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de Kok JWTM, van Rosmalen F, Koeze J, Keus F, van Kuijk SMJ, Castela Forte J, Schnabel RM, Driessen RGH, van Herpt TTW, Sels JWEM, Bergmans DCJJ, Lexis CPH, van Doorn WPTM, Meex SJR, Xu M, Borrat X, Cavill R, van der Horst ICC, van Bussel BCT. Deep embedded clustering generalisability and adaptation for integrating mixed datatypes: two critical care cohorts. Sci Rep 2024; 14:1045. [PMID: 38200252 PMCID: PMC10781731 DOI: 10.1038/s41598-024-51699-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 01/08/2024] [Indexed: 01/12/2024] Open
Abstract
We validated a Deep Embedded Clustering (DEC) model and its adaptation for integrating mixed datatypes (in this study, numerical and categorical variables). Deep Embedded Clustering (DEC) is a promising technique capable of managing extensive sets of variables and non-linear relationships. Nevertheless, DEC cannot adequately handle mixed datatypes. Therefore, we adapted DEC by replacing the autoencoder with an X-shaped variational autoencoder (XVAE) and optimising hyperparameters for cluster stability. We call this model "X-DEC". We compared DEC and X-DEC by reproducing a previous study that used DEC to identify clusters in a population of intensive care patients. We assessed internal validity based on cluster stability on the development dataset. Since generalisability of clustering models has insufficiently been validated on external populations, we assessed external validity by investigating cluster generalisability onto an external validation dataset. We concluded that both DEC and X-DEC resulted in clinically recognisable and generalisable clusters, but X-DEC produced much more stable clusters.
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Affiliation(s)
- Jip W T M de Kok
- Department of Intensive Care Medicine, Maastricht University Medical Centre+, P. Debyelaan, 25, 6229 HX, Maastricht, The Netherlands.
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands.
| | - Frank van Rosmalen
- Department of Intensive Care Medicine, Maastricht University Medical Centre+, P. Debyelaan, 25, 6229 HX, Maastricht, The Netherlands
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands
| | - Jacqueline Koeze
- Department of Critical Care, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Frederik Keus
- Department of Critical Care, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Sander M J van Kuijk
- Department of Clinical Epidemiology and Medical Technical Assessment, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - José Castela Forte
- Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- Bernoulli Institute for Mathematics, Computer Science and Artificial Intelligence, University of Groningen, Groningen, The Netherlands
| | - Ronny M Schnabel
- Department of Intensive Care Medicine, Maastricht University Medical Centre+, P. Debyelaan, 25, 6229 HX, Maastricht, The Netherlands
| | - Rob G H Driessen
- Department of Intensive Care Medicine, Maastricht University Medical Centre+, P. Debyelaan, 25, 6229 HX, Maastricht, The Netherlands
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands
- Department of Cardiology, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Thijs T W van Herpt
- Department of Intensive Care Medicine, Maastricht University Medical Centre+, P. Debyelaan, 25, 6229 HX, Maastricht, The Netherlands
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands
| | - Jan-Willem E M Sels
- Department of Intensive Care Medicine, Maastricht University Medical Centre+, P. Debyelaan, 25, 6229 HX, Maastricht, The Netherlands
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands
- Department of Cardiology, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Dennis C J J Bergmans
- Department of Intensive Care Medicine, Maastricht University Medical Centre+, P. Debyelaan, 25, 6229 HX, Maastricht, The Netherlands
- School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University, Maastricht, The Netherlands
| | - Chris P H Lexis
- Department of Intensive Care Medicine, Maastricht University Medical Centre+, P. Debyelaan, 25, 6229 HX, Maastricht, The Netherlands
| | - William P T M van Doorn
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands
- Department of Clinical Chemistry, Central Diagnostic Laboratory, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Steven J R Meex
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands
- Department of Clinical Chemistry, Central Diagnostic Laboratory, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Minnan Xu
- Takeda Pharmaceuticals, Deerfield, IL, USA
| | - Xavier Borrat
- Department of Biostatistics Harvard T.H, Chan School of Public Health, Boston, MA, USA
- Anaesthesiology and Critical Care Department, Hospital Clinic de Barcelona, Barcelona, Spain
- Medical Informatics Department, Hospital Clinic de Barcelona, Barcelona, Spain
| | - Rachel Cavill
- Department of Advanced Computing Sciences, Maastricht University, Maastricht, The Netherlands
| | - Iwan C C van der Horst
- Department of Intensive Care Medicine, Maastricht University Medical Centre+, P. Debyelaan, 25, 6229 HX, Maastricht, The Netherlands
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands
| | - Bas C T van Bussel
- Department of Intensive Care Medicine, Maastricht University Medical Centre+, P. Debyelaan, 25, 6229 HX, Maastricht, The Netherlands
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands
- Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
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Kim SH. [Radiologic Diagnosis of Gastrointestinal Bleeding]. JOURNAL OF THE KOREAN SOCIETY OF RADIOLOGY 2023; 84:520-535. [PMID: 37325008 PMCID: PMC10265251 DOI: 10.3348/jksr.2022.0174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 01/26/2023] [Accepted: 02/19/2023] [Indexed: 06/17/2023]
Abstract
Gastrointestinal (GI) bleeding is not a single disease but a symptom and clinical manifestation of a broad spectrum of conditions in the GI tract. According to its clinical presentation, GI bleeding can be classified into overt, occult, and obscure types. Additionally, it can be divided into upper and lower GI bleeding based on the Treitz ligament. Variable disease entities, including vascular lesions, polyps, neoplasms, inflammation such as Crohn's disease, and heterotopic pancreatic or gastric tissue, can cause GI bleeding. CT and conventional angiographies and nuclear scintigraphy are all radiologic imaging modalities that can be used to evaluate overt bleeding. For the work-up of occult GI bleeding, CT enterography (CTE) can be the first imaging modality. For CTE, an adequate bowel distention is critical for obtaining acceptable diagnostic performance as well as minimizing false positives and negatives. Meckel's scintigraphy can be complementarily useful in cases where the diagnosis of CTE is suboptimal. For the evaluation of obscured GI bleeding, various imaging modalities can be used based on clinical status and providers' preferences.
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Ritter AC, Ricart Arbona RJ, Livingston RS, Monette S, Lipman NS. Effects of Mouse Kidney Parvovirus on Pharmacokinetics of Chemotherapeutics and the Adenine Model of Chronic Kidney Disease. Comp Med 2023; 73:153-172. [PMID: 36973002 PMCID: PMC10162380 DOI: 10.30802/aalas-cm-22-000084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Revised: 10/21/2022] [Accepted: 12/07/2022] [Indexed: 03/29/2023]
Abstract
Mouse kidney parvovirus (MKPV) causes inclusion body nephropathy in severely immunocompromised mice and renal interstitial inflammation in immunocompetent mice. Here we sought to determine the effects of MKPV on pre-clinical murine models that depend on renal function. To assess the effects of MKPV infection on the pharmacokinetics of 2 renally excreted chemotherapeutic agents, methotrexate and lenalidomide, we measured drug concentrations in the blood and urine of MKPV-infected or uninfected immunodeficient NOD.Cg-PrkdcscidIl2rgtm1Wjl/SzJ (NSG) and immunocompetent C57BL/6NCrl (B6) female mice. No differences in plasma pharmacokinetics were observed for lenalidomide. However, the AUC of methotrexate was 1.5-fold higher in uninfected NSG mice compared with infected NSG mice, 1.9-fold higher in infected B6 mice compared with uninfected B6 mice, and 4.3-fold higher in uninfected NSG mice compared with uninfected B6 mice. MKPV infection did not significantly affect the renal clearance of either drug. To assess effects of MKPV infection on the adenine diet model of chronic kidney disease, MKPV-infected and uninfected B6 female mice were fed a 0.2% adenine diet, and clinical and histopathologic features of disease were assessed over 8 wk. MKPV infection did not significantly alter urine chemistry results, hemogram findings, or serum concentrations of BUN, creatinine, or symmetric dimethylarginine. However, infection did influence histologic outcomes. As compared with uninfected mice, MKPV-infected mice had more interstitial lymphoplasmacytic infiltrates after 4 and 8 wk of diet consumption and less interstitial fibrosis at week 8. Macrophage infiltrates and renal tubular injury were similar between in infected and uninfected mice. These findings indicate that MKPV infection had minimal effects on the renal excretion of 2 chemotherapeutics and on serum biomarkers of renal function. However, infection significantly influenced two histologic features of the adenine diet model of chronic renal disease. MKPV-free mice are critically important in studies evaluating renal histology as an experimental outcome.
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Affiliation(s)
- Amanda C Ritter
- Tri-Institutional Training Program in Laboratory Animal Medicine and Science, Memorial Sloan Kettering Cancer Center, Weill Cornell Medicine, and The Rockefeller University, New York, New York
| | - Rodolfo J Ricart Arbona
- Tri-Institutional Training Program in Laboratory Animal Medicine and Science, Memorial Sloan Kettering Cancer Center, Weill Cornell Medicine, and The Rockefeller University, New York, New York
- Center for Comparative Medicine and Pathology, Memorial Sloan Kettering Cancer Center and Weill Cornell Medicine, New York, New York; and
| | | | - Sébastien Monette
- Tri-Institutional Training Program in Laboratory Animal Medicine and Science, Memorial Sloan Kettering Cancer Center, Weill Cornell Medicine, and The Rockefeller University, New York, New York
- Center for Comparative Medicine and Pathology, Memorial Sloan Kettering Cancer Center and Weill Cornell Medicine, New York, New York; and
| | - Neil S Lipman
- Tri-Institutional Training Program in Laboratory Animal Medicine and Science, Memorial Sloan Kettering Cancer Center, Weill Cornell Medicine, and The Rockefeller University, New York, New York
- Center for Comparative Medicine and Pathology, Memorial Sloan Kettering Cancer Center and Weill Cornell Medicine, New York, New York; and
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Marks I, Janmohamed IK, Malas S, Mavrou A, Banister T, Patel N, Ayaru L. Derivation and validation of a novel risk score to predict need for haemostatic intervention in acute upper gastrointestinal bleeding (London Haemostat Score). BMJ Open Gastroenterol 2023; 10:bmjgast-2022-001008. [PMID: 36997237 PMCID: PMC10069503 DOI: 10.1136/bmjgast-2022-001008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 02/09/2023] [Indexed: 04/01/2023] Open
Abstract
BACKGROUND Acute upper gastrointestinal bleeding (AUGIB) is a common medical emergency, which takes up considerable healthcare resources. However, only approximately 20%-30% of bleeds require urgent haemostatic intervention. Current standard of care is for all patients admitted to hospital to undergo endoscopy within 24 hours for risk stratification, but this is difficult to achieve in practice, invasive and costly. AIM To develop a novel non-endoscopic risk stratification tool for AUGIB to predict the need for haemostatic intervention by endoscopic, radiological or surgical treatments. We compared this with the Glasgow-Blatchford Score (GBS). DESIGN Model development was carried out using a derivation (n=466) and prospectively collected validation cohort (n=404) of patients who were admitted with AUGIB to three large hospitals in London, UK (2015-2020). Univariable and multivariable logistic regression analysis was used to identify variables that were associated with increased or decreased chances of requiring haemostatic intervention. This model was converted into a risk scoring system, the London Haemostat Score (LHS). RESULTS The LHS was more accurate at predicting need for haemostatic intervention than the GBS, in the derivation cohort (area under the receiver operating curve (AUROC) 0.82; 95% CI 0.78 to 0.86 vs 0.72; 95% CI 0.67 to 0.77; p<0.001) and validation cohort (AUROC 0.80; 95% CI 0.75 to 0.85 vs 0.72; 95% CI 0.67 to 0.78; p<0.001). At cut-off scores at which LHS and GBS identified patients who required haemostatic intervention with 98% sensitivity, the specificity of the LHS was 41% vs 18% with the GBS (p<0.001). This could translate to 32% of inpatient endoscopies for AUGIB being avoided at a cost of only a 0.5% false negative rate. CONCLUSIONS The LHS is accurate at predicting the need for haemostatic intervention in AUGIB and could be used to identify a proportion of low-risk patients who can undergo delayed or outpatient endoscopy. Validation in other geographical settings is required before routine clinical use.
