Prevalence and risk factors for upper gastrointestinal bleeding secondary to post-ligation ulcers

Juan M Aldana-Ledesma; Grace A López-Cota; Miguel A Ibarra-Estrada; María F Rangel-Orozco; EC Mercado-Jáuregui Lydia; Monserrat Lazcano-Becerra; Alejandro Schmidt-Ramírez; Héctor J Rivera-Espíritu; Sergio Quintero-Luce; Paulo C Gómez-Castaños; José A Velarde-Ruiz Velasco

2018, Number 2

Rev Med MD 2018; 9.10 (2)

Prevalence and risk factors for upper gastrointestinal bleeding secondary to post-ligation ulcers

Aldana-Ledesma JM, López-Cota GA, Ibarra-Estrada MA, Rangel-Orozco MF, Mercado-Jáuregui LEC, Lazcano-Becerra M, Schmidt-Ramírez A, Rivera-Espíritu HJ, Quintero-Luce S, Gómez-Castaños PC, Velarde-Ruiz VJA

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ABSTRACT

Introduction. Variceal hemorrhage is the second most common cause of upper gastrointestinal bleeding (UGIB). The most effective treatment for its management is through endoscopic ligation. In the process, the ligated varices ulcerate, which may trigger another hemorrhage event with increased morbidity and mortality. The objective of this work is to describe the frequency and risk factors associated with digestive hemorrhage secondary to post-ligation ulcers (PLU).
Material and Methods. This is an analytical and retrospective study, patients with UGIB hospitalized in the Gastroenterology service from August 2013 to May 2018 were included. Variables analyzed: age, gender, comorbidities, manifestations at admission, laboratorial characteristics, severity of liver disease, mortality. The numerical variables were compared between the groups with the Mann-Whitney U test due to their non-parametric distribution. And the categorical variables were compared with Fisher's exact test. A ROC curve was constructed with the platelet variable to find the best equilibrium point between sensitivity and specificity to predict PLU with the Youden index. The risks calculated as OR are reported
Results. 648 patients were hospitalized for UGIB, being 175 of variceal origin and of these 16 (9.1%) by PLU. The comorbidities, clinical and laboratory manifestations were similar between the subgroups with and without PLU. The MELD score showed no association with the presence of PLU, however, patients with Child-Turcotte-Pugh Hepatopathy (CTP) class C had an OR 2.9 (p = 0.04) to present PLU. With the platelet cut-off point calculated in the ROC curve (AUC 0.73, p = ‹0.0001), it was found that a level ‹123 103 cells/µl, is associated with an OR of 10.8 (p = 0.002) for hemorrhage of the UPL (Sensibility 87.5%, Specificity 62.5%), with a negative predictive value of 98%. It was also found that AKI is significantly associated with this complication (OR 6.0, p = 0.001).
Discussion. The reported prevalence 9.1% coincides with that reported worldwide (3.6-15%). We identified AKI, advanced chronic hepatopathy, CTP class C, and decreased platelets as independent risk factors for PLU hemorrhage. A platelet level greater than 123 103 cells/µl is a clear protective factor for hemorrhage.

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