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Huang J, Liao F, Tang J, Shu X. Development of a model for predicting acute cerebral infarction induced by non-variceal upper gastrointestinal bleeding. Clin Neurol Neurosurg 2023; 235:107992. [PMID: 37944305 DOI: 10.1016/j.clineuro.2023.107992] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 07/04/2023] [Accepted: 09/26/2023] [Indexed: 11/12/2023]
Abstract
OBJECTIVE To evaluate the risk factors for acute cerebral infarction(ACI) in patients with non-variceal upper gastrointestinal bleeding(NVUGIB), and construct a model for predicting ACI in NVUGIB patients. METHODS A model for predicting ACI induced by NVUGIB was established on the basis of a retrospective study that involved 1282 patients who were diagnosed with NVUGIB in the emergency department and Gastroenterology Department of Nanchang University Affiliated Ganzhou Hospital from January 2019 to December 2021. Receiver operating characteristic (ROC) curves were drawn to evaluate the sensitivity and specificity of the model and CHA2DS2-VASc score to predict ACI. Delong's test was used to compare AUCs of the present score and the CHA2DS2-VASc score. RESULTS There were 1282 patients enrolled in the study, including 69 in the ACI group and 1213 in the non-ACI group. Multivariate analysis revealed that hypertension, diabetes, red blood cell (RBC) transfusion, mechanical ventilation, D-dimer, rate pressure product (RPP), somatostatin and mean platelet volume (MPV) were factors associated with ACI induced by NVUGIB. A model based on the eight factors was established, Logit(P)= 0.265 + 1.382 × 1 + 1.120 × 2 + 1.769 × 3 + 0.839 × 4-1.549 × 5-0.361 × 6 + 0.045 × 7 + 1.158 × 8(or 1.069 ×9) (X1, hypertension=1; X2, diabetes=1; X3, RBC transfusion=1; X4, mechanical ventilation=1; X5, somatostatin=1; X6, MPV(fL); X7, D-dimer(ng/l); X8, low RPP= 1; X9, high RPP = 2). The area under ROC curve of the model was 0.873, the sensitivity and specificity were 0.768 and 0.887, respectively. The area under ROC curve of CHA2DS2-VASc score was 0.792, the sensitivity and specificity were 0.728 and 0.716, respectively. Delong's test showed the area under ROC curve of the present study was significantly larger than that of CHA2DS2-VASc score. CONCLUSIONS Hypertension, diabetes, RBC transfusion, mechanical ventilation, D-dimer, RPP, somatostatin and MPV were factors associated with ACI induced by NVUGIB. A model constructed based on these factors showed excellent prediction of ACI, and was superior to CHA2DS2-VASc score. However, this needs to be further validated by multi-center study with a larger sample size.
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Affiliation(s)
- Jiaming Huang
- Department of Gastroenterology, Nanchang University Affiliated Ganzhou Hospital, Ganzhou, Jiangxi 341000, China
| | - Foqiang Liao
- Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi 330006, China
| | - Jianhua Tang
- Department of Gastroenterology, Nanchang University Affiliated Ganzhou Hospital, Ganzhou, Jiangxi 341000, China
| | - Xu Shu
- Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi 330006, China.
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Morarasu BC, Sorodoc V, Haisan A, Morarasu S, Bologa C, Haliga RE, Lionte C, Marciuc EA, Elsiddig M, Cimpoesu D, Dimofte GM, Sorodoc L. Age, blood tests and comorbidities and AIMS65 risk scores outperform Glasgow-Blatchford and pre-endoscopic Rockall score in patients with upper gastrointestinal bleeding. World J Clin Cases 2023; 11:4513-4530. [PMID: 37469720 PMCID: PMC10353516 DOI: 10.12998/wjcc.v11.i19.4513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 05/14/2023] [Accepted: 05/30/2023] [Indexed: 06/30/2023] Open
Abstract
BACKGROUND Upper gastrointestinal (GI) bleeding is a life-threatening condition with high mortality rates.
AIM To compare the performance of pre-endoscopic risk scores in predicting the following primary outcomes: In-hospital mortality, intervention (endoscopic or surgical) and length of admission (≥ 7 d).
