Causes, management, and prognosis of severe gastrointestinal bleedings in critically ill patients with pancreatic cancer: A retrospective multicenter study.

IF 4 3区 医学 Q1 GASTROENTEROLOGY & HEPATOLOGY Digestive and Liver Disease Pub Date : 2024-09-02 DOI:10.1016/j.dld.2024.08.041
B Picard, E Weiss, V Bonny, C Vigneron, A Goury, G Kemoun, O Caliez, M Rudler, R Rhaiem, V Rebours, J Mayaux, C Fron, F Pène, J B Bachet, A Demoule, M Decavèle
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Abstract

Background: Gastrointestinal (GI) bleeding is a leading cause of intensive care unit (ICU) admission in pancreatic cancer patients.

Aims: To analyze causes, ICU mortality and hemostatic treatment success rates of GI bleeding in pancreatic cancer patients requiring ICU admission.

Methods: Retrospective multicenter cohort study between 2009 and 2021. Patients with a recent pancreatic resection surgery were excluded.

Results: Ninety-five patients were included (62 % males, 67 years-old). Fifty-one percent presented hemorrhagic shock, 41 % required mechanical ventilation. Main GI bleeding causes were gastroduodenal tumor invasion (32 %), gastroesophageal varices (21 %) and arterial aneurysm (12 %). Arterial aneurysms were more frequent in patients with previous pancreatic resection (36 % vs 2 %, p < 0.001). Hemostatic procedures included gastroduodenal endoscopy in 81 % patients and arterial embolization in 28 % patients. ICU mortality was 19 %. Multivariate analysis identified four variables associated with mortality: performance status >2 (OR 9.34, p = 0.026), mechanical ventilation (OR 14.14, p = 0.003), treatment success (OR 0.09, p = 0.010), hemorrhagic shock (OR 11.24, p = 0.010). Treatment success was 46 % and was associated with aneurysmal bleeding (OR 29.89, p = 0.005), ongoing chemotherapy (OR 0.22, p = 0.016), and prothrombin time ratio (OR 1.05, p = 0.001).

Conclusion: In pancreatic cancer patients with severe GI bleeding, early identification of aneurysmal bleeding (particularly in case of previous resection surgery) and coagulopathy management may increase the treatment success and reduce mortality.

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胰腺癌重症患者严重消化道出血的原因、处理和预后:一项多中心回顾性研究。
背景:胃肠道出血是胰腺癌患者入住重症监护病房(ICU)的主要原因:目的:分析需要入住重症监护室的胰腺癌患者消化道出血的原因、重症监护室死亡率和止血治疗成功率:方法:2009年至2021年间的回顾性多中心队列研究。方法:2009 年至 2021 年期间的回顾性多中心队列研究,排除近期接受过胰腺切除手术的患者:结果:共纳入 95 名患者(62% 为男性,67 岁)。51%的患者出现失血性休克,41%的患者需要机械通气。消化道出血的主要原因是胃十二指肠肿瘤侵犯(32%)、胃食管静脉曲张(21%)和动脉瘤(12%)。动脉瘤在曾接受胰腺切除术的患者中更为常见(36% 对 2%,P < 0.001)。81%的患者接受过胃十二指肠内窥镜检查,28%的患者接受过动脉栓塞治疗。重症监护室死亡率为 19%。多变量分析确定了与死亡率相关的四个变量:表现状态>2(OR 9.34,p = 0.026)、机械通气(OR 14.14,p = 0.003)、治疗成功(OR 0.09,p = 0.010)、失血性休克(OR 11.24,p = 0.010)。治疗成功率为46%,与动脉瘤出血(OR 29.89,P = 0.005)、正在进行的化疗(OR 0.22,P = 0.016)和凝血酶原时间比(OR 1.05,P = 0.001)有关:结论:对于严重消化道出血的胰腺癌患者,早期发现动脉瘤出血(尤其是既往接受过切除手术的患者)并进行凝血病管理可提高治疗成功率并降低死亡率。
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来源期刊
Digestive and Liver Disease
Digestive and Liver Disease 医学-胃肠肝病学
CiteScore
6.10
自引率
2.20%
发文量
632
审稿时长
19 days
期刊介绍: Digestive and Liver Disease is an international journal of Gastroenterology and Hepatology. It is the official journal of Italian Association for the Study of the Liver (AISF); Italian Association for the Study of the Pancreas (AISP); Italian Association for Digestive Endoscopy (SIED); Italian Association for Hospital Gastroenterologists and Digestive Endoscopists (AIGO); Italian Society of Gastroenterology (SIGE); Italian Society of Pediatric Gastroenterology and Hepatology (SIGENP) and Italian Group for the Study of Inflammatory Bowel Disease (IG-IBD). Digestive and Liver Disease publishes papers on basic and clinical research in the field of gastroenterology and hepatology. Contributions consist of: Original Papers Correspondence to the Editor Editorials, Reviews and Special Articles Progress Reports Image of the Month Congress Proceedings Symposia and Mini-symposia.
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