Timing of endoscopy in patients with elevated lactate levels and acute upper gastrointestinal bleeding; a retrospective comparative study

Abstract

Background/Aims

While current guidelines recommend performing endoscopy within 24 h in case of acute upper gastrointestinal bleeding (AUGIB), the precise timing remains an issue of debate. Lactate is an established parameter for risk stratification in a variety of medical emergencies. This study evaluated the predictive ability of elevated lactate levels in identifying patients with UGIB, who may benefit from emergent endoscopy.

Methods

We retrospectively analyzed all patients with elevated lactate levels, who presented to our emergency department between 01 January 2015 and 31 December 2019 due to suspected AUGIB.

Results

Of 134 included cases, 81.3% had an Charlson comorbidity index of ≥3 and 50.4% presented with shock. Fifteen (11.2%) patients died and mortality rates rose with increasing lactate levels. Emergent endoscopy within 6 h (EE) and non-EE were performed in 64 (47.8%) and 70 (52.2%) patients, respectively. Patients who underwent EE had lower systolic blood pressure (107.6 mmHg vs. 123.2 mmHg; p = 0.001) and received blood transfusions more frequently (79.7% vs 64.3%; p = 0.048), but interestingly need for endoscopic intervention (26.6% vs 20.0%; p = 0.37), rebleeding (17.2% vs. 15.7%; p = 0.82) and mortality (9.4% vs. 11.4%; p = 0.7) did not differ significantly.

Conclusion

In conclusion, our findings support the recommendations of current guidelines to perform non-EE after sufficient resuscitation and management of comorbid illnesses.

Keywords:

• Gastrointestinal bleeding
• lactate
• risk assessment
• endoscopy

Acknowledgments

None

Ethics approval

This study was performed in line with the principles of the Declaration of Helsinki.

In accordance with the German law (paragraph 15, sentence 1, North Rhine Medical Association’s professional code of conduct from November 14, 1998 as amended on November 19, 2011, and paragraph 6, sentence 1, Health Data Protection Act of North Rhine-Westphalia), approval by a local Ethics Committee and written informed consent from the participants were not required because of the strictly retrospective design of our study.

Author contributions

G.A. and M.B. conceived of the presented idea and designed the study. G.A., D.G. and J.G. retrieved data. G.A. and M.B. performed the analytic calculations. S-H.C., P.K. and T.G. helped supervise the project. G.A., D.G., J.G., P.K., M.B., T.G., and S-H.C. contributed to the interpretation of the results. G.A. and M.B. took the lead in writing the manuscript. All authors provided critical feedback and helped shape the research, analysis, and manuscript.

Disclosure statement

Martin Bürger obtained consulting fees from Janssen and travel support from Pfizer. All other authors declare that they have no conflict of interests regarding this manuscript.

Additional information

Funding

None.