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Affiliation(s)
- Isobel Marks
- Gastroenterology, Imperial College Healthcare NHS Trust, London, UK
| | | | - Sadek Malas
- Gastroenterology, Imperial College Healthcare NHS Trust, London, UK
| | - Athina Mavrou
- Gastroenterology, Imperial College Healthcare NHS Trust, London, UK
| | - Thomas Banister
- Gastroenterology, Imperial College Healthcare NHS Trust, London, UK
| | - Nisha Patel
- Surgery and Cancer, Imperial College London, London, UK
| | - Lakshmana Ayaru
- Gastroenterology, Imperial College Healthcare NHS Trust, London, UK
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Margo TE, McMullin PR, Kaddouh F. An interval of clinically silent gastrointestinal bleed in dysautonomic spinal cord injury: a case report. BMC Neurol 2023; 23:70. [PMID: 36788525 PMCID: PMC9925924 DOI: 10.1186/s12883-023-03114-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Accepted: 02/08/2023] [Indexed: 02/16/2023] Open
Abstract
BACKGROUND Gastrointestinal bleed (GIB) has high incidence in traumatic spinal cord injured (tSCI) patients and can frequently be life-threatening, especially early post-injury. Several risk factors often compound bleeding risk, some are unique to this patient population. Normally, clinical suspicion for GIB arises from symptoms like coffee-ground emesis, hematemesis, melena or even hematochezia. A hemoglobin drop may be a late sign. Due to tSCI, however, patients often experience neurogenic bowels and dysautonomia, which may delay symptom presentation and complicate timely diagnosis of GIB. We report a case of an almost clinically silent GI bleed in the context of acute cervical tSCI. CASE PRESENTATION A 21-year-old female presented with cervical cord transection at C-7 in the setting of motor vehicle rollover, for which surgical decompression was performed. During the acute injury phase, she also received a 10-day course of dexamethasone for symptomatic COVID-19 pneumonia. Two weeks after injury, she underwent percutaneous endoscopic gastrostomy (PEG) placement which demonstrated normal gastric and duodenal anatomy. One week later, a large spike (10x) in blood urea nitrogen: creatinine (BUN: Cr) ratio raised concern for GIB, but hemoglobin remained stable, and stool color remained unchanged. The following day, a gastroenterology consult was requested under increased suspicion of GIB from a sudden 3.5 g/dL hemoglobin drop. The patient received blood transfusion and pantoprazole. An upper endoscopy was performed, revealing three small duodenal ulcers. Melanotic stool ensued afterwards. CONCLUSIONS Due to dysautonomia, clinical presentation of GIB can be significantly delayed in the tSCI patient population, leaving them vulnerable to succumb to illness. This case illustrates the possibility of an interval in which the patient was bleeding, with the sole indicator being an elevated BUN. Our case calls for closer monitoring of and vigilance for tSCI patients, and possibly employment of different strategies to reduce the incidence and enhance early detection of GIB in tSCI patients to subsequently decrease the morbidity and mortality associated with it.
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Affiliation(s)
- Theodore E. Margo
- grid.267309.90000 0001 0629 5880Long School of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, TX USA
| | - Preston R. McMullin
- grid.267309.90000 0001 0629 5880Long School of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, TX USA
| | - Firas Kaddouh
- grid.267309.90000 0001 0629 5880Neurosurgery Department, University of Texas Health Science Center at San Antonio, San Antonio, TX USA
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Nishiura N, Kitai T, Okada T, Sano M, Miyawaki N, Kim K, Murai R, Toyota T, Sasaki Y, Ehara N, Kobori A, Kinoshita M, Koyama T, Furukawa Y. Long-Term Clinical Outcomes in Patients With Severe Tricuspid Regurgitation. J Am Heart Assoc 2022; 12:e025751. [PMID: 36565178 PMCID: PMC9973603 DOI: 10.1161/jaha.122.025751] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Background The natural history and optimal interventional timing in patients with isolated severe tricuspid regurgitation (TR) have not been well studied. This study aimed to investigate long-term clinical outcomes and risk factors associated with poor prognosis in patients with isolated severe TR. Methods and Results Consecutive transthoracic echocardiographic examinations in 2877 patients with isolated severe TR were retrospectively reviewed. Patients with significant left-sided valve disease or repeated examinations were excluded. Primary outcome was defined as a composite of all-cause death and hospitalization for heart failure. Among the 613 enrolled patients (mean age, 74±13 years; men, 38%), 141 died, and 62 were hospitalized for heart failure during the median follow-up period of 26.5 (interquartile range, 6.0-57.9) months. The 5-year event-free rate was 60.1%. TR pressure gradient (adjusted hazard ratio [HR], 1.03 [95% CI, 1.01-1.04]), blood urea nitrogen (adjusted HR, 1.02 [95% CI, 1.01-1.04]), left atrial volume index (adjusted HR, 1.01 [95% CI, 1.002-1.02]), and serum albumin (adjusted HR, 0.56 [95% CI, 0.36-0.95]) were identified as independent predictors of adverse events. A risk model based on the 4 clinical factors that included pulmonary hypertension (TR pressure gradient >40 mm Hg), elevated blood urea nitrogen levels (>25 mg/dL), decreased albumin levels (<3.7 g/dL), and left atrial enlargement (left atrial volume index <34 mL/m2) revealed a graded increase in the risk of adverse events (P<0.001). Conclusions The prognosis of isolated severe TR is not always favorable. Careful attention should be paid to patients with concomitant risk factors, such as pulmonary hypertension, elevated blood urea nitrogen levels, decreased albumin levels, and left atrial enlargement.
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Affiliation(s)
- Naoki Nishiura
- Department of Cardiovascular MedicineKobe City Medical Center General HospitalKobeJapan
| | - Takeshi Kitai
- Department of Cardiovascular MedicineKobe City Medical Center General HospitalKobeJapan,Department of Cardiovascular MedicineNational Cerebral and Cardiovascular CenterOsakaJapan
| | - Taiji Okada
- Department of Cardiovascular MedicineKobe City Medical Center General HospitalKobeJapan
| | - Madoka Sano
- Department of Cardiovascular MedicineKobe City Medical Center General HospitalKobeJapan
| | - Norihisa Miyawaki
- Department of Cardiovascular MedicineKobe City Medical Center General HospitalKobeJapan
| | - Kitae Kim
- Department of Cardiovascular MedicineKobe City Medical Center General HospitalKobeJapan
| | - Ryosuke Murai
- Department of Cardiovascular MedicineKobe City Medical Center General HospitalKobeJapan
| | - Toshiaki Toyota
- Department of Cardiovascular MedicineKobe City Medical Center General HospitalKobeJapan
| | - Yasuhiro Sasaki
- Department of Cardiovascular MedicineKobe City Medical Center General HospitalKobeJapan
| | - Natsuhiko Ehara
- Department of Cardiovascular MedicineKobe City Medical Center General HospitalKobeJapan
| | - Atsushi Kobori
- Department of Cardiovascular MedicineKobe City Medical Center General HospitalKobeJapan
| | - Makoto Kinoshita
- Department of Cardiovascular MedicineKobe City Medical Center General HospitalKobeJapan
| | - Tadaaki Koyama
- Department of Cardiothoracic SurgeryKobe City Medical Center General HospitalKobeJapan
| | - Yutaka Furukawa
- Department of Cardiovascular MedicineKobe City Medical Center General HospitalKobeJapan
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Hao J, Dang P, Quan X, Chen Z, Zhang G, Liu H, Shi T, Yan Y. Risk factors, prediction model, and prognosis analysis of myocardial injury after acute upper gastrointestinal bleeding. Front Cardiovasc Med 2022; 9:1041062. [PMID: 36568536 PMCID: PMC9772534 DOI: 10.3389/fcvm.2022.1041062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Accepted: 11/18/2022] [Indexed: 12/13/2022] Open
Abstract
Background Cardiovascular complications in patients with acute upper gastrointestinal bleeding (AUGIB) have been associated with a high-risk of subsequent adverse consequences. This study aimed to analyze the risk factors for myocardial injury in AUGIB patients, predict the risk of myocardial injury, and explore the clinical prognosis and influencing factors in AUGIB patients with myocardial injury. Materials and methods A retrospective case-control study based on AUGIB patients in the First Affiliated Hospital of Xi'an Jiaotong University from 2016 to 2020 was performed. We divided the enrolled patients into a myocardial injury group and a control group according to whether they developed myocardial injury. The variables significant in the univariate analysis were subjected to binary logistic regression for risk factor analysis and were used to establish a nomogram for predicting myocardial injury. In addition, logistic regression analysis was performed to better understand the risk factors for in-hospital mortality after myocardial injury. Result Of the 989 AUGIB patients enrolled, 10.2% (101/989) developed myocardial injury. Logistic regression analysis showed that the strong predictors of myocardial injury were a history of hypertension (OR: 4.252, 95% CI: 1.149-15.730, P = 0.030), blood urea nitrogen (BUN) (OR: 1.159, 95% CI: 1.026-1.309, P = 0.018) and left ventricular ejection fraction (LVEF) <68% (OR: 3.667, 95% CI: 1.085-12.398, P = 0.037). The patients with a tumor history (digestive system tumors and non-digestive system tumors) had no significant difference between the myocardial injury group and the control group (P = 0.246). A prognostic nomogram model was established based on these factors with an area under the receiver operator characteristic curve of 0.823 (95% CI: 0.730-0.916). The patients with myocardial injury had a much higher in-hospital mortality rate (10.9% vs. 2.0%, P < 0.001), and an elevated D-dimer level was related to in-hospital mortality among the AUGIB patients with myocardial injury (OR: 1.273, 95% CI: 1.085-1.494, P = 0.003). Conclusion A history of hypertension, renal dysfunction, and cardiac function with LVEF <68% were strong predictors of myocardial injury. Coagulopathy was found to be associated with poor prognosis in AUGIB patients with myocardial injury.
