Evaluatıon Of Volume Status And Treatment Response Wıth Point-of-Care Inferior Vena Cava Ultrasound In Patıents With Gastrointestinal Bleeding In The Emergency Department

Authors

  • Gaye Atak Kepez State Hospital, Emergency Department
  • Fevzi Yılmaz SBU Antalya Research and Training Hospital https://orcid.org/0000-0002-3675-7457
  • İnan Beydilli Mersin City Hospital Training and Research Hospital
  • Cemil Kavalcı University of Health Sciences, Antalya Training and Research Hospital https://orcid.org/0000-0003-2529-2946
  • Bülent Çekiç University of Health Sciences, Antalya Training and Research Hospital
  • Yavuz Fatih Yavuz University of Health Sciences, Antalya Training and Research Hospital
  • Tayfun Anıl Demir Antalya Gazipaşa State Hospital

DOI:

https://doi.org/10.5281/zenodo.17608104

Keywords:

Inferior vena cava, Gastrointestinal bleeding, Volume Status, Prognosis

Abstract

Backgraund: Gastrointestinal bleeding (GIB) is a medical problem with significant morbidity and mortality and high consumption of healthcare resources, and is one of the main reasons for consultation in emergency department (ED). In critically ill patients, measuring the Inferior Vena Cava (IVC) diameter by bedside ultrasonography helps in the evaluation of intravascular status.

Objective: The aim of this study was to assess the association of point-of-care ultrasound (POCUS) used by emergency physicians to examine IVC diameter ratio in patients with GIB.

Methods: A single-center prospective observational study was conducted on consecutive patients with GIB who presented to the ED. Epidemiological and clinical characteristics of the patients, laboratory results and pre- and post-treatment IVC diameter were measured. Patients were divided into two groups as upper GIB (UGIB) and lower GIB (LGIB) based on endoscopic data.

Results: A total of 150 patients were included in our study. 39.3% of the patients were female, 60.7% were male, and the mean age was 59.25 ±19.91 (min: 19, max: 93). 77% (n=116) of the patients presented with UGIB, and 23% (n=34) with LGIB. In patients with UGIB, IVC MIN and IVC MAX values were significantly increased 2 hours after treatment (p<0.05); IVCCI value after 2 hours was statistically insignificant (p>0.05). In patients with LGIB, IVC MIN, IVC MAX and IVCCI were statistically insignificant in measurements taken 2 hours after treatment (p>0.05). IVC MIN and IVC MAX values of the entire group were significantly increased at the 2-hour measurement after treatment (p<0.05), however, IVCCI changes were statistically insignificant (p>0.05)

Conclusion: The inferior vena cava diameter ratio was independently associated with a poor outcome in patients with GIB.

References

1. Martínez-Cara JG, Jiménez-Rosales R, Úbeda-Muñoz M, de Hierro ML, de Teresa J, Redondo-Cerezo E. Comparison of AIMS65, Glasgow–Blatchford score, and Rockall score in a European series of patients with upper gastrointestinal bleeding: performance when predicting in-hospital and delayed mortality. United European Gastroenterol J 2016; 4: 371–9

2. Stanley AJ, Laine L. Management of acute upper gastrointestinal bleeding. BMJ. 2019 Mar 25;364:l536.

3. Antunes C, Tian C, Copelin II EL. Upper Gastrointestinal Bleeding. 2024 Aug 17. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan–.

4. Jairath V, Kahan BC, Gray A et al. Restrictive versus liberal blood transfusion for acute upper gastrointestinal bleeding (TRIGGER): a pragmatic, open-label, cluster randomised feasibility trial. Lancet 2015; 386: 137–44.

5. Lee HA, Jung HK, Kim TO et al. Clinical outcomes of acute upper gastrointestinal bleeding according to the risk indicated by Glasgow-Blatchford risk score-computed tomography score in the emergency room. Korean J Intern Med 2022; 37: 1176–85.

6. Ayar MS, Baydın A, Ustaoglu M, Caliskan F, Erenler AK. Inferior vena cava collapsibility index and stroke volume as predictors of blood transfusion in upper gastrointestinal bleeding in the emergency department. J Gastroenterol Hepatol. 2024 Jun;39(6):1040-1047.

7. Mackenzie DC, Noble VE. Assessing volume status and fluid responsiveness in the emergency department. Clin Exp Emerg Med. 2014;1(2):67-77.

8. Marik PE. Techniques for assessment of intravascular volume in critically ill patients. J Intensive Care Med. 2009 Sep-Oct;24(5):329-37.

