[PP.01.35] ROLE OF SYSTOLIC ARTERIAL PRESSURE AS PREDICTOR OF ADVERSE OUTCOME IN PATIENTS PRESENTING WITH MAJOR BLEEDING TO THE EMERGENCY DEPARTMENT. AD-INTERIM RESULTS OF A MULTICENTER POPULATION BASED STUDY. (September 2017)

• Record Type: Journal Article
• Authors: Bianchi, S.; Renzi, N.; Molesti, D.; Vanni, S.; Pastorelli, M.; Cipriano, A.; Santini, M.; Beerman, U.; Frosini, F.; Mecca, F.; Di Corato, P.R.; Procacci, V.; Chiaradia, P.; Spisni, L.; Conti, A.
• Is Part Of: Journal of hypertension. Volume 35(2017)Supplement 2
• Publication Date: 2017-09
• Subjects: Hypertension -- Periodicals; Hypertension -- Periodicals; 616.132005
• DOI: 10.1097/01.hjh.0000523242.66390.0c
• Languages: English
• ISSNs: 1473-5598

Abstract

Abstract : Objective: Bleeding events at the Emergency Department (ED) are still under investigation. Aim of the present study was to analyze baseline characteristics which could be associated with any treatment strategies and outcomes. Design and method: Visits to the ED were considered during a 2016 three-month survey. Inclusion-exclusion criteria were as follows: presence of any bleeding event and age <18. Clinical parameters, major-minor bleeding, site of bleeding, treatments, need of reversal treatment/transfusion and adverse outcomes were prospectively collected. Primary endpoint was the presence of major bleeding. Secondary were the composite of admission-death and the need of reversal treatment-transfusions Results: Out of 155.320 visits, 2.592 patients were enrolled (mean age 64.9 ± 20.3 year). Major bleedings account for 26%. Mean systolic arterial pressure was 138 ± 28 mmHg, heart rate 81 ± 15 b/min, haemoglobin 12.1 ± 2.5 g/dL, creatinine 1.07 ± 0.75 mg/dL. Patients who were given antiplatelets or anticoagulants (393, 15%; 275, 11%) more likely presented with major bleeding (171, 44%; 127, 46%; p < 0.001). Overall, 179 patients received reversal treatment (108, 4%), transfusions (86, 3%), VitK (30, 1%); 59 (22%) patients were given anticoagulants (p < 0.001) and 43 (11%) antiplatelets (p = 0.049); 193 (7%) need observation and 503 (19%) admission. In-hospital death accounts for 30 (1.2%) patients. Receiver Operator Characteristics analysis for major bleeding showed higher values of age (area 0.62, CI 0.59–0.66), creatinine (0.55, 0.52–0.59), systolic arterial pressure (0.53, 0.49–0.56) over anticoagulants (0.50, 0.48–0.54) and antiplatelets (0.51, 0.48–0.55). Age > 65 (Odds Ratio, OR 6), major bleeding (OR 9), systolic arterial pressure (OR 1.10), antiplatelets (OR 2) were predictors of death at the univariate analysis; Age > 65 (OR 2), major bleeding (OR 101), antiplatelets (OR 2) and female gender (0R 0.69) of the composite endpoint of death-admission. Age > 65 (OR 1.04), major bleeding (OR 68), anticoagulants (OR 4), warfarin (OR 5) were predictors of reversal treatment-transfusion at the univariate analysis. Conclusions: Up to 2% of population presents with bleeding events to the ED. Older age was predictor of death; older age, major bleeding and female gender predict the primary endpoint; while major bleeding, use of warfarin the composite of reversal treatment-transfusion. Older age, creatinine, systolic arterial pressure were associate with major bleeding.