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Affiliation(s)
- Junjun Hao
- Department of Cardiovascular Surgery, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Peizhu Dang
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Xingpu Quan
- Department of Gastroenterology, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Zexuan Chen
- Department of Cardiovascular Surgery, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Guiyun Zhang
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Hui Liu
- The Biobank of The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Tao Shi
- Department of Cardiovascular Surgery, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China,*Correspondence: Tao Shi,
| | - Yang Yan
- Department of Cardiovascular Surgery, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China,Yang Yan,
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Rezagholizadeh A, Adib ZK, Entezari-Maleki T. Evaluation of the activated partial thromboplastin time and its influential factors in ischemic heart disease patients under heparin treatment. Blood Coagul Fibrinolysis 2021; 32:496-503. [PMID: 34650022 DOI: 10.1097/mbc.0000000000001088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
This study aimed to detect the defects of the current methods used to monitor unfractionated heparin (UFH) anticoagulant effect and find possible assistive parameters for activated partial thromboplastin time (aPTT) test to improve treatment performance. The required information was gathered from patients' case records, treatment charts and laboratory reports. Kendall's tau correlation coefficient was calculated for analysing the relationship between variables. The partial least squares (PLS) and the stepwise multiple regression were operated, and the area under the receiver operating characteristic curve (AUC) and the r-squared (r2) were used to show the analytical ability of the models, respectively. Overall, 102 UFH-receiving ischemic heart disease patients participated in this study. The aPTT value varied from 30 to 95 s (mean ± SD = 44 ± 14). Therapeutic aPTT values were observed in 15% of hospitalization days. The aPTT value showed statistically significant correlations with mean UFH infusion (U/kg/h), age, prothrombin time (PT), smoking, international normalized ratio, haemoglobin (Hgb) and blood triglyceride level. Triglyceride level and PT were efficacious predictors of aPTT value (P < 0.001, r2 = 0.336). Moreover, blood urea nitrogen (BUN) and blood creatinine (Cr) levels were the best predictors for mortality. The mean BUN/Cr ratio was 18 ± 5 and 25 ± 12 in nonexpired and expired subjects, respectively. If calibrated institution-specific therapeutic aPTT ranges and updated weight-based UFH nomograms get employed, aPTT test, along with the BUN/Cr ratio and Hgb level, as assistive parameters for predicting haemorrhagic incidents, would be near ideal monitoring method in UFH-receiving patients.
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Affiliation(s)
| | | | - Taher Entezari-Maleki
- Department of Clinical Pharmacy, Faculty of Pharmacy
- Cardiovascular Research Centre, Tabriz University of Medical Sciences, Tabriz, Iran
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Stiller J, Defarges AM, Brisson BA, Bersenas AME, Pomrantz JS, Lang B, Pearl DL. Diagnostic evaluation of urea nitrogen/creatinine ratio in dogs with gastrointestinal bleeding. J Vet Intern Med 2021; 35:1427-1438. [PMID: 33728701 PMCID: PMC8162593 DOI: 10.1111/jvim.16101] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 02/24/2021] [Accepted: 02/24/2021] [Indexed: 12/25/2022] Open
Abstract
Background Urea nitrogen/creatinine ratio (UCR) is a marker for upper gastrointestinal bleeding (GIB) in people. Objectives To assess the usefulness of UCR to predict occult GIB and distinguish upper from lower GIB in dogs. Animals Eighty‐nine dogs with GIB and 65 clinically healthy dogs. Dogs were grouped according to 65 overt GIB and 24 occult GIB, and based on lesion localization (37 upper, 13 lower, and 8 both). Methods Seventy‐four dogs were included retrospectively and 15 dogs prospectively. Serum urea nitrogen and creatinine concentrations, UCR, hemoglobin concentration, hematocrit, mean corpuscular volume, and mean corpuscular hemoglobin concentration were compared between groups. Logistic regression models were fitted to assess if variables could distinguish occult GIB from being healthy and upper from lower GIB. Results The UCR was significantly higher in dogs with overt GIB compared to control dogs (P = .02) and dogs with occult GIB (P = .05). The UCR was not significantly associated with occult GIB vs being healthy, or upper vs lower GIB (P > .05 each). Dogs with higher hemoglobin concentration and hematocrit had significantly lower odds of having occult GIB than being healthy (P < .0001 each). Conclusions and Clinical Importance The UCR does not seem to be a clinically useful marker of occult GIB and appears to have poor discriminatory ability between upper and lower GIB. An increased UCR in a dog without signs of overt GIB, especially if its hematocrit is within the middle or upper reference interval, does not appear to warrant prompt prescription of gastrointestinal protectants.
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Affiliation(s)
- Jenny Stiller
- Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Guelph, Ontario, Canada.,Small Animal Clinic, College of Veterinary Medicine, University of Leipzig, Leipzig, Saxony, Germany
| | - Alice M Defarges
- Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Guelph, Ontario, Canada
| | - Brigitte A Brisson
- Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Guelph, Ontario, Canada
| | - Alexa M E Bersenas
- Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Guelph, Ontario, Canada
| | - Jill S Pomrantz
- North America Medical Consulting Services, IDEXX Laboratories, Inc., Westbrook, Maine, USA
| | - Brittany Lang
- Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Guelph, Ontario, Canada
| | - David L Pearl
- Department of Population Medicine, Ontario Veterinary College, University of Guelph, Guelph, Ontario, Canada
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10
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Dubin I, Schattner A. In a patient with shock, melena can be much delayed. Intern Emerg Med 2021; 16:241-242. [PMID: 32691213 DOI: 10.1007/s11739-020-02414-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 06/16/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Ina Dubin
- Department of Medicine, Laniado Hospital, Sanz Medical Centre, Netanya, Israel
| | - Ami Schattner
- Department of Medicine, Laniado Hospital, Sanz Medical Centre, Netanya, Israel.
- Faculty of Medicine, Hebrew University and Hadassah Medical School, Jerusalem, Israel.
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11
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Veerabathini BC, Manthani K, Gandhi S, Duddala N. A Very Rare Case of Primary Renal Squamous Cell Carcinoma Presenting With Xanthogranulomatous Pyelonephritis on Radiological Imaging. Cureus 2020; 12:e11871. [PMID: 33282610 PMCID: PMC7714747 DOI: 10.7759/cureus.11871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Xanthogranulomatous pyelonephritis (XGP) and primary renal squamous cell carcinoma (SCC) are both rare conditions that can present very similarly in a patient with renal staghorn calculi. We report a case of a 54-year-old male who presented with fatigue, vomiting and significant acute weight loss. The patient was initially believed to have XGP, but was ultimately diagnosed with both XGP and primary renal SCC. This case report and literature review is meant to elucidate the similarities and differences between XGP and primary renal SCC as both can be diagnostically challenging.
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Affiliation(s)
| | - Kaushik Manthani
- Family Medicine, Peconic Bay Medical Center - Northwell Health, Riverhead, USA
| | - Sandeep Gandhi
- Medicine, Peconic Bay Medical Center - Northwell Health, Riverhead, USA
| | - Nerin Duddala
- Internal Medicine, Prathima Institute of Medical Sciences, Karimnagar, IND
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12
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Zeighami S, Naghdi Sede N, Khajeh F, Ariafar A, Soltani M, Jahanabadi Z, Khaleghi A, Bazargan Z. Genital exam, a missed piece of the puzzle in medical diagnosis, can be lifesaving in men: A lesson from a case of a state of shock due to duodenal metastasis of testicular choriocarcinoma. Qatar Med J 2020; 2020:31. [PMID: 33282715 PMCID: PMC7684557 DOI: 10.5339/qmj.2020.31] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 06/06/2020] [Indexed: 01/23/2023] Open
Abstract
Here we reported a case of a 17-year-old man with a history of weakness, vertigo, nausea, vomiting and dark stool within the last three months prior to admission. He was taken to the Emergency Room in a state of shock. After resuscitation, vital signs became stable, but due to low hemoglobin (HB = 5 g/dl), to find the source of bleeding, endoscopy was performed and a mass in the duodenum was detected. The pathology report was metastatic germ cell tumor. On genital physical exam (PE) there was a mass in the right testis; thus, the patient underwent radical orchiectomy and choriocarcinoma was diagnosed. The patient then received chemotherapy for six months, and he responded well to the treatment. This case report confirmed that genital PE should be part of a patients visit, even when we cannot find logical relation between clinical presentation and genital PE.
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Affiliation(s)
- Shahryar Zeighami
- Urology Department, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Nima Naghdi Sede
- Urology Department, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Fatemeh Khajeh
- Pathology Department, Fasa University of Medical Sciences, Iran
| | - Ali Ariafar
- Urology Department, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Zahra Jahanabadi
- Urology Department, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Aliasghar Khaleghi
- Emergency medicine department, Fasa University of Medical Sciences, Iran
| | - Zahra Bazargan
- Pediatrics Department, Fasa University of Medical Sciences, Iran
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13
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Li D, Lv B, Wang D, Xu D, Qin S, Zhang Y, Chen J, Zhang W, Zhang Z, Xu F. Network Pharmacology and Bioactive Equivalence Assessment Integrated Strategy Driven Q-markers Discovery for Da-Cheng-Qi Decoction to Attenuate Intestinal Obstruction. PHYTOMEDICINE : INTERNATIONAL JOURNAL OF PHYTOTHERAPY AND PHYTOPHARMACOLOGY 2020; 72:153236. [PMID: 32464544 DOI: 10.1016/j.phymed.2020.153236] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Revised: 04/14/2020] [Accepted: 04/24/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Intestinal obstruction (IO) is a kind of acute abdomen with high morbidity and mortality. Patients suffer from poor quality of life and tremendous financial pressure. Da-Cheng-Qi decoction (DCQD), a classical purgation prescription, has clinically been proven to be an effective treatment for IO. PURPOSE Network pharmacology integrated with bioactive equivalence assessment was used to discover the quality marker (Q-marker) of DCQD against IO. METHODS As there is hardly any targets recorded in database, thus the collection of IO targets was conducted by searching those of alternative diseases which have similar pathological symptoms with IO. In order to improve the reliability of the obtained targets, IO metabolomics data was introduced. Active compounds combination (ACC) was focused as potential Q-markers via component-target network analysis and function query from the identified components corresponding to the common targets. Bioequivalence between ACC and DCQD was assessed from the aspects of intestine motility (somatostatin secretion), inflammation (IL-6 secretion) and injury (wound healing assay) in vitro and was further validated in ileus rat model. PPI network analysis of core targets followed by gene pedigree classification and experimental validation confirmed the potential intervention pathway. RESULTS A combination of 11 ingredients, including emodin, physcion, aloe-emodin, rhein, chrysophanol, gallic acid, magnolol, honokiol, naringenin, tangeretin, and nobiletin was finally confirmed bioequivalence with DQCD to some extent and could serve as Q-markers for DCQD to attenuate IO. PI3K/AKT was verified as a possible affected pathway that DCQD exerted the effectiveness against IO. CONCLUSION For the disease with few recorded targets, searching those of alternative diseases which have similar pathological symptoms could be a feasible and effective approach. The proposed network pharmacology integrated bioactive equivalence evaluation paradigm is efficient to discover Q-marker of herbal formulae.
