Hemodynamic Status and Outcomes in Emergency Department Patients With Gastrointestinal Hemorrhage

First Author: Anushka Deogaonkar, MBBS – Research Fellow, 1. Department of Emergency Medicine, George Washington University School of Medicine and Health Sciences, Washington, DC, United States
Co-Author: Ronaldo Pichardo Gonzalez, MD
Co-Author: Samantha Camp, BS
Co-Author: Quincy K. Tran, MD, PhD – University of Maryland Medical Center, R. Adams Cowley Shock Trauma Center
Co-Author: Marie Borum, MD EdD MPH – Resident Physician, 1. Department of Emergency Medicine, George Washington University School of Medicine and Health Sciences, Washington, DC, United States
Co-Author: Ali Pourmand, MD MPH – Attending physician, George Washington University school of medicine and Health Sciences


Introduction: Acute gastrointestinal (GI) haemorrhage is a potentially life-threatening condition that may precipitate major adverse cardiovascular events (MACE). Despite its acute severity, the long-term vascular sequelae of GI haemorrhage remain underrecognized. This study investigates whether the severity of initial bleeding, defined by hemodynamic and hematologic parameters, is associated with 180-day risks of MACE and all-cause mortality.


Methods: The TriNetX database yielded a total of 307,636 after PSM. Mean age ( SD) was 65  14.3 years, 32,881 (43.5 %) were female and 59% were white. Individual components of major adverse cardiac events with the greatest risk difference were AKI with a risk difference of 2.2 % (95 % CI 1.85%, 2.57 p < 0.0001), CHF with a risk difference of 1.56 % (95 % CI 1.29%, 1.83%, p < 0.0001), MI with a risk difference of 0.82% (95 % CI 0.64, 0.99, p < 0.0001), stroke with a risk difference of 0.085% (95 % CI -0.05%, 0.22%, p = 0.2162), and all-cause mortality with a risk difference of 5.8% (95 % CI 5.43%, 6.18%, p < 0.0001) with an odds ratio 1.53 % (95 % CI 1.49,1.58).


Results: The TriNetX database yielded a total of 307,636 patients meeting inclusion criteria with 75,439 included in each group after PSM. Mean age ( SD) was 65  14.3 years, 32,881 (43.5 %) were female and 59% were white. Individual components of major adverse cardiac events with the greatest risk difference were AKI with a risk difference of 2.2 % (95 % CI 1.85%, 2.57 p < 0.0001), CHF with a risk difference of 1.56 % (95 % CI 1.29%, 1.83%, p < 0.0001), MI with a risk difference of 0.82% (95 % CI 0.64, 0.99, p < 0.0001), stroke with a risk difference of 0.085% (95 % CI -0.05%, 0.22%, p = 0.2162), and all-cause mortality with a risk difference of 5.8% (95 % CI 5.43%, 6.18%, p < 0.0001) with an odds ratio 1.53 % (95 % CI 1.49,1.58).


Conclusions: In this large, propensity score–matched cohort of patients with GI haemorrhage, clinical instability was associated with significantly higher risks of AKI, CHF, and all-cause mortality. The most notable difference was observed in mortality. These findings underscore the prognostic significance of early hemodynamic and hematologic assessment in patients with gastrointestinal haemorrhage.