Skip to main content

The effectiveness of Glasgow-Blatchford Score in early risk assessment of hemodialysis patients

Abstract

In the emergency departments (ED), the incidence of admission is increasing gradually due to gastrointestinal system (GIS) complications of hemodialysis (HD) patients. With this increasing number of patients, there are many classification systems developed in early risk assessment before endoscopy. In this study, we aimed to evaluate the Glasgow-Blatchford Score’s (GBS) effectiveness in HD patients with suspected GIS hemorrhage in the ED.The files of 169 patients who received HD treatment were retrospectively reviewed. 64 patients who were examined and treated for reasons other than GIS hemorrhage in the ED were excluded, and the files of a total of 105 were analyzed retrospectively. The demographic characteristics and laboratory values of the patients were recorded from the patient files. When the patients were evaluated according to GBS parameters, a significant difference was found between the two groups in terms of pulse pressure, systolic blood pressure, hemoglobin value, melena, and accompanying comorbid diseases (p < 0.05). Of the 16 patients who presented to the ED due to syncope, 2 were in the GIS hemorrhage (+) group, and 14 patients were in the control group. In this study, we aimed to show that the increase in the number of admissions in the ED due to complications secondary to HD treatment and the accompanying serious changes in laboratory parameters may cause misleading results in patients with suspected GIS hemorrhage, and it is necessary to plan comprehensive and multi-center studies on new alternative scoring systems to GBS in specific patient groups such as HD patients.

This is a preview of subscription content, access via your institution.

References

  1. 1.

    Ismail N, Becker BN (1994) Treatment options and strategies in uremia: current trends and future directions. Semin Nephrol 14:292–299

    Google Scholar 

  2. 2.

    Zawada ET (1994) Indications for dialysis. In: Daugirdas JT, Ing TS (eds) Handbook of dialysis. Little Brown and Company, Boston, pp 3–9

    Google Scholar 

  3. 3.

    Süleymanlar G, Ateş K, Seyahi N (2018) National nephrology, dialysis and transplantation registry report of Turkey

  4. 4.

    Akdağ İ (2006) Acute complıcatıons of hemodıalysıs and treatment. Turkiye Klinikleri J Surg Med Sci 2(37):40–48

    Google Scholar 

  5. 5.

    Gangji AS, Sohal AS, Treleaven D, Crowther MA (2006) Bleeding in patients with renal insufficiency: a practical guide to clinical management. Thromb Res 118(3):423–428

    Article  CAS  Google Scholar 

  6. 6.

    Mohapatra A, Valson AT, Gopal B, Singh S, Nair SC, Viswabandya A et al (2018) Hemostatic abnormalities in severe renal failure: do they bark or bite? Indian J Nephrol 28(2):135–142

    PubMed  PubMed Central  CAS  Google Scholar 

  7. 7.

    Monteiro S, Gonçalves TC, Magalhães J, Cotter J (2016) Upper gastrointestinal bleeding risk scores: who, when, and why? World J Gastrointest Pathophysiol 7(1):86–96

    Article  Google Scholar 

  8. 8.

    Blatchford O, Murray WR, Blatchford M (2000) A risk score to predict need for treatment for upper gastrointestinal hemorrhage. Lancet 356:1318–1321

    Article  CAS  Google Scholar 

  9. 9.

    Von Elm E, Altman DG, Egger M et al (2007) The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. Ann Intern Med 147:573577. https://doi.org/10.1016/j.jclinepi.2007.11.00

    Article  Google Scholar 

  10. 10.

    Günsar F, Akarca US, Yönetçi N, Özütemiz Ö, Aydın A, Ersöz G (1997) Üst gastrointestinal sistem kanamalı yüz hastanın değerlendirilmesi. Türk J Gastroenterol 8:188–193

    Google Scholar 

  11. 11.

    Türedi S, Gündüz A, Yandı M (2010) An etiological and prognostic evaluation of patients with upper gastrointestinal bleeding from Karadeniz Technical University Department of Emergency Medicine. Turk J Emerg Med 10:20–25

    Google Scholar 

  12. 12.

    Shennak MM (1995) Etiology of upper gastrointestinal bleeding in Jordanian patients: a prospective study. Ann Saudi Med 15:54–59

    Article  CAS  Google Scholar 

  13. 13.

    Günşar F, Akarca US, Yönetçi N (1997) Üst gastrointestinal sistem kanamalı 502 hastanın değerlendirilmesi. Turk J Gastroenterol 8:188–193

    Google Scholar 

  14. 14.

    Barkun A, Bardou M, Marshall JK, Nonvariceal Upper GI Bleeding Consensus Conference Group (2003) Consensus recommendations for managing patients with nonvariceal upper gastrointestinal bleeding. Ann Intern Med 139:843–857

    Article  Google Scholar 

  15. 15.

    Cryer B, Kliewer D, Sie H, McAllister L, Feldman M (1999) Effects of cutaneous aspirin on the human stomach and duodenum. Proc Assoc Am Physicians 111(5):448–456

    Article  CAS  Google Scholar 

  16. 16.

    Yalçın MS, Kara B, Öztürk NA, Ölmez Ş, Taşdoğan BE, Taş A (2016) Üst Gastrointestinal Sistem Kanamalı Hastaların Epidemiyolojisi ve Endoskopik Bulguları. Dicle Med J 43:73–76

    Article  Google Scholar 

  17. 17.

    Baş B, Oymacı E, Dinç B (2015) Evaluation of results in patients with acute upper gis bleeding: a government hospital experience. J Clin Anal Med 6:362–365

    Google Scholar 

  18. 18.

    Farooq FT, Lee MH, Das A, Dixit R, Wong RC (2012) Clinical triage decision vs risk scores in predicting the need for endotherapy in upper gastrointestinal bleeding. Am J Emerg Med 30(1):129–134

    Article  Google Scholar 

  19. 19.

    Ali H, Lang E, Barkan A (2012) Emergency department risk stratification in upper gastrointestinal bleeding. CJEM 14(1):45–49

    Article  Google Scholar 

Download references

Funding

This research received no grant from any funding agency in the public, commercial, or not for profit sectors.

Author information

Affiliations

Authors

Corresponding author

Correspondence to Dilay Satılmış.

Ethics declarations

Conflict of interest

The authors declare that there is no conflict of interest.

Statements on human and animal rights

This article does not contain any studies with human participants or animals performed by any of the authors.

Informed consent

The ethics committee of our hospital waived written informed consent because of its retrospective nature and evaluation of only clinical data of the patients, involving no potential risk.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Satılmış, D., Yavuz, B.G., Güven, O. et al. The effectiveness of Glasgow-Blatchford Score in early risk assessment of hemodialysis patients. Intern Emerg Med (2021). https://doi.org/10.1007/s11739-021-02869-8

Download citation

Keywords

  • End-stage renal disease
  • Glasgow-Blatchford Score
  • Hemodialysis
  • Hemorrhage
  • Gastrointestinal system