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Affiliation(s)
- Danting Li
- Key Laboratory of Drug Quality Control and Pharmacovigilance (Ministry of Education), State Key Laboratory of Natural Medicine, China Pharmaceutical University, Nanjing 210009, P. R. China
| | - Bo Lv
- Key Laboratory of Drug Quality Control and Pharmacovigilance (Ministry of Education), State Key Laboratory of Natural Medicine, China Pharmaceutical University, Nanjing 210009, P. R. China
| | - Di Wang
- Key Laboratory of Drug Quality Control and Pharmacovigilance (Ministry of Education), State Key Laboratory of Natural Medicine, China Pharmaceutical University, Nanjing 210009, P. R. China
| | - Doudou Xu
- Key Laboratory of Drug Quality Control and Pharmacovigilance (Ministry of Education), State Key Laboratory of Natural Medicine, China Pharmaceutical University, Nanjing 210009, P. R. China
| | - Siyuan Qin
- Key Laboratory of Drug Quality Control and Pharmacovigilance (Ministry of Education), State Key Laboratory of Natural Medicine, China Pharmaceutical University, Nanjing 210009, P. R. China
| | - Ying Zhang
- Key Laboratory of Drug Quality Control and Pharmacovigilance (Ministry of Education), State Key Laboratory of Natural Medicine, China Pharmaceutical University, Nanjing 210009, P. R. China
| | - Jie Chen
- Key Laboratory of Drug Quality Control and Pharmacovigilance (Ministry of Education), State Key Laboratory of Natural Medicine, China Pharmaceutical University, Nanjing 210009, P. R. China
| | - Wei Zhang
- State Key Laboratory for Quality Research in Chinese Medicines, Macau University of Science and Technology, Taipa, Macau, China
| | - Zunjian Zhang
- Key Laboratory of Drug Quality Control and Pharmacovigilance (Ministry of Education), State Key Laboratory of Natural Medicine, China Pharmaceutical University, Nanjing 210009, P. R. China.
| | - Fengguo Xu
- Key Laboratory of Drug Quality Control and Pharmacovigilance (Ministry of Education), State Key Laboratory of Natural Medicine, China Pharmaceutical University, Nanjing 210009, P. R. China.
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Contreras-Aguilar MD, Escribano D, Martínez-Subiela S, Martín-Cuervo M, Lamy E, Tecles F, Cerón JJ. Changes in saliva analytes in equine acute abdominal disease: a sialochemistry approach. BMC Vet Res 2019; 15:187. [PMID: 31170977 PMCID: PMC6554884 DOI: 10.1186/s12917-019-1933-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2019] [Accepted: 05/23/2019] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND The biochemical components of saliva can change in certain pathologies in horses, for example in acute abdominal disease. The aim of this study was (1) to evaluate if a panel of biochemical analytes usually used in serum can be measured in saliva of horses and (2) to study the possible changes of these biochemical analytes in saliva of horses affected by acute abdominal disease. A panel of 23 analytes was analytically validated in saliva of horses and possible changes in these analytes in a pilot study with six healthy horses and six horses with acute abdominal disease were evaluated. The analytes with significant changes were then evaluated in a larger population of 20 healthy and 37 diseased horses. RESULTS Seven analytes showed significant increases in the pilot study which were confirmed in the larger population. The analytes which showed significant changes, and their median fold increase and significance shown in the larger population were salivary γ-glutamyl transferase (gGT, 2.3 fold, P = 0.001), creatine kinase (CK, 6.2 fold, P < 0.001), urea (2.3 fold, P = 0.001), total bilirubin (2.6 fold, P < 0.001), total proteins (3.2 fold, P < 0.001), phosphorus (P, 4.5 fold, P < 0.001) and alpha-amylase (sAA, 8.5 fold, P < 0.001). Total proteins, P and sAA showed sensitivities higher than 70% at their optimal cut-off points and a specificity of 100% in differentiating between healthy horses and those with acute abdominal disease. CONCLUSIONS A panel of 23 biochemical analytes can be measured in saliva of horses, where gGT, CK, urea, total bilirubin, total protein, P and sAA levels are raised in horses with acute abdominal disease.
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Affiliation(s)
- María Dolores Contreras-Aguilar
- Interdisciplinary Laboratory of Clinical Analysis (Interlab-UMU), Veterinary School, Campus of Excellence Mare Nostrum, University of Murcia, Campus de Espinardo s/n, 30100 Espinardo, Murcia, Spain
| | - Damián Escribano
- Interdisciplinary Laboratory of Clinical Analysis (Interlab-UMU), Veterinary School, Campus of Excellence Mare Nostrum, University of Murcia, Campus de Espinardo s/n, 30100 Espinardo, Murcia, Spain
- Department of Food and Animal Science, School of Veterinary Medicine, University of Barcelona, Bellaterra, 08193 Barcelona, Spain
| | - Silvia Martínez-Subiela
- Interdisciplinary Laboratory of Clinical Analysis (Interlab-UMU), Veterinary School, Campus of Excellence Mare Nostrum, University of Murcia, Campus de Espinardo s/n, 30100 Espinardo, Murcia, Spain
| | - María Martín-Cuervo
- Animal Medicine, Faculty of Veterinary Medicine of Cáceres, University of Extremadura, Av. de la Universidad S-N, 10005 Cáceres, Spain
| | - Elsa Lamy
- Institute of Mediterranean Agricultural and Environmental Sciences, University of Évora, Núcleo da Mitra, Apartado 94, 7006-554 Évora, Portugal
| | - Fernando Tecles
- Interdisciplinary Laboratory of Clinical Analysis (Interlab-UMU), Veterinary School, Campus of Excellence Mare Nostrum, University of Murcia, Campus de Espinardo s/n, 30100 Espinardo, Murcia, Spain
| | - Jose Joaquín Cerón
- Interdisciplinary Laboratory of Clinical Analysis (Interlab-UMU), Veterinary School, Campus of Excellence Mare Nostrum, University of Murcia, Campus de Espinardo s/n, 30100 Espinardo, Murcia, Spain
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15
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Wu KH, Shih HA, Hung MS, Hsiao CT, Chen YC. The association between blood urea nitrogen to creatinine ratio and mortality in patients with upper gastrointestinal bleeding. Arab J Gastroenterol 2018; 19:143-147. [PMID: 30522883 DOI: 10.1016/j.ajg.2018.11.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Revised: 10/12/2018] [Accepted: 11/25/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND STUDY AIMS Azotaemia is commonly identified among patients with upper gastrointestinal bleeding (UGIB) due to absorption of blood products in the small bowel. Previous studies have found blood urea nitrogen-to-creatinine (BUN/Cr) ratio to be significantly elevated among patients UGIB bleeding compared to patients with lower GI bleeding. However, no studies have explored the relationship between BUN/Cr ratio and mortality. This study is aimed at investigating how BUN/Cr ratio relates to outcomes for UGIB patients. PATIENTS AND METHODS This study was conducted prospectively at a university-affiliated teaching hospital with approximate 70,000 annual emergency department (ED) visits. Data from a total of 258 adult UGIB patients were collected between March 1, 2011 and March 1, 2012. Cox regression analysis was used to identify risk factors for 30-day mortality. RESULTS Malignancy and Rockall score were associated with increased risk of 30-day mortality (Unadjusted hazard ratio (HR): 3.87, 95% CI: 1.59-9.41, p = 0.0029; HR: 1.31, 95% CI: 1.02-1.71, p = 0.0476, respectively). However, BUN/Cr > 30 was associated with lower risk of 30-day mortality (HR: 0.32, 95% CI: 0.11-0.97, p = 0.0441). CONCLUSIONS A BUN/Cr ratio of >30 was found to be an independent risk factor for mortality and may be useful for pre-endoscopic assessment. Development of future risk scoring systems might warrant consideration of including BUN/Cr ratio as a parameter for estimating risk.
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Affiliation(s)
- Kai-Hsiang Wu
- Department of Emergency Medicine, Chang Gung Memorial Hospital, No. 6, W. Sec., Jiapu Rd., Puzih City, Chiayi County 613, Taiwan
| | - Hsin-An Shih
- Department of Emergency Medicine, Chang Gung Memorial Hospital, No. 6, W. Sec., Jiapu Rd., Puzih City, Chiayi County 613, Taiwan
| | - Ming-Szu Hung
- Chang Gung University College of Medicine, No. 5, Fusing St., Gueishan Township, Taoyuan County 333, Taiwan; Division of Thoracic Oncology, Department of Pulmonary and Critical Care Medicine, Chang Gung Memorial Hospital, No. 6, W. Sec., Jiapu Rd., Puzih City, Chiayi County 613, Taiwan
| | - Cheng-Ting Hsiao
- Department of Emergency Medicine, Chang Gung Memorial Hospital, No. 6, W. Sec., Jiapu Rd., Puzih City, Chiayi County 613, Taiwan; Chang Gung University College of Medicine, No. 5, Fusing St., Gueishan Township, Taoyuan County 333, Taiwan
| | - Yi-Chuan Chen
- Department of Emergency Medicine, Chang Gung Memorial Hospital, No. 6, W. Sec., Jiapu Rd., Puzih City, Chiayi County 613, Taiwan; Department of Nursing, Chang Gung University of Science and Technology, Chiayi Campus, Chiayi, Taiwan.
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16
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Kim G, Soto JA, Morrison T. Radiologic Assessment of Gastrointestinal Bleeding. Gastroenterol Clin North Am 2018; 47:501-514. [PMID: 30115434 DOI: 10.1016/j.gtc.2018.04.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
Abstract
Gastrointestinal (GI) bleeding represents a broad differential of disease throughout the GI tract. The proper diagnostic evaluation of patients presenting with symptoms of GI bleeding depends on the overall clinical acuity and suspected source locations. The radiologic assessment of these patients is centered around computed tomography (CT) angiography, CT enterography, conventional angiography, and nuclear scintigraphy.
