{"id":2280,"date":"2019-12-31T19:32:06","date_gmt":"2019-12-31T18:32:06","guid":{"rendered":"https:\/\/angh.net\/abstracts\/sanghria-resultats-de-letude-princeps\/"},"modified":"2019-12-31T19:32:06","modified_gmt":"2019-12-31T18:32:06","slug":"sanghria-resultats-de-letude-princeps","status":"publish","type":"post","link":"https:\/\/angh.net\/abstracts\/sanghria-resultats-de-letude-princeps\/","title":{"rendered":"SANGHRIA : RESULTATS DE L\u2019ETUDE PRINCEPS"},"content":{"rendered":"

2019<\/strong><\/p>\n

Vincent QUENTIN, St\u00e9phane NAHON, Pierre LAHMEK et le groupe ANGH-SANGHRIA<\/em><\/p>\n

Endoscopie <\/strong>– \u00a02019-05-02 –\u00a0CO –<\/p>\n

________________________________<\/p>\n

Introduction et objectifs
\nDurant cette derni\u00e8re d\u00e9cennie les facteurs de risques et les facteurs pronostiques des h\u00e9morragies digestives pourraient avoir \u00e9volu\u00e9 du fait de l\u2019arriv\u00e9e des anticoagulants directs, d\u2019une meilleure diffusion des techniques d\u2019h\u00e9mostase endoscopique, de la publication de nouvelles recommandations et de la g\u00e9n\u00e9ralisation des astreintes territoriales d\u2019endoscopie. Cette \u00e9tude a pour but d\u2019actualiser les donn\u00e9es \u00e9pid\u00e9miologiques et pronostiques des h\u00e9morragies digestives haute \u00e0 l\u2019aune de ces nouveaux \u00e9l\u00e9ments.
\nM\u00e9thodes
\nCette \u00e9tude a \u00e9t\u00e9 men\u00e9e de novembre 2017 \u00e0 Octobre 2018, de fa\u00e7on prospective dans 46 centres hospitaliers g\u00e9n\u00e9raux. Tous les patients inclus pr\u00e9sentaient une h\u00e9morragie digestive haute, qu\u2019elle soit communautaire ou survenant au cours d\u2019une hospitalisation pour une autre cause. Le suivi \u00e9tait de 6 semaines. Les caract\u00e9ristiques cliniques, endoscopiques et de suivi \u00e9taient collect\u00e9es et analys\u00e9es de fa\u00e7on uni et multivari\u00e9e pour identifier les facteurs pr\u00e9dictifs de r\u00e9cidive h\u00e9morragique et de mortalit\u00e9.
\nR\u00e9sultats
\nSur les 2498 patients inclus, 74.6% pr\u00e9sentaient une h\u00e9morragie communautaire et 25.4% hospitali\u00e8re. L\u2019\u00e2ge moyen \u00e9tait de 68.5 ans +\/- 16.3, 67.1% \u00e9tait des hommes et 20.9% \u00e9taient cirrhotiques. Le score m\u00e9dian de Charlson score \u00e9tait de 2 (IQR: 1-4), de Blatchford de 11 (IQR: 7-13), de Rockall de 5 (IQR: 3-6). Dix-neuf pour cent des patients prenait un traitement anticoagulant oral dont 43.8% un anticoagulant oral direct. L\u2019endoscopie \u00e9tait r\u00e9alis\u00e9e dans les 24 heures dans 84.2% des cas, sous anesth\u00e9sie g\u00e9n\u00e9rale dans 31%. Une aide endoscopique \u00e9tait pr\u00e9sente dans la majorit\u00e9 des cas (91.5%). Les principales causes de saignement \u00e9taient 1) la pathologie ulc\u00e9reuse (44.9%), 2) l\u2019hypertension portale (18.8%) et 3) une oesophagite (11.5%). Un saignement actif \u00e9tait observ\u00e9 chez 24.5% des patients, essentiellement en lien avec la pathologie ulc\u00e9reuse et l\u2019hypertension portale, ce saignement actif b\u00e9n\u00e9ficiait d\u2019un traitement endoscopique dans respectivement 86.7% et 79.6% des cas. Pendant l\u2019hospitalisation 10.5% des patients