The objective of this study was to investigate the association between mortality and inflammation in patients who were admitted to the emergency room with gastrointestinal bleeding. Patients (n = 96) managed at two medical centres were included in the study. Initial levels of serum C-reactive protein (CRP), haemoglobin and albumin, and leucocyte and thrombocyte counts for 28 patients who died were compared with those for the 68 patients who survived and were successfully discharged. The data were analysed using the χ2-test. Serum levels of CRP and leucocyte counts were significantly higher, and albumin and haemoglobin were significantly lower in patients who died compared with patients who survived. The increased levels of serum CRP and leucocyte counts, and decreased levels of albumin and haemoglobin were found to be independent risk factors for mortality. It is concluded that increased serum CRP levels and leucocyte counts combined with decreased albumin and haemoglobin levels on admission to the emergency room may be used as predictive factors of mortality in patients with gastrointestinal bleeding.
LangmanMJWeilJWainwrightP: Risks of bleeding peptic ulcer associated with individual non-steroidal anti-inflammatory drugs. Lancet1994; 343: 1075–1078.
3.
ZaragozaAMTeníasJMLlorenteMJ: Prognostic factors in gastrointestinal bleeding due to peptic ulcer: Construction of a predictive model. J Clin Gastroenterol2008; 42: 786–790.
4.
BourienneAPagenaultMHeresbachD: Multicenter prospective study of prognostic factors of gastroduodenal ulcer hemorrhages. Reevaluation of clinical and endoscopic factors in the era of endoscopic hemostasis. Gastroenterol Clin Biol2000; 24: 193–200 [in French].
5.
RoumenRMRedlHSchlagG: Inflammatory mediators in relation to the development of multiple organ failure in patients after severe blunt trauma. Crit Care Med1995; 23: 474–480.
6.
PinillaJCHayesPLavertyW: The C-reactive protein to prealbumin ratio correlates with the severity of multiple organ dysfunction. Surgery1998; 124: 799–805.
7.
SmithRPLipworthBJCreeIA: C-reactive protein. A clinical marker in community-acquired pneumonia. Chest1995; 108: 1288–1291.
8.
PóvoaPAlmeidaEMoreiraP: C-reactive protein as an indicator of sepsis. Intensive Care Med1998; 24: 1052–1056.
9.
de BeauxACGoldieASRossJA: Serum concentrations of inflammatory mediators related to organ failure in patients with acute pancreatitis. Br J Surg1996; 83: 349–353.
10.
RidkerPMStampferMJRifaiN: Novel risk factors for systemic atherosclerosis: A comparison of C-reactive protein, fibrinogen, homocysteine, lipoprotein(a), and standard cholesterol screening as predictors of peripheral arterial disease. JAMA2001; 285: 2481–2485.
11.
LoboSMLoboFRBotaDP: C-reactive protein levels correlate with mortality and organ failure in critically ill patients. Chest2003; 123: 2043–2049.
12.
HoKMLeeKYDobbGJ: C-reactive protein concentration as a predictor of inhospital mortality after ICU discharge: A prospective cohort study. Intensive Care Med2008; 34: 481–487.
13.
NikfardjamMMullnerMSchreiberW: The association between C-reactive protein on admission and mortality in patients with acute myocardial infarction. J Intern Med2000; 247: 341–345.
14.
ZimmermannMBuschKKuhnS: Endotoxin adsorbent based on immobilized human serum albumin. Clin Chem Lab Med1999; 37: 373–379.
15.
PanichiVMiglioriMDe PietroS: Plasma C-reactive protein in haemodialysis. Blood Purif1999; 17: 142–148.
16.
JensenJUHesletLJensenTH: Procalcitonin increase in early identification of critically ill patients at high risk of mortality. Crit Care Med2006; 34: 2596–2602.
17.
YapFHJoyntGMBuckleyTA: Association of serum albumin concentration and mortality risk in critically ill patients. Anaesth Intensive Care2002; 30: 202–207.
18.
LecleireSDi FioreFMerleV: Acute upper gastrointestinal bleeding in patients with liver cirrhosis and in noncirrhotic patients: Epidemiology and predictive factors of mortality in a prospective multicenter population-based study. J Clin Gastroenterol2005; 39: 321–327.
19.
LundahlTHLindahlTLFagerbergIH: Activated platelets and impaired platelet function in intensive care patients analyzed by flow cytometry. Blood Coagul Fibrinolysis1996; 7: 218–220.
20.
StraussRWehlerMMehlerK: Thrombocytopenia in patients in the medical intensive care unit: Bleeding prevalence, transfusion requirements, and outcome. Crit Care Med2002; 30: 1765–1771.
21.
ChakravertyRDavidsonSPeggsK: The incidence and cause of coagulopathies in an intensive care population. Br J Haematol1996; 93: 460–463.
22.
KinasewitzGTZeinJGLeeGL: Prognostic value of a simple evolving disseminated intravascular coagulation score in patients with severe sepsis. Crit Care Med2005; 33: 2214–2221.
23.
DhainautJFShorrAFMaciasWL: Dynamic evolution of coagulopathy in the first day of severe sepsis: Relationship with mortality and organ failure. Crit Care Med2005; 33: 341–348.
24.
KuvandikGUcarEBorazanA: Markers of inflammation as determinants of mortality in intensive care unit patients. Adv Ther2007; 24: 1078–1084.
25.
VincentJLPiagnerelliM: Transfusion in the intensive care unit. Crit Care Med2006; 34 (5 suppl): S96–S101.
