THE PREVALENCE AND SIGNIFICANCE OF LEUKOCYTOSIS IN UPPER GASTROINTESTINAL-BLEEDING

Although leukocytosis has long been recognized to occur in patients wi th hemorrhage, there are no data regarding leucocytosis in patients wi th upper gastrointestinal bleeding. We evaluated the prevalence and si gnificance of the admission white blood cell count in consecutive pati ents admitted to Grady Memorial Hospital with upper gastrointestinal b leeding seen prospectively over a 50-month period. Any white count gre ater than 8.5 x 10(3)/mm(3) was considered abnormal. Of the 731 patien ts eligible for the study, leukocytosis was seen in 463 (63%). When co mpared to patients with a normal white count, patients with leukocytos is on admission were more likely to be tachycardic (31.4% versus 24.3% , P = 0.04) and hypotensive (10.9% versus 5.7%, P = 0.018), required m ore units of blood (4.6 +/- 5.9 versus 3.5 +/- 6.0, P = 0.01), had a l onger hospital stay (7.3 +/- 9.7 versus 5.9 +/- 6.2 days, P = 0.01), a nd required more frequent surgical intervention for bleeding (8.0% ver sus 4.2%, P = 0.04). No significant difference in mortality was seen b etween patients with leukocytosis and those with a normal white count (8.7% versus 6.4%, P = 0.27). Leukocytosis is common in patients with upper gastrointestinal bleeding, appears to reflect the severity of th e bleeding episode, and is associated with a more complicated course.