r\u00e9cidivaient et 8.6% d\u00e9c\u00e9daient. Le taux de mortalit\u00e9 intra-hospitali\u00e8re \u00e9tait plus faible chez les patients pr\u00e9sentant une h\u00e9morragie communautaire par rapport \u00e0 ceux pr\u00e9sentant une h\u00e9morragie intra-hospitali\u00e8re (5.8% vs 16.8%, p<0.0001). Les facteurs pr\u00e9dictifs associ\u00e9s \u00e0 la r\u00e9cidive h\u00e9morragique \u00e9tait le caract\u00e8re intra-hospitalier de celle-ci (OR=1.36; 95%CI: 1.03-1.79), le score de Blatchford >11 (OR=1.45; 95%CI: 1.08-1.94) et un saignement actif (OR=1.94; 95%CI: 1.48-2.55). Le taux de mortalit\u00e9 \u00e0 6 semaines \u00e9tait de 12.0%. Il \u00e9tait plus bas pour le groupe des h\u00e9morragies communautaires qu\u2019intra-hospitali\u00e8res (9.1% vs 22.2%; p<0.0001). Les facteurs pr\u00e9dictifs associ\u00e9s \u00e0 la mortalit\u00e9 \u00e0 6 semaines \u00e9tait la n\u00e9cessit\u00e9 d\u2019une transfusion initiale (OR=1.53; 95%CI: 1.04-2.27), le score de Charlson >4 (OR=1.80; 95%CI: 1.31-2.48), le score de Rockall >5 (OR=1.97; 95%CI: 1.39-2.80), une h\u00e9morragie de survenue intra-hospitali\u00e8re (OR=2.44; 95%CI: 1.75-3.40), et la survenue d\u2019une r\u00e9cidive h\u00e9morragique (OR=2.59; 95%CI: 1.85-3.64).
\nConclusion
\nCette \u00e9tude montre une am\u00e9lioration de la prise en charge des h\u00e9morragies digestives hautes compar\u00e9e aux \u00e9tudes plus anciennes. Malgr\u00e9 cela le taux de mortalit\u00e9 \u00e0 6 semaines reste \u00e9lev\u00e9, notamment pour les h\u00e9morragies intra-hospitali\u00e8res. Cela pourrait \u00eatre expliqu\u00e9 par la s\u00e9v\u00e9rit\u00e9 des pathologies ou des comorbidit\u00e9s motivant l\u2019hospitalisation initiale. Les facteurs pr\u00e9dictifs de mortalit\u00e9 les plus significatifs sont la survenue intra-hospitali\u00e8re de l\u2019h\u00e9morragie et la survenue d\u2019une r\u00e9cidive h\u00e9morragique. Il n\u2019a pas \u00e9t\u00e9 d\u00e9tect\u00e9 d\u2019influence notable des traitements anticoagulants. Cette \u00e9tude confirme \u00e9galement que les facteurs pr\u00e9dictifs d\u00e9j\u00e0 connus restent valides, m\u00eame avec l\u2019\u00e9volution actuelle des th\u00e9rapeutiques.<\/p>\n","protected":false},"excerpt":{"rendered":"

2019 Vincent QUENTIN, St\u00e9phane NAHON, Pierre LAHMEK et le groupe ANGH-SANGHRIA Endoscopie – \u00a02019-05-02 –\u00a0CO – ________________________________ Introduction et objectifs Durant cette derni\u00e8re d\u00e9cennie les facteurs de risques et les facteurs pronostiques des h\u00e9morragies digestives pourraient avoir \u00e9volu\u00e9 du fait de l\u2019arriv\u00e9e des anticoagulants directs, d\u2019une meilleure diffusion des techniques d\u2019h\u00e9mostase endoscopique, de la publication […]<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_exactmetrics_skip_tracking":false,"_exactmetrics_sitenote_active":false,"_exactmetrics_sitenote_note":"","_exactmetrics_sitenote_category":0,"footnotes":""},"categories":[6],"tags":[30],"class_list":["post-2280","post","type-post","status-publish","format-standard","hentry","category-endoscopie","tag-30"],"yoast_head":"\nSANGHRIA : RESULTATS DE L\u2019ETUDE PRINCEPS - 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