9. Pasquero P, Albani S, Sitia E, Taulaigo AV, Borio L, Berchialla P, et al. Inferior vena cava diameters and collapsibility index reveal early volume depletion in a blood donor model. Crit Ultrasound J. 2015 Dec;7(1):17.

10. Hacıalioğulları F, Yılmaz F, Yılmaz A, Sönmez BM, Demir TA, Karadaş MA, et al. Role of Point-of-Care Lung and Inferior Vena Cava Ultrasound in Clinical Decisions for Patients Presenting to the Emergency Department With Symptoms of Acute Decompensated Heart Failure. J Ultrasound Med. 2021 Apr;40(4):751-761

11. Tung Chen Y, Blancas Gómez-Casero R, Quintana Díaz M, Villén Villegas T, Cobo Mora J, Carballo Cardona C. Results of a Prospective Study to Evaluate the Impact of Point-of-Care Ultrasound in the Enhancement of Gastrointestinal Bleeding Risk Scores. J Ultrasound Med. 2020 Feb;39(2):279-287.

12. Jo N, Oh J, Kang H, Lim TH, Ko BS. Association of inferior vena cava diameter ratio with outcomes in patients with gastrointestinal bleeding. Clin Exp Emerg Med. 2022;9(2): 101-107.

13. Ayar MS, Baydın A, Ustaoglu M, Caliskan F, Erenler AK. Inferior vena cava collapsibility index and stroke volume as predictors of blood transfusion in upper gastrointestinal bleeding in the emergency department. J Gastroenterol Hepatol. 2024 ;39(6):1040-1047.

14. Laursen SB, Hansen JM, Schaffalitzky de Muckadell OB. The Glasgow Blatchford score is the most accurate assessment of patients with upper gastrointestinal hemorrhage. Clin Gastroenterol Hepatol 2012;10:1130-5.

15. Hyett BH, Abougergi MS, Charpentier JP, et al. The AIMS65 score compared with the Glasgow-Blatchford score in predicting outcomes in upper GI bleeding. Gastrointest Endosc 2013;77:551-7.

16. Nagdev AD, Merchant RC, Tirado-Gonzalez A, Sisson CA, Murphy MC. Emergency department bedside ultrasonographic measurement of the caval index for noninvasive determination of low central venous pressure. Ann Emerg Med 2010; 55: 290–5

17. Perera P, Mailhot T, Riley D, Mandavia D. The RUSH exam: rapid ultrasound in shock in the evaluation of the critically ill. Emerg Med Clin North Am 2010 Feb; 28:29–56 vii.

18. Liao YY, Lin HJ, Lu YH, Foo NP, Guo HR, Chen KT. Does CT evidence of a flat inferior vena cava indicate hypovolemia in blunt trauma patients with solid organ injuries? J Trauma. 2011 Jun;70(6):1358-61.

19. Yanagawa Y, Nishi K, Sakamoto T, Okada Y. Early diagnosis of hypovolemic shock by sonographic measurement of inferior vena cava in trauma patients. J Trauma. 2005 Apr;58(4):825-9.

20. T. van Rooyen PL, Karusseit VO, Mokoena T. Inferior vena cava injuries: a case series and review of the South African experience. Injury. 2015 Jan;46(1):71-5.

21. Johnson JJ, Garwe T, Albrecht RM, et al. Initial inferior vena cava diameter on computed tomographic scan independently predicts mortality in severely injured trauma patients. J Trauma Acute Care Surg 2013;74:741-5.

22. Barbier C, Loubieres Y, Schmit C, et al. Respiratory changes in inferior vena cava diameter are helpful in predicting fluid re sponsiveness in ventilated septic patients. Intensive Care Med 2004;30:1740-6.

Downloads

Published

2025-11-15

How to Cite

Atak, G., Yılmaz, F., Beydilli, İnan, Kavalcı, C., Çekiç, B., Yavuz, Y. F., & Demir, T. A. (2025). Evaluatıon Of Volume Status And Treatment Response Wıth Point-of-Care Inferior Vena Cava Ultrasound In Patıents With Gastrointestinal Bleeding In The Emergency Department. Acta Medica Young Doctors, 1(3). https://doi.org/10.5281/zenodo.17608104

Issue

Vol. 1 No. 3 (2025): Vol. 1. No:3 : Acta Medica Young Doctors

Section

Original Article

License

Copyright (c) 2025 Gaye Atak, Fevzi Yılmaz, İnan Beydilli, Cemil Kavalcı, Bülent Çekiç, Yavuz Fatih Yavuz, Tayfun Anıl Demir

Creative Commons License

This work is licensed under a Creative Commons Attribution 4.0 International License.