FACTORES PRONÓSTICOS DE SEVERIDAD EN LA HEMORRAGIA DIGESTIVA ALTA

Abstract

Aims: Identify prognostic factors for severity in patients with upper digestive hemorrhage. Methods: A transverse study was conducted in emergency department of the HGR1 of the IMSS Querétaro in the period from July to November - 2010. Prognostic factors recorded included the following: sex, age, presence of melaena, hematemesis or hematoquezia, clinical manifestations of liver failure, hypotension systolic, tachycardia, hematocrit below of 30 %, precedent of varices esophageal, use of anti-inflammatory agents, chronic alcoholism, smoking and co-morbidities. Severity were defined as needed multitransfusion, placement tube gastric balloon, hospitalization, endoscopy or present result endoscopic of hemorrhagic risk, death and recurrence of bleeding with readmission in the emergency department. A descriptive statistics was used by means of x2. Results: 79 patients were studied, 39 % required endoscopy. Compared to patients who required multitransfusion against not multitransfusion revealed that had significance in the male gender, hematemesis of fresh blood, clinical manifestations of liver failure, hematocrit below of 30, alcoholism and hepatic cirrhosis. We compare to patients underwent placement tube gastric balloon against those who did not need it, had accepted significance level in the hematemesis of fresh blood and clinical manifestations of liver failure. Comparing those who needed hospitalization against those who were not hospitalized, the hypotension and the alcoholism were significant. We compare the need of endoscopia against those who did not need it, there were significant in the male gender, the hypotension and the alcoholism. Comparing Dagradi III, IV and V result endoscopic of variceal esophageal against other results endoscopic there were significant in the clinical manifestations of liver failure, hematocrit below of 30 % and hepatic cirrhosis. Conclusions: The main variables that predict severity are the clinical manifestations of liver failure and alcoholism, in addition hepatic cirrhosis, male gender, hypotension and hematocrit below of 30 %, which can be detected from the first hour of evaluation in the emergency department.