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Affiliation(s)
- Gene Kim
- Department of Radiology, Boston University Medical Center, 820 Harrison Avenue FGH Building, 3rd Floor, Boston, MA 02118, USA.
| | - Jorge A Soto
- Department of Radiology, Boston University Medical Center, 820 Harrison Avenue FGH Building, 3rd Floor, Boston, MA 02118, USA
| | - Trevor Morrison
- Department of Radiology, Boston University Medical Center, 820 Harrison Avenue FGH Building, 3rd Floor, Boston, MA 02118, USA
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17
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Kumar NL, Claggett BL, Cohen AJ, Nayor J, Saltzman JR. Association between an increase in blood urea nitrogen at 24 hours and worse outcomes in acute nonvariceal upper GI bleeding. Gastrointest Endosc 2017; 86:1022-1027.e1. [PMID: 28377105 DOI: 10.1016/j.gie.2017.03.1533] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Accepted: 03/26/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND AIMS An increase in blood urea nitrogen (BUN) at 24 hours is a solitary and significant predictor of mortality in patients with acute pancreatitis, which may predict worse outcomes in the similarly resuscitation-requiring condition of acute nonvariceal upper GI bleeding (UGIB). The aim of our study was to assess whether an increase in BUN at 24 hours is predictive of worse clinical outcomes in acute nonvariceal UGIB. METHODS A retrospective cohort study including patients admitted to an academic hospital from 2004 to 2014 was conducted. An increase in BUN was defined as an increase in BUN at 24 hours of hospitalization compared with BUN at presentation. The primary outcome was a composite of inpatient death, inpatient rebleeding, need for surgical or radiologic intervention, or endoscopic reintervention. Associations between BUN change and outcomes were assessed via the Pearson χ2 test and the Fisher exact test and via logistic regression for adjusted analyses. RESULTS There were 357 patients included in the analysis with a mean age of 64 years; 54% were men. The mean change in BUN was -10.1 mg/dL (standard deviation, 12.7 mg/dL). Patients with an increased BUN (n = 37 [10%]) were significantly more likely to experience the composite outcome (22% vs 9%, P = .014), including an increased risk of inpatient death (8% vs 1%, P = .004), compared with patients with a decreased or unchanged BUN (n = 320 [90%]). In a logistic regression model adjusting for the AIMS65 score, an increase in BUN was independently associated with an increased risk for the composite outcome (odds ratio, 2.75; P = .026). CONCLUSION Increasing BUN at 24 hours likely reflects under resuscitation and is a predictor of worse outcomes in patients with acute nonvariceal UGIB.
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Affiliation(s)
- Navin L Kumar
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Boston, Massachusetts, USA; Harvard Medical School, Boston, Massachusetts, USA
| | | | | | - Jennifer Nayor
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Boston, Massachusetts, USA; Harvard Medical School, Boston, Massachusetts, USA
| | - John R Saltzman
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Boston, Massachusetts, USA; Harvard Medical School, Boston, Massachusetts, USA
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18
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Zamparini E, Ahmed P, Belhassan M, Horaist C, Bouguerba A, Ayed S, Barchasz J, Boukari M, Goldgran-Toledano D, Yaacoubi S, Bornstain C, Nahon S, Vincent F. Orientation des patients adultes consultant aux urgences pour hémorragie digestive (hors hypertension portale prouvée ou présumée) : intérêt des scores pronostiques. MEDECINE INTENSIVE REANIMATION 2017. [DOI: 10.1007/s13546-017-1288-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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19
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Cano-Torres EA, Simental-Mendía LE, Morales-Garza LA, Ramos-Delgado JM, Reyes-Gonzalez MM, Sánchez-Nava VM, Barragán-Berlanga ADJ, Rangel-Rodríguez I, Guerrero-Romero F. Impact of Nutritional Intervention on Length of Hospital Stay and Mortality among Hospitalized Patients with Malnutrition: A Clinical Randomized Controlled Trial. J Am Coll Nutr 2017; 36:235-239. [PMID: 28318388 DOI: 10.1080/07315724.2016.1259595] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
OBJECTIVE The objective of this study was to evaluate the impact of a nutritional intervention on hospital stay and mortality among hospitalized patients with malnutrition. METHODS Hospitalized patients with a diagnosis of malnutrition were enrolled and randomly allocated to either an intervention or control group. Participants in the intervention group received an individualized nutrition plan according to energy and protein (1.0-1.5 g/kg) intake requirements as well as dietary advice based on face-to-face interviews with patients and their caregivers or family members. Individuals in the control group received standard nutritional management according to the Hospital Nutrition Department. Nutritional status and disease severity were assessed using nutritional risk screening. Length of hospital stay was defined by the number of days of hospitalization from hospital admission to medical discharge. Reference to another service or death were criteria for study withdrawal. To evaluate mortality, individuals were followed up for 6 months after hospital discharge. Hospital stay and mortality were the intention-to-treat analysis. RESULTS A total of 55 patients with an average age of 57.1 ± 20.7 years were included into intervention (n = 28) and control (n = 27) groups, respectively. At basal condition, nutritional status, measured by nutritional risk screening score, was similar between the study groups (4.1 ± 0.8 vs 4.2 ± 1.2, p = 0.6). The average hospital stay was lower in the intervention group compared to the control group (6.4 ± 3.0 vs 8.4 ± 4.0 days, p = 0.03). Finally, the mortality rate at 6 months of follow-up was similar in both groups (hazard ratio [HR] = 0.85; 95% confidence interval [CI], 0.17-4.21). CONCLUSIONS Results of this study suggest that, in hospitalized patients with malnutrition, nutritional intervention and dietary advice decrease hospital stay but not mortality.
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Affiliation(s)
- Edgar A Cano-Torres
- a Hospital San José, Escuela Nacional de Medicina del Tecnológico de Monterrey , Monterrey , Nuevo León , México
| | - Luis E Simental-Mendía
- b Biomedical Research Unit of the Mexican Social Security Institute at Durango , Durango , Dgo ., México
| | - Luis A Morales-Garza
- a Hospital San José, Escuela Nacional de Medicina del Tecnológico de Monterrey , Monterrey , Nuevo León , México
| | - José M Ramos-Delgado
- a Hospital San José, Escuela Nacional de Medicina del Tecnológico de Monterrey , Monterrey , Nuevo León , México
| | - Mirthala M Reyes-Gonzalez
- a Hospital San José, Escuela Nacional de Medicina del Tecnológico de Monterrey , Monterrey , Nuevo León , México
| | - Victor M Sánchez-Nava
- a Hospital San José, Escuela Nacional de Medicina del Tecnológico de Monterrey , Monterrey , Nuevo León , México
| | - Abel de J Barragán-Berlanga
- c Hospital Metropolitano Dr. Bernardo Sepúlveda, Secretaria de Salud de Nuevo León , Monterrey , Nuevo León , México
| | - Ignacio Rangel-Rodríguez
- a Hospital San José, Escuela Nacional de Medicina del Tecnológico de Monterrey , Monterrey , Nuevo León , México
| | - Fernando Guerrero-Romero
- b Biomedical Research Unit of the Mexican Social Security Institute at Durango , Durango , Dgo ., México
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20
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García-Iglesias P, Botargues JM, Feu Caballé F, Villanueva Sánchez C, Calvet Calvo X, Brullet Benedi E, Cánovas Moreno G, Fort Martorell E, Gallach Montero M, Gené Tous E, Hidalgo Rosas JM, Lago Macía A, Nieto Rodríguez A, Papo Berger M, Planella de Rubinat M, Saló Rich J, Campo Fernández de Los Ríos R. Management of non variceal upper gastrointestinal bleeding: position statement of the Catalan Society of Gastroenterology. GASTROENTEROLOGIA Y HEPATOLOGIA 2017; 40:363-374. [PMID: 28109636 DOI: 10.1016/j.gastrohep.2016.11.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/11/2016] [Revised: 11/22/2016] [Accepted: 11/25/2016] [Indexed: 12/11/2022]
Abstract
In recent years there have been advances in the management of non-variceal upper gastrointestinal bleeding that have helped reduce rebleeding and mortality. This document positioning of the Catalan Society of Digestologia is an update of evidence-based recommendations on management of gastrointestinal bleeding peptic ulcer.
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Affiliation(s)
- Pilar García-Iglesias
- Servei de Digestiu, Hospital de Sabadell-Corporació Sanitària i Universitària Parc Taulí, Sabadell, Barcelona, España.
| | - Josep-Maria Botargues
- Servei de Digestiu, Hospital Universitari de Bellvitge, l'Hospitalet, Barcelona, España
| | - Faust Feu Caballé
- Servei de Gastroenterologia, Institut de Malalties Digestives i Metabòliques, Hospital Clínic, Barcelona, España
| | | | - Xavier Calvet Calvo
- Servei de Digestiu, Hospital de Sabadell-Corporació Sanitària i Universitària Parc Taulí, Sabadell, Barcelona, España; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, España; Departament de Medicina, Universitat Autònoma de Barcelona, España
| | - Enric Brullet Benedi
- Servei de Digestiu, Hospital de Sabadell-Corporació Sanitària i Universitària Parc Taulí, Sabadell, Barcelona, España; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, España
| | - Gabriel Cánovas Moreno
- Servei de Cirurgia, Hospital de Sabadell-Corporació Sanitària i Universitària Parc Taulí, Sabadell, Barcelona, España
| | | | - Marta Gallach Montero
- Servei de Digestiu, Hospital de Sabadell-Corporació Sanitària i Universitària Parc Taulí, Sabadell, Barcelona, España; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, España
| | - Emili Gené Tous
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, España; Departament de Medicina, Universitat Autònoma de Barcelona, España; Servei d'Urgències, Hospital de Sabadell-Corporació Sanitària i Universitària Parc Taulí, Sabadell, Barcelona, España
| | - José-Manuel Hidalgo Rosas
- Servei de Cirurgia, Hospital de Sabadell-Corporació Sanitària i Universitària Parc Taulí, Sabadell, Barcelona, España
| | - Amelia Lago Macía
- Servei de Digestiu, Hospital de Tortosa Verge de la Cinta, Tortosa, Tarragona, España
| | | | | | | | - Joan Saló Rich
- Servei de Digestiu, Hospital de Vic, Vic, Barcelona, España
| | - Rafel Campo Fernández de Los Ríos
- Servei de Digestiu, Hospital de Sabadell-Corporació Sanitària i Universitària Parc Taulí, Sabadell, Barcelona, España; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, España; Departament de Medicina, Universitat Autònoma de Barcelona, España
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22
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Vinholt PJ, Alnor A, Nybo M, Hvas AM. Prediction of bleeding and prophylactic platelet transfusions in cancer patients with thrombocytopenia. Platelets 2016; 27:547-54. [DOI: 10.3109/09537104.2015.1131814] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
- Pernille J. Vinholt
- Department of Clinical Biochemistry and Pharmacology, Odense University Hospital, Odense C, Denmark
| | - Anne Alnor
- Department of Clinical Biochemistry and Pharmacology, Odense University Hospital, Odense C, Denmark
| | - Mads Nybo
- Department of Clinical Biochemistry and Pharmacology, Odense University Hospital, Odense C, Denmark
| | - Anne-Mette Hvas
- Department of Clinical Biochemistry, Aarhus University Hospital, Aarhus, Denmark
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23
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Guo H, Chen J, Huang Y, Zhang W, Xu F, Zhang Z. A pseudo-kinetics approach for time-series metabolomics investigations: more reliable and sensitive biomarkers revealed in vincristine-induced paralytic ileus rats. RSC Adv 2016. [DOI: 10.1039/c6ra12641c] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
A pseudo-kinetics approach was proposed to investigate global metabolic alterations and screen sensitive biomarkers based on AUC and Tmax calculations.