METHODS We performed a retrospective analysis of 363 patients presenting with upper GI bleeding from December 2020 to January 2021. We calculated and compared the area under the receiver operating characteristics curves (AUROCs) of Glasgow-Blatchford score (GBS), pre-endoscopic Rockall score (PERS), albumin, international normalized ratio, altered mental status, systolic blood pressure, age older than 65 (AIMS65) and age, blood tests and comorbidities (ABC), including their optimal cut-off in variceal and non-variceal upper GI bleeding cohorts. We subsequently analyzed through a logistic binary regression model, if addition of lactate increased the score performance.
RESULTS All scores had discriminative ability in predicting in-hospital mortality irrespective of study group. AIMS65 score had the best performance in the variceal bleeding group (AUROC = 0.772; P < 0.001), and ABC score (AUROC = 0.775; P < 0.001) in the non-variceal bleeding group. However, ABC score, at a cut-off value of 5.5, was the best predictor (AUROC = 0.770, P = 0.001) of in-hospital mortality in both populations. PERS score was a good predictor for endoscopic treatment (AUC = 0.604; P = 0.046) in the variceal population, while GBS score, (AUROC = 0.722; P = 0.024), outperformed the other scores in predicting surgical intervention. Addition of lactate to AIMS65 score, increases by 5-fold the probability of in-hospital mortality (P < 0.05) and by 12-fold if added to GBS score (P < 0.003). No score proved to be a good predictor for length of admission.
CONCLUSION ABC score is the most accurate in predicting in-hospital mortality in both mixed and non-variceal bleeding population. PERS and GBS should be used to determine need for endoscopic and surgical intervention, respectively. Lactate can be used as an additional tool to risk scores for predicting in-hospital mortality.
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Affiliation(s)
- Bianca Codrina Morarasu
- Department of Internal Medicine and Toxicology, Saint Spiridon University Regional Emergency Hospital, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, Iasi 700111, Romania
| | - Victorita Sorodoc
- Department of Internal Medicine and Toxicology, Saint Spiridon University Regional Emergency Hospital, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, Iasi 700111, Romania
| | - Anca Haisan
- Department of Emergency Medicine, Saint Spiridon University Regional Emergency Hospital, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, Iasi 700111, Romania
| | - Stefan Morarasu
- Second Department of Surgical Oncology, Regional Institute of Oncology, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, Iasi 700111, Romania
| | - Cristina Bologa
- Department of Internal Medicine and Toxicology, Saint Spiridon University Regional Emergency Hospital, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, Iasi 700111, Romania
| | - Raluca Ecaterina Haliga
- Department of Internal Medicine and Toxicology, Saint Spiridon University Regional Emergency Hospital, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, Iasi 700111, Romania
| | - Catalina Lionte
- Department of Internal Medicine and Toxicology, Saint Spiridon University Regional Emergency Hospital, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, Iasi 700111, Romania
| | - Emilia Adriana Marciuc
- Department of Radiology, Emergency Hospital “Prof. Dr. N. Oblu”, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, Iasi 700309, Romania
| | - Mohammed Elsiddig
- Department of Gatroenterology, Beaumont Hospital, Dublin D09V2N0, Ireland
| | - Diana Cimpoesu
- Department of Emergency Medicine, Saint Spiridon University Regional Emergency Hospital, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, Iasi 700111, Romania
| | - Gabriel Mihail Dimofte
- Second Department of Surgical Oncology, Regional Institute of Oncology, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, Iasi 700111, Romania
| | - Laurentiu Sorodoc
- Department of Internal Medicine and Toxicology, Saint Spiridon University Regional Emergency Hospital, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, Iasi 700111, Romania
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Cazacu SM, Alexandru DO, Statie RC, Iordache S, Ungureanu BS, Iovănescu VF, Popa P, Sacerdoțianu VM, Neagoe CD, Florescu MM. The Accuracy of Pre-Endoscopic Scores for Mortality Prediction in Patients with Upper GI Bleeding and No Endoscopy Performed. Diagnostics (Basel) 2023; 13:diagnostics13061188. [PMID: 36980496 PMCID: PMC10047350 DOI: 10.3390/diagnostics13061188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 03/15/2023] [Accepted: 03/17/2023] [Indexed: 03/30/2023] Open
Abstract
