Need of Emergency Surgery in Elderly Patients with Upper Gastrointestinal Bleeding: Survival Analysis during 2009-2015

Efficacy of ferric carboxymaltose on haemoglobin response among older patients with gastrointestinal bleeding: a randomised clinical trial

BACKGROUND

Acute gastrointestinal bleeding (AGIB) is common in older patients but the use of iron in this context remains understudied.

AIMS

This study aimed to evaluate prospectively the efficacy of ferric carboxymaltose to treat anaemia in older patients after AGIB.

METHODS

This randomised double-blinded placebo-controlled clinical trial was conducted in 10 French centres. Eligible patients were 65 years or more, had controlled upper or lower gastrointestinal bleeding and a haemoglobin level of 9-11 g/dl. Patients were randomly assigned, in a 1:1 ratio, to receive either one intravenous iron injection of ferric carboxymaltose or one injection of saline solution. The primary endpoint was the difference in haemoglobin level between day 0 and day 42. Secondary endpoints were treatment-emergent adverse events, serious adverse events, rehospitalisation and improvement of quality of life (QOL) at day 180.

RESULTS

From January 2013 to January 2017, 59 patients were included. The median age of patients was 81.9 [75.8, 87.3] years. At day 42, a significant difference in haemoglobin level increase was observed (2.49 g/dl in the ferric carboxymaltose group vs. 1.56 g/dl in the placebo group, P = 0.02). At day 180, QOL, measured on European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30, improved by 10.5 points in the ferric carboxymaltose group and by 8.2 points in the placebo group (P = 0.56). Rates of adverse events and rehospitalisation were similar in the two groups.

CONCLUSIONS

Intravenous iron seems safe and effective to treat anaemia in older patients after AGIB and should be considered as a standard-of-care treatment. ClinicalTrials.gov (NCT01690585).

Prevalence and risk factors of upper gastrointestinal bleeding in chronic obstructive pulmonary disease patients

BACKGROUND

Chronic obstructive pulmonary disease (COPD) can cause upper gastrointestinal bleeding. In this study we identified the risk factors for upper gastrointestinal bleeding in patients with COPD by logistic regression analysis and established a logistic regression equation to predict the probability of upper gastrointestinal bleeding in COPD patients.

AIM

To investigate the prevalence and risk factors of upper gastrointestinal bleeding in patients with COPD.

METHODS

A total of 400 COPD patients treated at our hospital from October 2016 to October 2021 were selected, of which 240 were used for modeling. The prevalence of upper gastrointestinal bleeding in the modeling group was counted, the clinical data of patients with and without upper gastrointestinal bleeding were compared, and the factors influencing the occurrence of upper gastrointestinal bleeding were identified by logistic regression analysis. The rest 160 cases were included in a validation group to verify the performance of the logistic regression model developed.

RESULTS

Among the 240 COPD patients in the modeling group, the prevalence of upper gastrointestinal bleeding was 19.58% (47/240). The proportions of patients with coronary heart disease, severe infection, pulmonary encephalopathy, low ALB, and Helicobacter pylori infection were significantly higher in patients with upper gastrointestinal bleeding than in those without (P < 0.05). Age ≥ 60 years, COPD grade III, disease duration ≥ 4.3 years, gastritis, peptic ulcer, coronary heart disease, severe infection, pulmonary encephalopathy, and Helicobacter pylori infection were identified to be independent risk factors for upper gastrointestinal bleeding in COPD patients, while ALB elevation was a protective factor (P < 0.05). The area under the curve (AUC) of the logistic regression prediction model for predicting upper gastrointestinal bleeding in COPD patients was 0.867 (95% confidence interval [CI]: 0.818-0.907), with a sensitivity of 85.11% and specificity of 75.13%. When the logistic regression prediction model was applied to the validation group (160 COPD patients), the Hosmer-Lemeshow χ² value was 3.142 (P = 0.514) and the AUC was 0.900 (95%CI: 0.855-0.935), suggesting good discriminant validity and calibration of the model.

CONCLUSION

The prevalence of upper gastrointestinal bleeding in COPD patients is relatively high, and its occurrence is related to many factors such as patient age, COPD severity and course, gastritis, peptic ulcer, coronary heart disease, severe infection, pulmonary encephalopathy, Helicobacter pylori infection, and elevated ALB. The logistic regression prediction model developed has good discriminant validity and calibration for predicting the risk of upper gastrointestinal bleeding in COPD patients.