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Affiliation(s)
- Huimin Guo
- Key Laboratory of Drug Quality Control and Pharmacovigilance
- China Pharmaceutical University
- Ministry of Education
- Nanjing 210009
- China
| | - Jiaqing Chen
- Key Laboratory of Drug Quality Control and Pharmacovigilance
- China Pharmaceutical University
- Ministry of Education
- Nanjing 210009
- China
| | - Yin Huang
- Key Laboratory of Drug Quality Control and Pharmacovigilance
- China Pharmaceutical University
- Ministry of Education
- Nanjing 210009
- China
| | - Wei Zhang
- State Key Laboratory of Quality Research in Chinese Medicines
- Macau University of Science and Technology
- Taipa
- China
| | - Fengguo Xu
- Key Laboratory of Drug Quality Control and Pharmacovigilance
- China Pharmaceutical University
- Ministry of Education
- Nanjing 210009
- China
| | - Zunjian Zhang
- Key Laboratory of Drug Quality Control and Pharmacovigilance
- China Pharmaceutical University
- Ministry of Education
- Nanjing 210009
- China
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24
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Simon TG, Travis AC, Saltzman JR. Initial Assessment and Resuscitation in Nonvariceal Upper Gastrointestinal Bleeding. Gastrointest Endosc Clin N Am 2015; 25:429-42. [PMID: 26142029 DOI: 10.1016/j.giec.2015.02.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Acute nonvariceal upper gastrointestinal bleeding remains an important cause of hospital admission with an associated mortality of 2-14%. Initial patient evaluation includes rapid hemodynamic assessment, large-bore intravenous catheter insertion and volume resuscitation. A hemoglobin transfusion threshold of 7 g/dL is recommended, and packed red blood cell transfusion may be necessary to restore intravascular volume and improve tissue perfusion. Patients should be risk stratified into low- and high-risk categories, using validated prognostic scoring systems such as the Glasgow-Blatchford, AIMS65 or Rockall scores. Effective early management of acute, nonvariceal upper gastrointestinal hemorrhage is critical for improving patient outcomes.
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Affiliation(s)
- Tracey G Simon
- Department of Medicine, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02215, USA
| | - Anne C Travis
- Division of Gastroenterology, Hepatology and Endoscopy, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
| | - John R Saltzman
- Division of Gastroenterology, Hepatology and Endoscopy, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA.
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25
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Daimee UA, Moss AJ, Biton Y, Solomon SD, Klein HU, McNitt S, Polonsky B, Zareba W, Goldenberg I, Kutyifa V. Long-Term Outcomes With Cardiac Resynchronization Therapy in Patients With Mild Heart Failure With Moderate Renal Dysfunction. Circ Heart Fail 2015; 8:725-32. [DOI: 10.1161/circheartfailure.115.002082] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2015] [Accepted: 05/15/2015] [Indexed: 11/16/2022]
Abstract
Background—
We aimed to determine the impact of renal function on long-term outcomes with cardiac resynchronization therapy with defibrillator among patients with mild heart failure (HF).
Methods and Results—
We stratified 1820 Multicenter Automatic Defibrillator Implantation Trial–Cardiac Resynchronization Therapy patients by QRS morphology into those with and without left bundle-branch block. Subgroups within each QRS morphology category were created based on glomerular filtration rate (GFR): GFR <60 and ≥60 mL/min per 1.73 m
2
. Primary end point was death; secondary end points were HF/death and HF events alone during long-term follow-up. Among 1274 left bundle-branch block patients, 413 (32%) presented with GFR <60 (mean, 48.1±8.3) mL/min per 1.73 m
2
. Relative to the 861 (68%) patients with GFR ≥60 (mean, 79.6±16.0) mL/min per 1.73 m
2
, low-GFR patients experienced higher risk of death (hazard ratio [HR], 2.09; 95% confidence interval [CI], 1.53–2.86;
P
<0.01) and HF/death (HR, 1.46; 95% CI, 1.17–1.82;
P
<0.01). In both GFR groups, cardiac resynchronization therapy with defibrillator was associated with reduction in death (GFR <60: HR, 0.66; 95% CI, 0.44–1.00;
P
=0.05 and GFR ≥60: HR, 0.68; 95% CI, 0.44–1.05;
P
=0.08) and HF/death (GFR <60: HR, 0.49; 95% CI, 0.36–0.67;
P
<0.01 and GFR ≥60: HR, 0.50; 95% CI, 0.38–0.66;
P
<0.01). In the low-GFR group, there was greater absolute reduction in risk of death (GFR <60: 14% and GFR ≥60: 6%) and HF/death (GFR <60: 25 and GFR ≥60: 15%). Among non–left bundle-branch block patients, low GFR predicted outcomes; however, no benefit from cardiac resynchronization therapy with defibrillator was observed.
Conclusions—
In patients with mild HF, moderate renal dysfunction is associated with higher risk of death and HF during long-term follow-up. Patients with left bundle-branch block, regardless of baseline renal function, derive long-term benefit from cardiac resynchronization therapy with defibrillator, with greater absolute risk reduction in death and HF among those with moderate renal dysfunction.
Clinical Trial Registration—
URL:
http://www.clinicaltrials.gov
. Unique identifiers: NCT00180271, NCT01294449, and NCT02060110.
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Affiliation(s)
- Usama A. Daimee
- From the Heart Research Follow-up Program, Division of Cardiology, University of Rochester Medical Center, NY (U.A.D., A.J.M., Y.B., H.U.K., S.M., B.P., W.Z., I.G., V.K.); and Cardiovascular Division, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA (S.D.S.)
| | - Arthur J. Moss
- From the Heart Research Follow-up Program, Division of Cardiology, University of Rochester Medical Center, NY (U.A.D., A.J.M., Y.B., H.U.K., S.M., B.P., W.Z., I.G., V.K.); and Cardiovascular Division, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA (S.D.S.)
| | - Yitschak Biton
- From the Heart Research Follow-up Program, Division of Cardiology, University of Rochester Medical Center, NY (U.A.D., A.J.M., Y.B., H.U.K., S.M., B.P., W.Z., I.G., V.K.); and Cardiovascular Division, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA (S.D.S.)
| | - Scott D. Solomon
- From the Heart Research Follow-up Program, Division of Cardiology, University of Rochester Medical Center, NY (U.A.D., A.J.M., Y.B., H.U.K., S.M., B.P., W.Z., I.G., V.K.); and Cardiovascular Division, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA (S.D.S.)
| | - Helmut U. Klein
- From the Heart Research Follow-up Program, Division of Cardiology, University of Rochester Medical Center, NY (U.A.D., A.J.M., Y.B., H.U.K., S.M., B.P., W.Z., I.G., V.K.); and Cardiovascular Division, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA (S.D.S.)
| | - Scott McNitt
- From the Heart Research Follow-up Program, Division of Cardiology, University of Rochester Medical Center, NY (U.A.D., A.J.M., Y.B., H.U.K., S.M., B.P., W.Z., I.G., V.K.); and Cardiovascular Division, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA (S.D.S.)
| | - Bronislava Polonsky
- From the Heart Research Follow-up Program, Division of Cardiology, University of Rochester Medical Center, NY (U.A.D., A.J.M., Y.B., H.U.K., S.M., B.P., W.Z., I.G., V.K.); and Cardiovascular Division, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA (S.D.S.)
| | - Wojciech Zareba
- From the Heart Research Follow-up Program, Division of Cardiology, University of Rochester Medical Center, NY (U.A.D., A.J.M., Y.B., H.U.K., S.M., B.P., W.Z., I.G., V.K.); and Cardiovascular Division, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA (S.D.S.)
| | - Ilan Goldenberg
- From the Heart Research Follow-up Program, Division of Cardiology, University of Rochester Medical Center, NY (U.A.D., A.J.M., Y.B., H.U.K., S.M., B.P., W.Z., I.G., V.K.); and Cardiovascular Division, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA (S.D.S.)
| | - Valentina Kutyifa
- From the Heart Research Follow-up Program, Division of Cardiology, University of Rochester Medical Center, NY (U.A.D., A.J.M., Y.B., H.U.K., S.M., B.P., W.Z., I.G., V.K.); and Cardiovascular Division, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA (S.D.S.)
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26
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Kim KS, Kang CH, Kim JY. Availability of blood urea nitrogen/creatinine ratio in gastrointestinal bleeding with melena in children. Pediatr Gastroenterol Hepatol Nutr 2015; 18:30-8. [PMID: 25866731 PMCID: PMC4391998 DOI: 10.5223/pghn.2015.18.1.30] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2014] [Revised: 12/23/2014] [Accepted: 01/13/2015] [Indexed: 12/02/2022] Open
Abstract
PURPOSE The aims of our study were to evaluate the blood urea nitrogen to creatinine ratio (BUN/Cr ratio) for distinguishing between an upper and lower gastrointestinal bleeding (GIB), and differentiating between the two most common causes of upper gastrointestinal bleeding (UGIB) presenting with melena in children. METHODS Retrospective data of patients with GIB presenting with melena were analyzed. The data from 60 cases were reviewed including demographics, laboratory findings, diagnostic modalities and results, treatments, and transfusions. RESULTS Among the 60 cases, UGIB and lower gastrointestinal bleeding (LGIB) were found in 35 cases (58.3%) and 14 cases (23.3%), respectively. The two common causes of UGIB were varices (37.1%), and peptic ulcer diseases (PUD) (31.4%). The BUN/Cr ratio of 30 or greater was higher in UGIB than LGIB (odds ratio [OR], 6.9; 95% confidence interval [95% CI], 1.3-37.2). In UGIB, the BUN/Cr ratio of the varices group was higher than that of the PUD group (p=0.015). The OR for the BUN/Cr ratio appeared as 1.2 per unit increase in the varices group than the PUD group (95% CI, 1.03-1.3). There was no difference between the PUD group and Meckel's diverticulum group. CONCLUSION The BUN/Cr ratio was not uneven in differentiating UGIB from LGIB of children with melena in our study. This suggests that BUN/Cr ratio should be interpreted carefully.
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Affiliation(s)
- Kyu Seon Kim
- Department of Pediatrics, Chungnam National University School of Medicine, Daejeon, Korea
| | - Chan Ho Kang
- Department of Pediatrics, Chungnam National University School of Medicine, Daejeon, Korea
| | - Jae Young Kim
- Department of Pediatrics, Chungnam National University School of Medicine, Daejeon, Korea
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27
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How to differentiate sites of gastrointestinal bleeding in patients with hematochezia by using clinical factors? Gastroenterol Res Pract 2013; 2013:265076. [PMID: 24348531 PMCID: PMC3852082 DOI: 10.1155/2013/265076] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2013] [Revised: 10/03/2013] [Accepted: 10/19/2013] [Indexed: 01/05/2023] Open
Abstract
Hematochezia is one of common gastrointestinal complaint at the Emergency Department (ED). Causes may be due to upper (UGIB) or lower (LGIB) gastrointestinal tract bleeding. Here, clinical factors were studied to differentiate sites of bleeding in patients with hematochezia. All patients with an age of more than 18 years who were diagnosed with GIB at the ED, Ramathibodi Hospital, Thailand were enrolled. Patients who presented with hematochezia and received complete workups to identify causes of bleeding were studied and categorized as being in the UGIB or LGIB groups. There were 1,854 patients who presented with GIB at the ED. Of those, 76 patients presented with hematochezia; 30 patients were in the UGIB group, while 43 patients were in the LGIB group. Clinical variables between both groups were mostly comparable. Three clinical factors were significantly associated with UGIB causes in patients with hematochezia including systolic blood pressure, hematocrit level, and BUN/Cr ratio. The adjusted odds ratios for all three factors were 0.725 (per 5 mmHg increase), 0.751 (per 3% increase), and 1.11 (per unit increase). Physicians at the ED could use these clinical factors as a guide for further investigation in patients who presented with hematochezia.