(1) Background: The assessment of mortality and rebleeding rate in upper gastrointestinal bleeding (UGIB) is essential, and several prognostic scores have been proposed. Some patients with UGIB did not undergo endoscopy, either because they refused the procedure, suffered from alcohol withdrawal symptoms or altered general status, or because the bleeding was severe enough to cause death before the endoscopy. The mortality risk in the subgroup of patients without endoscopy is poorly evaluated in the literature. (2) Methods: The purpose of the study was to identify the most useful scores for the assessment of in-hospital mortality in patients with UGIB with no endoscopy performed and no known etiology. A total of 198 patients with UGIB and no endoscopy performed were admitted between January 2017 and December 2021 and the accuracy of 12 prognostic scores and the Charlson comorbidity index for in-hospital mortality prediction were analyzed, as well as Child-Pugh Turcotte (CPT) and Meld scores in patients with cirrhosis. (3) Results: The mortality rate was 37.9%, higher than in variceal (21.9%, p < 0.0001) and non-variceal bleeding (7.4%, p < 0.0001). The most accurate scores by AUC were the International Bleeding score (INBS, 0.844), Glasgow Blatchford (0.783), MAP score (0.78), Iino (0.766), AIM65 and modified N-score (0.745 each), modified Glasgow-Blatchford (0.73), H3B2 and N-score (0.701); Rockall, Baylor, and T-score had an AUC below 0.7. MELD score was superior to CPT in patients with cirrhosis (AUC 0.811 versus 0.670). (4) Conclusions: The mortality rate in UGIB with no endoscopy was higher than in both variceal and non-variceal bleeding and was higher in the pandemic period but with no statistical significance (45.3% versus 32.14%, p = 0.0586), mainly because of positive cases. Only one case of rebleeding was noted; the hospitalization period was significantly shorter. The most accurate score was International Bleeding Score; the MELD score had a higher but moderate accuracy compared with CPT in patients with cirrhosis.
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Affiliation(s)
- Sergiu Marian Cazacu
- Research Center of Gastroenterology and Hepatology, Gastroenterology Department, University of Medicine and Pharmacy Craiova, Petru Rares Street No 2-4, 200349 Craiova, Dolj County, Romania
| | - Dragoș Ovidiu Alexandru
- Biostatistics Department, University of Medicine and Pharmacy Craiova, Petru Rares Street No 2-4, 200349 Craiova, Dolj County, Romania
| | | | - Sevastița Iordache
- Research Center of Gastroenterology and Hepatology, Gastroenterology Department, University of Medicine and Pharmacy Craiova, Petru Rares Street No 2-4, 200349 Craiova, Dolj County, Romania
| | - Bogdan Silviu Ungureanu
- Research Center of Gastroenterology and Hepatology, Gastroenterology Department, University of Medicine and Pharmacy Craiova, Petru Rares Street No 2-4, 200349 Craiova, Dolj County, Romania
| | - Vlad Florin Iovănescu
- Research Center of Gastroenterology and Hepatology, Gastroenterology Department, University of Medicine and Pharmacy Craiova, Petru Rares Street No 2-4, 200349 Craiova, Dolj County, Romania
| | - Petrică Popa
- Research Center of Gastroenterology and Hepatology, Gastroenterology Department, University of Medicine and Pharmacy Craiova, Petru Rares Street No 2-4, 200349 Craiova, Dolj County, Romania
| | - Victor Mihai Sacerdoțianu
- Research Center of Gastroenterology and Hepatology, Gastroenterology Department, University of Medicine and Pharmacy Craiova, Petru Rares Street No 2-4, 200349 Craiova, Dolj County, Romania
| | - Carmen Daniela Neagoe
- Research Center of Gastroenterology and Hepatology, Gastroenterology Department, University of Medicine and Pharmacy Craiova, Petru Rares Street No 2-4, 200349 Craiova, Dolj County, Romania
| | - Mirela Marinela Florescu
- Pathology Department, University of Medicine and Pharmacy Craiova, Petru Rares Street No 2-4, 200349 Craiova, Dolj County, Romania
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Jiang GJ, Gao RK, Wang M, Xie TX, Zhan LY, Wei J, Sun SN, Ji PY, Tan DY, Lyu JJ. A Nomogram Model for Predicting Type-2 Myocardial Infarction Induced by Acute Upper Gastrointestinal Bleeding. Curr Med Sci 2022; 42:317-326. [PMID: 35290603 DOI: 10.1007/s11596-022-2543-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Accepted: 11/10/2021] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To examine the independent risk factors of type-2 myocardial infarction (T2MI) elicited by acute upper gastrointestinal bleeding (AUGIB), and to establish a nomogram model for the prediction of AUGIB-induced T2MI. METHODS A nomogram model was established on the basis of a retrospective study that involved 533 patients who suffered from AUGIB in the Department of Critical Care Medicine (CCM) or Emergency Intensive Care Unit (EICU) of Renmin Hospital of Wuhan University, Wuhan, China, from January 2017 to December 2020. The predictive accuracy and discriminative power of the nomogram were initially evaluated by internal validation, which involved drawing the receiver operating characteristic (ROC) curve, calculating the area under the curve (AUC), plotting the calibration curve derived from 1000 resampled bootstrap data sets, and computing the root mean square error (RMSE). The predictive ability of the