Background Acute gastrointestinal bleeding (GIB) is a life-threatening event. Around 20-30% of patients with GIB will develop hemodynamic instability (HI). Objectives We aimed to quantify HI as a risk factor for the development of relevant end points in acute GIB. Design A systematic search was conducted in three medical databases in October 2021. Data sources and methods Studies of GIB patients detailing HI as a risk factor for the investigated outcomes were selected. For the overall results, pooled odds ratios (ORs) with 95% confidence intervals (CIs) were calculated based on a random-effects model. Subgroups were formed based on the source of bleeding. The Quality of Prognostic Studies tool was used to assess the risk of bias. Results A total of 62 studies were eligible, and 39 were included in the quantitative synthesis. HI was found to be a risk factor for both in-hospital (OR: 5.48; CI: 3.99-7.52) and 30-day mortality (OR: 3.99; CI: 3.08-5.17) in upper GIB (UGIB). HI was also associated with higher in-hospital (OR: 3.68; CI: 2.24-6.05) and 30-day rebleeding rates (OR: 4.12; 1.83-9.31) among patients with UGIB. The need for surgery was also more frequent in hemodynamically compromised UGIB patients (OR: 3.65; CI: 2.84-4.68). In the case of in-hospital mortality, the risk of bias was high for 1 (4%), medium for 13 (48%), and low for 13 (48%) of the 27 included studies. Conclusion Hemodynamically compromised patients have increased odds of all relevant untoward end points in GIB. Therefore, to improve the outcomes, adequate emergency care is crucial in HI. Registration PROSPERO registration number: CRD42021285727.

中文翻译：

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入院时血流动力学不稳定与急性胃肠道出血死亡率和再出血率增加相关：系统评价和荟萃分析。

背景 急性胃肠道出血（GIB）是一种危及生命的事件。大约 20-30% 的 GIB 患者会出现血流动力学不稳定 (HI)。目标 我们旨在量化 HI 作为急性 GIB 相关终点发展的风险因素。设计 2021 年 10 月在三个医学数据库中进行了系统检索。数据来源和方法 选择了对 GIB 患者进行的研究，详细说明了 HI 作为调查结果的危险因素。对于总体结果，基于随机效应模型计算了具有 95% 置信区间 (CI) 的合并比值比 (OR)。根据出血来源形成亚组。预后研究质量工具用于评估偏倚风险。结果 共有 62 项研究符合条件，其中 39 项纳入定量综合。研究发现，HI 是上消化道 (UGIB) 院内死亡率（OR：5.48；CI：3.99-7.52）和 30 天死亡率（OR：3.99；CI：3.08-5.17）的危险因素。HI 还与 UGIB 患者较高的住院率（OR：3.68；CI：2.24-6.05）和 30 天再出血率（OR：4.12；1.83-9.31）相关。血流动力学受损的 UGIB 患者需要手术的频率也更高（OR：3.65；CI：2.84-4.68）。就院内死亡率而言，27 项纳入研究中，1 项研究的偏倚风险较高（4%），13 项研究的偏倚风险为中等（48%），13 项研究的偏倚风险较低（48%）。结论 血流动力学受损的患者发生 GIB 所有相关不良终点的几率增加。因此，为了改善预后，充分的急救护理对于 HI 至关重要。注册 PROSPERO 注册号：CRD42021285727。