Ocjena potrebe za ranom endoskopskom intervencijom u bolesnika s akutnim krvarenjem iz gornjega dijela probavne cijevi

Iveković, Hrvoje (2014) Ocjena potrebe za ranom endoskopskom intervencijom u bolesnika s akutnim krvarenjem iz gornjega dijela probavne cijevi. PhD thesis, Sveučilište u Zagrebu.

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Abstract

Previous research have indicated a number of predictors which have been subsequently formulated into the predictive models for assessing the treatment outcomes in the patients with acute UGIB. However, in terms of predicting the need for an early endoscopic procedure, these models perform less than optimal. Based on analysis of clinical and laboratory data in our group of patients with UGIB, a simple predictive model for assessment of the need for an early endoscopic procedure was created, based on three dihotomised variables (haemathemesis, lower hematocrit values and a raised serum urea levels). In terms of predicting the adverse outcomes, three more predictive models were created (risk of persistent bleeding, risk of death and risk of any adverse outcome). Diagnostic accuracy of these models was not inferior compared with the Blatchford and Rockall score. Results of this study forster the pardigm shift in managing the patients with UGIB: from endoscopy-based triage, towards clinical-based with regard to the need for an early endoscopic intervention, as well as in assessing the risk of adverse outcomes. Future studies are needed to evaluate both organisational and financial outcomes with regard to the pardigm shift in approach to the patients with UGIB.

Abstract in Croatian

Dosada su prepoznati brojni predskazatelji koji upućuju na rizik ponovne pojave krvarenja i smrtnosti kod bolesnika s GGIK-om. Temeljem ovih predskazatelja, formulirani su modeli za predikciju rizika, koji su međutim manjkavi u procjeni potrebe za ranim endoskopskim zahvatom. Analiziranjem kliničkih i laboratorijskih parametara u derivacijskoj kohorti bolesnika s GGIK-om kreiran je jednostavan prediktivni model ocjene potrebe za ranom endoskopskom hemostazom temeljen na tri dihotomizirane varijable (prisutnost hematemeze, snižene vrijednosti hematokrita i povišene serumskih vrijednosti ureje). K tomu, kreirana su još tri modela predikcije neželjenih događaja u ovoj populaciji bolesnika (predviđanje pojave perzistentnog krvarenja, pojave smrti ili pojave bilo kojeg neželjenog događaja). Dijagnostička točnost ovih modela nije bila inferiornija u odnosu na ranije etablirane prediktivne modele neželjenih događaja kod bolesnika s GGIK-om (Blatchfordov i Rockallov zbroj). Rezultati ovog ispitivanja govore u prilog promjene paradigme u pristupu bolesnicima s GGIK-om, odnosno pomaku od endoskoski bazirane trijaže prema kategorizaciji bolesnika u one visokog i niskog rizika za ranu endoskopsku hemostazu s jedne strane, te nastanak neželjenih događaja s druge strane. Organizacijske i financijske reperkusije ove promjene paradigme u pristupu bolesnicima s GGIK-om, trebat će provjeriti budućim ispitivanjima na većem broj ispitanika.

Item Type: Thesis (PhD)
Mentors:
Mentor
Ostojić, Rajko
Departments: Izvan medicinskog fakulteta
Depositing User: Marijan Šember
University: Sveučilište u Zagrebu
Institution: Medicinski fakultet
Number of Pages: 103
Status: Unpublished
Creators:
CreatorsEmail
Iveković, HrvojeUNSPECIFIED
Date: 22 December 2014
Date Deposited: 30 Jan 2015 11:27
Last Modified: 30 Jan 2015 11:27
Subjects: /
Related URLs:
    URI: http://medlib.mef.hr/id/eprint/2183

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