nomogram was further validated through the prospective and multicenter study conducted by the investigators, which enrolled 240 AUGIB patients [including 88 cases from Renmin Hospital of Wuhan University, 73 cases from Qilu Hospital of Shandong University (Qingdao), and 79 cases from Northern Jiangsu People's Hospital)], who were admitted to the Department of CCM or EICU, from February 2021 to July 2021. RESULTS Among the 533 patients in the training cohort, 78 (14.6%) patients were assigned to the T2MI group and 455 (85.4%) patients were assigned to the non-T2MI group. The multivariate analysis revealed that age >65, hemorrhagic shock, cerebral stroke, heart failure, chronic kidney disease, increased blood urea nitrogen, decreased hematocrit, and elevated D-Dimer were independent risk factors for AUGIB-induced T2MI. All these factors were incorporated into the nomogram model. The AUC for the nomogram for predicting T2MI was 0.829 (95% CI, 0.783-0.875) in the internal validation cohort and 0.848 (95% CI, 0.794-0.902) in the external validation cohort. The calibration curve for the risk of T2MI exhibited good consistency between the prediction by the nomogram and the actual clinical observation in both the internal validation (RMSE=0.016) and external validation (RMSE=0.020). CONCLUSION The nomogram was proven to be a useful tool for the risk stratification of T2MI in AUGIB patients, and is helpful for the early identification of AUGIB patients who are prone to T2MI for early intervention, especially in emergency departments and intensive care units.
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Affiliation(s)
- Gui-Jun Jiang
- Emergency Department, Renmin Hospital of Wuhan University, Wuhan, 430060, China.,Department of Critical Care Medicine, Renmin Hospital of Wuhan University, Wuhan, 430060, China
| | - Ru-Kai Gao
- Wuhan Britain-China School, Wuhan, 430022, China
| | - Min Wang
- Medical College of Wuhan University of Science and Technology, Wuhan, 430065, China
| | - Tu-Xiu Xie
- Department of General Practice, Renmin Hospital of Wuhan University, Wuhan, 430060, China
| | - Li-Ying Zhan
- Department of Critical Care Medicine, Renmin Hospital of Wuhan University, Wuhan, 430060, China
| | - Jie Wei
- Emergency Department, Renmin Hospital of Wuhan University, Wuhan, 430060, China
| | - Sheng-Nan Sun
- Emergency Department, Qilu Hospital of Shandong University (Qingdao), Qingdao, 266000, China
| | - Pei-Yu Ji
- Emergency Department, Clinical Medical College of Yangzhou University, Northern Jiangsu People's Hospital, Yangzhou, 225001, China
| | - Ding-Yu Tan
- Emergency Department, Clinical Medical College of Yangzhou University, Northern Jiangsu People's Hospital, Yangzhou, 225001, China
| | - Jing-Jun Lyu
- Emergency Department, Renmin Hospital of Wuhan University, Wuhan, 430060, China.
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Zhao Q, Chi T. Biopsy in emergency gastroscopy does not increase the risk of rebleeding in patients with Forrest I acute nonvariceal upper gastrointestinal bleeding combined with suspected malignant gastric ulcer: a multicenter retrospective cohort study. BMC Gastroenterol 2021; 21:250. [PMID: 34092231 PMCID: PMC8183090 DOI: 10.1186/s12876-021-01836-z] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Accepted: 05/31/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Few studies have reported whether a biopsy in emergency gastroscopy (EG) increased the risk of rebleeding in patients with Forrest I acute nonvariceal upper gastrointestinal bleeding (ANVUGIB) combined with suspected malignant gastric ulcer (SMGU). This study aims to conduct a multicenter retrospective cohort study using propensity score matching to verify whether a biopsy in EG increases the risk of rebleeding in patients diagnosed with Forrest I ANVUGIB combined with SMGU. METHODS Using the data for propensity-matched patients, logistic regression models were fitted using rebleeding as the dependent variable. Survival time was defined as the length of time the patient experienced from visiting the emergency department to rebleeding. We used the Kaplan-Meier (KM) method to analyze the 30-day survival of the patients with and without a biopsy after matching, and the log-rank test was performed to examine the differences in survival. RESULTS With the use of propensity score matching, 308 patients who underwent a biopsy in EG were matched with 308 patients who did not. In the five logistic regression models, there were no significant group differences in the risk of rebleeding in patients with Forrest I ANVUGIB combined with SMGU between the biopsy and no-biopsy groups. The probability of survival was not significantly different between the no-biopsy and biopsy groups. CONCLUSIONS In this multicenter, retrospective propensity score matching cohort study, compared with patients without a biopsy, patients with a biopsy during EG had no increased risk of rebleeding, and there was no significant difference in the rate of rebleeding.
