengi EMVB 2019-2023 var sambærilegt við nýgengi á heimsvísu. Þrjátíu daga dánartíðni var lág miðað við erlendar rannsóknir.

Introduction: Upper gastrointestinal bleeding (UGIB) is a common cause of emergency department visit and can lead to death.Aims: Estimate the incidence of acute UGIB that leads to presentation at the emergency department and evaluate prognosis of patients.Methods: A retrospective population-based study on emergency department visits with suspected UGIB in 2019-2023. Data were collected on symptoms, endoscopy results, blood transfusions, comorbidities, and drugs. Cox analysis and Kaplan-Meier were performed to calculate survival and Chi-squared tests and ANOVA used to determine differences between groups.Results: The mean incidence of UGIB cases was 66.4/100,000 per year over the 5-year period. There were 886 emergency department visits with suspected UGIB after first evaluation, of whom 87.2% (n=773) had a final diagnosis of UGIB. Of those suspected to have UGIB (n=886), 54.1% (n=479) were 60 years or older and 63.1% (n=559) were male. Of those suspected to have UGIB, 60.2% (n=533) were admitted, of whom 12.4% (n=66) were admitted to the intensive care unit. Endoscopy was performed on 77.5% (n=687) and during endoscopy, 28.7% (n=197) needed intervention. The thirty-day all-cause mortality rate was 3.1%. In 2020, the year COVID-19 reached Iceland, fewer visits with suspected UGIB occurred compared to other years. No significant difference in outcomes was observed between March and April 2019 and the same months in 2020.Conclusion: UGIB incidence in Iceland in 2019-2023 was comparable to worldwide incidence. The thirty-day mortality was low compared to international studies.