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28
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dos Santos LF, Zanatta AL, Soccol VT, Torres MF, Bonatto SJR, Rubel R, Soccol CR. Hypolipidemic and antiatherosclerotic potential of Pleurotus ostreatus, cultived by submerged fermentation in the high-fat diet fed rats. BIOTECHNOL BIOPROC E 2013. [DOI: 10.1007/s12257-012-0561-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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29
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Geffroy Y, Rodallec MH, Boulay-Coletta I, Jullès MC, Fullès MC, Ridereau-Zins C, Zins M. Multidetector CT angiography in acute gastrointestinal bleeding: why, when, and how. Radiographics 2011; 31:E35-46. [PMID: 21721196 DOI: 10.1148/rg.313105206] [Citation(s) in RCA: 82] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Acute gastrointestinal (GI) bleeding remains an important cause of emergency hospital admissions, with substantial related morbidity and mortality. Bleeding may relate to the upper or lower GI tract, with the dividing anatomic landmark between these two regions being the ligament of Treitz. The widespread availability of endoscopic equipment has had an important effect on the rapid identification and treatment of the bleeding source. However, the choice of upper or lower GI endoscopy is largely dictated by the clinical presentation, which in many cases proves misleading. Furthermore, there remains a large group of patients with negative endoscopic results or failed endoscopy, in whom additional techniques are required to identify the source of GI bleeding. Multidetector computed tomography (CT) with its speed, resolution, multiplanar techniques, and angiographic capabilities allows excellent visualization of both the small and large bowel. Multiphasic multidetector CT allows direct demonstration of bleeding into the bowel and is helpful in the acute setting for visualization of the bleeding source and its characterization. Thus, multidetector CT angiography provides a time-efficient method for directing and planning therapy for patients with acute GI bleeding. The additional information provided by multidetector CT angiography before attempts at therapeutic angiographic procedures leads to faster selective catheterization of bleeding vessels, thereby facilitating embolization. Supplemental material available at http://radiographics.rsna.org/lookup/suppl/doi:10.1148/rg.313105206/-/DC1.
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Affiliation(s)
- Yann Geffroy
- Department of Radiology, Foundation Hôpital Saint-Joseph, Paris, France
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30
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Reduced hydration status characterized by disproportionate elevation of blood urea nitrogen to serum creatinine among the patients with cerebral infarction. Med Hypotheses 2011; 77:601-4. [PMID: 21778021 DOI: 10.1016/j.mehy.2011.06.044] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2011] [Accepted: 06/27/2011] [Indexed: 12/19/2022]
Abstract
The significance of fluid metabolism among the patients with cerebral infarction has barely mentioned in the literature despite the several reports suggesting the potential risk of reduced hydration status for the development of cerebral infarction. The aim of the this study is to explore the validity of the presumable relationship between hydration status and cerebral infarction. Ninety-seven patients with cerebral infarction from April 1, 2008 to March 31, 2009 were retrospectively investigated, and their hydration status were evaluated by using several clinical parameters such as a blood urea nitrogen to serum creatinine (BUN/Cr) ratio of >25 and plasma osmolality. Subjects with active infection, congestive heart failure, hepatic failure, gastrointestinal bleeding, or a malignancy were excluded since these conditions should modulate the absolute value of BUN/Cr ratio without a change in hydration status. Twenty-eight patients (29%) were considered as having reduced hydration status. The BUN/Cr ratio decreased significantly after the initiation of medical support (median 21.3; IR: 18.1-24.6), including oral or parenteral fluid supplementation, in comparison to the values at the time of patient admission (median 30.0; IR: 26.8-40.7; p<0.0001). Similar decreases were also observed in the hematocrit, hemoglobin, and plasma osmolality. The group considered to have reduced hydration status had a significantly higher prevalence of cardioembolic stroke than the other subjects. The hydration status may be a contributing factor to subtypes of cerebral infarction. Whether our findings are also the case with overall patients with cerebral infarction should be evaluated in greater detail.
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31
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Abstract
Gastrointestinal bleeding is a common complaint encountered in the emergency department and frequent cause of hospitalization. Important diagnostic factors that increase morbidity and mortality include advanced age, serious comorbid conditions, hemodynamic instability, esophageal varices, significant hematemesis or melena, and marked anemia. Because gastrointestinal bleeding carries a 10% overall mortality rate, emergency physicians must perform timely diagnosis, aggressive resuscitation, risk stratification, and early consultation for these patients.
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Affiliation(s)
- Ritu Kumar
- Department of Emergency Medicine, University of Pennsylvania School of Medicine, Ground Ravdin, Philadelphia, PA 19104, USA
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32
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Kulstad C, Hannafin B. Dizzy and confused: a step-by-step evaluation of the clinician's favorite chief complaint. Emerg Med Clin North Am 2010; 28:453-69. [PMID: 20709238 DOI: 10.1016/j.emc.2010.03.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
This article covers the general approach to patients who present to the emergency department with a complaint of dizziness or vertigo, and altered mentation. Patients' histories and physical examination findings are discussed first, then a pertinent differential diagnosis, ranging from neurological causes and poor perfusion states to toxicologic causes, is described along with the distinguishing features and potential diagnostic pitfalls of each problem. Case scenarios are presented and the treatment and disposition of patients from the emergency department are discussed.
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Affiliation(s)
- Christine Kulstad
- Department of Emergency Medicine, Advocate Christ Medical Center, 4440 West 95th Street, Oak Lawn, IL 60453, USA.
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33
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Does blood urea nitrogen level predict severity and high-risk endoscopic lesions in patients with nonvariceal upper gastrointestinal bleeding? CANADIAN JOURNAL OF GASTROENTEROLOGY = JOURNAL CANADIEN DE GASTROENTEROLOGIE 2008; 22:399-403. [PMID: 18414716 DOI: 10.1155/2008/207850] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Nonvariceal upper gastrointestinal bleeding (UGIB) is a serious medical condition requiring prompt resuscitation and early endoscopic therapy in those with high-risk endoscopic lesions (HRLs). There are little or no data correlating sole blood urea nitrogen (BUN) level with the severity of nonvariceal UGIB or the presence of HRLs in the adult population. OBJECTIVES To determine if the BUN level on presentation correlates with parameters of severity of UGIB (need for blood transfusion or intensive care unit [ICU] admission) or to the subsequent finding of HRL, and in so doing identify patients who will require early endoscopic intervention. METHODS The Canadian Registry of patients with Upper Gastrointestinal Bleeding undergoing Endoscopy was used to identify patients enrolled from the McGill University Health Centre (Montreal, Quebec) who presented with or developed acute nonvariceal UGIB while admitted. All comparisons were performed using Student's t test or Wilcoxon's signed rank test, as appropriate. Logistic regression modelling using a stepwise method was performed to identify independent predictors of severe nonvariceal UGIB and HRL. RESULTS Two hundred nine patients were enrolled in the study. The mean age was 67+/-18 years and 59.8% were male. The mean BUN level was 13.4+/-9.4 mmol/L. Univariate analysis demonstrated that the BUN level was a significant predictor of ICU admission (BUN 14.7+/-10.4 mmol/L versus 12.0+/-8.0 mmol/L, P=0.035). However, when adjusted for systolic blood pressure, BUN level became a weaker predictor of ICU admission, just failing to achieve statistical significance (OR 1.03, 95% CI 1.00 to 1.06; P=0.08). Univariate analysis also demonstrated that BUN level was not a statistically significant predictor of blood transfusion requirement (BUN 14.1+/-10.6 mmol/L versus 13.6+/-8.6 mmol/L, P=0.508), nor of HRL (BUN 14.2+/-10.7 mmol/L versus 12.9+/-8.6 mmol/L, P=0.605). CONCLUSION In patients with nonvariceal UGIB, the BUN level at initial presentation is a weak predictor of the severity of UGIB as defined by ICU admission, but is not helpful in identifying patients with a HRL.
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34
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Chen CC, Chong CF, Kuo CD, Wang TL. A risk score to predict silent myocardial ischemia in patients with coronary artery disease under aspirin therapy presenting with upper gastrointestinal hemorrhage. Am J Emerg Med 2007; 25:406-13. [PMID: 17499658 DOI: 10.1016/j.ajem.2006.09.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2006] [Revised: 09/11/2006] [Accepted: 09/25/2006] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Silent myocardial ischemia (SMI) is a relatively common complication in patients with coronary artery disease (CAD) under aspirin therapy presenting with upper gastrointestinal hemorrhage (UGIH). AIM This study was conducted to develop and prospectively validate a risk prediction score to identify SMI in patients undergoing aspirin therapy for CAD presenting with UGIH in the emergency department (ED). METHODS This was a 2-phase noninterventional study. In the derivation phase, adults with CAD under aspirin therapy (100 mg once daily) presenting to the ED with UGIH were retrospectively recruited. By multiple logistic regression analysis, we derived a risk score from 224 patients that predicts the patients' risk of SMI. In the validation phase, we prospectively validated this score using receiver operating characteristic curves with data from 110 patients. We also developed a fast-track screening procedure from this score. RESULTS There were 56 patients (25.0%) and 29 patients (26.4%) with SMI in the derivation and validation sets, respectively. Independent multivariate predictors of SMI were age of older than 75 years, severity of CAD, systolic blood pressure of less than 110 mm Hg, diastolic blood pressure of less than 85 mm Hg, hematocrit of less than 30%, and blood urea nitrogen-creatinine ratio of more than 30. The area under receiver operating characteristic curve for the rule was 0.93 in the derivation set and 0.96 in the validation set. At the cutoff value of 5 points or higher, the sensitivity and specificity of the fast-track screening procedure for SMI were 96.6% and 86.4%, respectively. The positive and negative predictive values were 71.8% and 98.6%, respectively. CONCLUSIONS This simple risk prediction score is easily calculated and is based on rapidly available clinical and laboratory data in the ED. It can be used to stratify patients undergoing aspirin therapy for CAD presenting with UGIH by risk of SMI.