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Affiliation(s)
- Quchuan Zhao
- Department of Gastroenterology, Xuanwu Hospital of Capital Medical University, 45 Chang-chun Street, Beijing, 100053, China
| | - Tianyu Chi
- Department of Gastroenterology, Xuanwu Hospital of Capital Medical University, 45 Chang-chun Street, Beijing, 100053, China.
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Maia S, Falcão D, Silva J, Pedroto I. The Clinical Impact of Rockall and Glasgow-Blatchford Scores in Nonvariceal Upper Gastrointestinal Bleeding. GE-PORTUGUESE JOURNAL OF GASTROENTEROLOGY 2021; 28:243-252. [PMID: 34386553 DOI: 10.1159/000511809] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 09/13/2020] [Indexed: 12/26/2022]
Abstract
Introduction Risk stratification in patients with nonvariceal upper gastrointestinal bleeding (NVUGIB) is crucial for proper management. Rockall score (RS; pre-endoscopic and complete) and Glasgow-Blatchford score (GBS) are some of the most used scoring systems. This study aims to analyze these scores' ability to predict various clinical outcomes and possible cutoff points to identify low- and high-risk patients. Secondarily, this study intents to evaluate the appropriateness of patients' transfers to our facility, which provides a specialized emergency endoscopy service. Methods This study was retrospectively conducted at Centro Hospitalar Universitário do Porto and included patients admitted to the Emergency Department with acute manifestations of NVUGIB between January 2016 and December 2018. Receiver operating characteristic (ROC) curves and corresponding areas under the curve (AUC) were calculated. Transferred patients from other institutions and nontransferred (directly admitted to this institution) patients were also compared. Results Of a total of 420 patients, 23 (5.9%) died, 34 (8.4%) rebled, 217 (51.7%) received blood transfusion, 153 (36.3%) received endoscopic therapy, 22 (5.7%) had surgery, and 171 (42.3%) required hospitalization in the Intermediate or Intensive Care Unit. Regarding mortality prediction, both complete RS (AUC 0.756, p < 0.001) and pre-endoscopic RS (AUC 0.711, p = 0.001) showed good performance. In the prediction of rebleeding, only complete RS (AUC 0.735, p < 0.001) had discriminative ability. GBS had good performance in the prediction of transfusion (AUC 0.785, p < 0.001). No score showed discriminative capability in the prediction of other outcomes. Transferred and nontransferred patients had similar pre-endoscopic RS (3.41 vs. 3.34, p = 0.692) and GBS (13.29 vs. 12.29, p = 0.056). Only patients with GBS ≥6 were transferred to our facility. There were no adverse outcomes recorded in any group when GBS was ≤3. Discussion/Conclusion Complete RS and pre-endoscopic RS are effective at predicting mortality, but only complete RS showed good performance at predicting rebleeding. GBS is better at predicting transfusion requirement. Our study suggests that a transfer can possibly be reconsidered if GBS is ≤3, although current recommendations only propose outpatient care when GBS is 0 or 1. Patients' transfers were appropriate, considering the high GBS scores and the outcomes of these patients.
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Affiliation(s)
- Susana Maia
- Instituto de Ciências Biomédicas Abel Salazar, Porto, Portugal
| | - Daniela Falcão
- Department of Gastroenterology, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Joana Silva
- Department of Gastroenterology, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Isabel Pedroto
- Instituto de Ciências Biomédicas Abel Salazar, Porto, Portugal.,Department of Gastroenterology, Centro Hospitalar Universitário do Porto, Porto, Portugal
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