Prevalence and risk factors of upper gastrointestinal bleeding in chronic obstructive pulmonary disease patients

BACKGROUND

Chronic obstructive pulmonary disease (COPD) can cause upper gastrointestinal bleeding. In this study we identified the risk factors for upper gastrointestinal bleeding in patients with COPD by logistic regression analysis and established a logistic regression equation to predict the probability of upper gastrointestinal bleeding in COPD patients.

AIM

To investigate the prevalence and risk factors of upper gastrointestinal bleeding in patients with COPD.

METHODS

A total of 400 COPD patients treated at our hospital from October 2016 to October 2021 were selected, of which 240 were used for modeling. The prevalence of upper gastrointestinal bleeding in the modeling group was counted, the clinical data of patients with and without upper gastrointestinal bleeding were compared, and the factors influencing the occurrence of upper gastrointestinal bleeding were identified by logistic regression analysis. The rest 160 cases were included in a validation group to verify the performance of the logistic regression model developed.

RESULTS

Among the 240 COPD patients in the modeling group, the prevalence of upper gastrointestinal bleeding was 19.58% (47/240). The proportions of patients with coronary heart disease, severe infection, pulmonary encephalopathy, low ALB, and Helicobacter pylori infection were significantly higher in patients with upper gastrointestinal bleeding than in those without (P < 0.05). Age ≥ 60 years, COPD grade III, disease duration ≥ 4.3 years, gastritis, peptic ulcer, coronary heart disease, severe infection, pulmonary encephalopathy, and Helicobacter pylori infection were identified to be independent risk factors for upper gastrointestinal bleeding in COPD patients, while ALB elevation was a protective factor (P < 0.05). The area under the curve (AUC) of the logistic regression prediction model for predicting upper gastrointestinal bleeding in COPD patients was 0.867 (95% confidence interval [CI]: 0.818-0.907), with a sensitivity of 85.11% and specificity of 75.13%. When the logistic regression prediction model was applied to the validation group (160 COPD patients), the Hosmer-Lemeshow χ² value was 3.142 (P = 0.514) and the AUC was 0.900 (95%CI: 0.855-0.935), suggesting good discriminant validity and calibration of the model.

CONCLUSION

The prevalence of upper gastrointestinal bleeding in COPD patients is relatively high, and its occurrence is related to many factors such as patient age, COPD severity and course, gastritis, peptic ulcer, coronary heart disease, severe infection, pulmonary encephalopathy, Helicobacter pylori infection, and elevated ALB. The logistic regression prediction model developed has good discriminant validity and calibration for predicting the risk of upper gastrointestinal bleeding in COPD patients.

Decreased Serum Monocyte Chemoattractant Protein-1 (MCP-1) Expression in Patients with Upper Gastrointestinal Bleeding

BACKGROUND The aim of this study was to investigate the expression of monocyte chemoattractant protein-1 (MCP-1) and its correlation with the blood lipid level in upper gastrointestinal bleeding (UGIB). MATERIAL AND METHODS A total of 118 patients with UGIB were enrolled in this study. The relevant indicators for blood lipid levels were detected using a biochemical analyzer. MCP-1 levels in the serum of patients was determined through enzyme-linked immunosorbent assay (ELISA). Statistical Product and Service Solutions (SPSS) 17.0 software was used for the statistical analysis. Two-sample t-test was used for the intergroup comparison. The significant indicators were included in a multivariate logistic regression model to analyze the prognostic factors of UGIB. Pearson analysis was applied to the correlation analysis. P<0.05 suggested that the difference was statistically significant. RESULTS MCP-1 expression levels in patients with UGIB were significantly lower than that in the control group and were even further reduced in patients with massive hemorrhage. The levels of total cholesterol (TC), triglyceride (TG), and low-density lipoprotein (LDL) in the serum of patients with UGIB were decreased compared with those in the control group and these indicators of the blood lipid level were decreased much more in patients with massive hemorrhage. The MCP-1 expression was positively correlated with the levels of TC, TG, and LDL in serum. MCP-1 and TC were the prognostic influencing factors of UGIB. CONCLUSIONS Serum MCP-1 expression was significantly decreased in patients with UGIB and correlated with blood lipid level, suggesting it might be a prognostic factor for UGB.