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Affiliation(s)
- Chien-Chih Chen
- Department of Emergency Medicine, Shin-Kong Wu Ho-Su Memorial Hospital, Taipei 111, Taiwan
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35
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Chen CC, Chong CF, Kuo CD, Wang TL. Silent myocardial ischemia in coronary artery disease patients under aspirin therapy presenting with upper gastrointestinal hemorrhage. J Gastroenterol Hepatol 2007; 22:13-7. [PMID: 17201874 DOI: 10.1111/j.1440-1746.2006.04277.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Abstract
AIM To identify the risk factors for myocardial ischemia in patients undergoing aspirin therapy for coronary artery disease (CAD) presenting with upper gastrointestinal hemorrhage and to ascertain the impacts on mortality and length of hospital stay. METHODS Adults with CAD under aspirin therapy (100 mg once daily) presenting to the emergency department with upper gastrointestinal hemorrhage were retrospectively recruited and divided into group A (ischemia) and group B (non-ischemia). Charts were reviewed for various demographic, laboratory and outcome data. Electrocardiograms were interpreted blindly by a senior cardiologist. RESULTS A total of 152 patients, 72.4% men and 27.6% women, were analyzed. Of these, 31 patients had ischemia and were placed in group A and 121 patients did not have ischemia and were in group B. Independent multivariate predictors of myocardial ischemia were history of triple vessel disease (odds ratio [OR], 9.24; 95% confidence interval [CI], 2.00-42.72), lower diastolic blood pressure (OR, 1.09; 95% CI, 1.02-1.16), lower hematocrit (OR, 1.41; 95% CI, 1.16-1.70), and higher blood urea nitrogen (OR, 0.94; 95% CI, 0.89-0.98). Patients with myocardial ischemia had significantly longer hospital length of stay (8.7 +/- 4.0 days vs 5.4 +/- 1.7 days; P < 0.001) and higher in-hospital mortality (16.1%vs 2.5%; P < 0.01) than did those without myocardial ischemia. CONCLUSION Myocardial ischemia is a relatively common complication in CAD patients under aspirin therapy presenting with upper gastrointestinal hemorrhage. A history of CAD with triple vessel disease, higher blood urea nitrogen, lower diastolic blood pressure and lower hematocrit may help identify patients who are at increased risk of myocardial ischemia, which tends to be associated with higher in-hospital mortality and increased length of hospital stay.
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Affiliation(s)
- Chien-Chih Chen
- Institute of Emergency and Critical Care Medicine, National Yang-Ming University, Taipei, Taiwan
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36
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Witting MD, Magder L, Heins AE, Mattu A, Granja CA, Baumgarten M. ED predictors of upper gastrointestinal tract bleeding in patients without hematemesis. Am J Emerg Med 2006; 24:280-5. [PMID: 16635697 DOI: 10.1016/j.ajem.2005.11.005] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2005] [Revised: 11/09/2005] [Accepted: 11/09/2005] [Indexed: 10/24/2022] Open
Abstract
OBJECTIVES In patients with gastrointestinal (GI) tract bleeding, the bleeding source is uncertain in the absence of hematemesis. We sought to identify clinical variables predictive of an upper GI bleeding source. METHODS This retrospective cohort study involved patients admitted via the ED for GI tract bleeding without hematemesis, who underwent confirmatory testing. We used logistic regression analysis to identify clinical variables independently associated with an upper GI source. RESULTS Among 325 patients, odds ratios for the strongest predictors were as follows: black stool, 16.6 (95% confidence interval [CI], 7.7-35.7); age less than 50 years, 8.4 (95% CI, 3.2-22.1); and blood urea nitrogen/creatinine ratio 30 or greater, 10.0 (95% CI, 4.0-25.6). Seven (5%) of 151 with none of these factors had an upper GI tract bleed, versus 63 (93%) of 68 with 2 or 3 factors. CONCLUSION Black stool, age less than 50 years, and blood urea nitrogen/creatinine ratio of 30 or greater independently predict an upper GI tract bleeding source.
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Affiliation(s)
- Michael D Witting
- Department of Epidemiology and Preventive Medicine, University of Maryland School of Medicine, Baltimore, MD 21201, USA
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Zhu BL, Ishikawa T, Michiue T, Li DR, Zhao D, Quan L, Maeda H. Evaluation of postmortem urea nitrogen, creatinine and uric acid levels in pericardial fluid in forensic autopsy. Leg Med (Tokyo) 2006; 7:287-92. [PMID: 16048740 DOI: 10.1016/j.legalmed.2005.04.005] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2004] [Revised: 03/17/2005] [Accepted: 04/04/2005] [Indexed: 11/19/2022]
Abstract
In postmortem biochemistry, there is insufficient data available for the practical analysis of factors in the pericardial fluid. The aim of the present study was to examine postmortem pericardial fluid for urea nitrogen (UN), creatinine (Cr) and uric acid (UA) levels to investigate the pathophysiology of death in forensic autopsy cases (total, n = 409; within 48 h postmortem), which included blunt, sharp instrument injury, asphyxiation, drowning, fire fatalities, hyperthermia, hypothermia, methamphetamine-related fatalities, other poisoning, delayed death from trauma and natural diseases. There was a significant elevation in the three markers for chronic renal failure, gastrointestinal bleeding, hyperthermia, hypothermia, methamphetamine fatalities and delayed traumatic death, which was comparable with the clinical criteria for their serum levels. These postmortem findings showed azotemia due to renal failure, elevated protein catabolism and rhabdomyolysis. Although the pericardial levels were otherwise similar to the clinical serum reference ranges, only the drowning fatalities showed significantly lower levels for each marker. These observations suggested the stability of UN, Cr and UA in the pericardial fluid within 48 h postmortem and their usefulness for the pathophysiological investigation of death involving azotemia.
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Affiliation(s)
- Bao-Li Zhu
- Department of Legal Medicine, Osaka City University Medical School, Asahi-machi 1-4-3, Abeno, 545-8585 Osaka, Japan.
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Esrailian E, Gralnek IM. Nonvariceal upper gastrointestinal bleeding: epidemiology and diagnosis. Gastroenterol Clin North Am 2005; 34:589-605. [PMID: 16303572 DOI: 10.1016/j.gtc.2005.08.006] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Nonvariceal upper gastrointestinal bleeding remains an important cause of patient morbidity, mortality, and use of considerable health care resources. An early and accurate diagnosis is critical for guiding appropriate management and facilitating patient care. This article reviews the most recent epidemiologic data on acute nonvariceal upper gastrointestinal bleeding and outlines important aspects of making the diagnosis.
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Affiliation(s)
- Eric Esrailian
- David Geffen School of Medicine at UCLA, VA Greater Los Angeles Healthcare System, UCLA/VA Center for Outcomes Research and Education, CA 90073, USA
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Schloerb PR, Moncure M. Increased blood urea nitrogen/creatinine ratio with excess protein. Nutr Clin Pract 2005; 19:539. [PMID: 16215150 DOI: 10.1177/0115426504019005539] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Caregaro L, Di Pascoli L, Favaro A, Nardi M, Santonastaso P. Sodium depletion and hemoconcentration: overlooked complications in patients with anorexia nervosa? Nutrition 2005; 21:438-45. [PMID: 15811763 DOI: 10.1016/j.nut.2004.08.022] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2004] [Accepted: 08/14/2004] [Indexed: 11/22/2022]
Abstract
OBJECTIVE This study evaluated sodium and fluid balance disturbances in anorexia nervosa. METHODS Serum urea, creatinine, urea nitrogen/creatinine ratio, protein concentration, osmolality, electrolytes, hemoglobin, and hematocrit were evaluated on admission, after intravenous fluid supplementation, and at discharge in 14 patients who had anorexia nervosa and were admitted to a medical unit for severe malnutrition and/or medical complications. Diet history and physical signs of salt and water depletion were also evaluated on admission. The diagnosis of plasma volume depletion was considered confirmed if serum urea nitrogen/creatinine ratio was higher than 25. RESULTS Mean body mass indexes were 12.9 +/- 2.4 kg/m2 on admission and 14.2 +/- 2.0 kg/m2 at discharge. Mean duration of hospitalization was 24.2 +/- 11.9 d. Plasma volume depletion was found on admission in nine patients (64%), and hyponatremia was associated with hypovolemia (hypovolemic hyponatremia) in three of them. Most of the commonly used indexes of hemoconcentration (hematocrit, hemoglobin, serum urea, and creatinine) were normal on admission but decreased significantly after intravenous fluid supplementation and were maintained at lower levels at discharge (P < 0.001, P < 0.0004, P < 0.009, and P < 0.001, respectively, compared with admission values). Hemoconcentration masked an underlying anemia (hemoglobin < 12 g/dL) in six patients. Only two of the nine patients with plasma volume depletion had a history of diuretic abuse, and the other seven patients reported long-term sodium restriction as a method to control body weight. CONCLUSIONS Plasma volume depletion and hypovolemic hyponatremia are common in the most severely malnourished patients with anorexia nervosa. Clinicians should be aware that, because of malnutrition, the common indexes of hemoconcentration may be within normal range and that hemoconcentration may mask anemia. Further studies are needed to assess the role of neglected behaviors such as sodium and fluid restriction.
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Affiliation(s)
- Lorenza Caregaro
- Department of Clinical and Experimental Medicine, University of Padua, Padua, Italy.
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Zhu BL, Ishida K, Quan L, Taniguchi M, Oritani S, Li DR, Fujita MQ, Maeda H. Postmortem serum uric acid and creatinine levels in relation to the causes of death. Forensic Sci Int 2002; 125:59-66. [PMID: 11852203 DOI: 10.1016/s0379-0738(01)00617-x] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Serum uric acid (UA) and creatinine (Cr) mainly derive from skeletal muscle tissues. Although, remarkable postmortem stability of the serum levels has been reported, there appears to be very poor knowledge of the diagnostic value in investigation of death, except for uremia. The aim of the present study was to evaluate postmortem serum UA and Cr levels using 395 forensic autopsy cases, in comparison with blood urea nitrogen (BUN), for investigation of the pathophysiology of death with special regard to the causes of death involving possible skeletal muscle damage, e.g. due to hypoxia, heat or agonal convulsions. Cr and BUN showed relatively good topographic stability in the cadaveric blood, whereas, UA was often much higher in the right heart blood than in the left heart and peripheral blood, independent of postmortem intervals. Moderate to marked elevation of Cr and BUN accompanied with hyperuricemia was observed in delayed death. In the acute death cases (survival time <30 min), UA, especially in the right heart blood, showed a considerable elevation in mechanical asphyxiation and drowning. The Cr level in fire victims with a lower carboxyhemoglobin (COHb) level (<60%) was significantly higher than in those with the possible fatal level (>60%). A similar elevation of Cr was observed in fatalities from heat stroke and methamphetamine (MA) poisoning. The observations suggested that hyperuricemia in acute death may be indicative of advanced hypoxia and that elevated Cr level may reflect the skeletal muscle damage, especially due to thermal influence.
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Affiliation(s)
- Bao-Li Zhu
- Department of Legal Medicine, Osaka City University Medical School, Asahi-machi 1-4-3, Abeno, 545-8585 Osaka, Japan.
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Carlson SA. Diagnosis and management of gastrointestinal bleeding. JOURNAL OF THE AMERICAN ACADEMY OF NURSE PRACTITIONERS 1999; 11:441-9; quiz 450-2. [PMID: 10766488 DOI: 10.1111/j.1745-7599.1999.tb01239.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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