Akademik Veri Yönetim Sistemi
Journal of Emergency Medicine, cilt.86, ss.161-168, 2026 (SCI-Expanded, Scopus)
Background Upper gastrointestinal bleeding (UGIB) is a time-critical emergency where early identification of transfusion needs and hypovolemia is essential, yet conventional risk scores rely on often delayed laboratory and endoscopy data. Objectives The primary objective of this study was to determine the prognostic value of the peripheral perfusion index (PPI) for predicting two critical outcomes in patients with UGIB: the requirement for blood transfusion and the development of hypovolemic shock. Methods This prospective observational study enrolled 134 adult patients with endoscopically confirmed UGIB at a tertiary emergency department (ED). Following rest in a temperature-controlled room (24°C), PPI was measured. The primary outcomes were transfusion requirement and hypovolemic shock (systolic blood pressure [SBP] <90 mm Hg or shock index [SI] >1). PPI’s predictive performance was evaluated against the shock index, lactate, and base deficit using receiver operating characteristic (ROC) analysis and multivariate logistic regression. Results Of 134 patients (61.2% male, mean age 68.0 ± 14.7 years), 49.3% (n = 66) had a PPI <1.0. These patients demonstrated significantly higher rates of transfusion (71.2% vs. 27.9%, p < 0.001) and mortality (21.2% vs. 8.8%, p = 0.044). A PPI <1.0 was significantly associated with markers of severity, including lower blood pressure, higher shock index, and worse laboratory values (all p < 0.01). Multivariate analysis identified PPI <1.0 as a strong independent predictor of transfusion (OR: 7.68). PPI showed superior predictive accuracy for transfusion (area under the curve [AUC] = 0.771) compared to shock index (AUC = 0.750), lactate (AUC = 0.628), and base deficit (AUC = 0.682). Conclusion A PPI value <1.0 was a strong independent predictor of transfusion need and demonstrated excellent discriminative power. The PPI is therefore a rapid, non-invasive bedside tool that reliably identifies patients with UGIB at risk of needing transfusions.