Hypoalbuminemia in the outcome of patients with non-variceal upper gastrointestinal bleeding

González-González, J.A.; Vázquez-Elizondo, Genaro; Monreal-Robles, Roberto; García-Compeán, Diego; Borjas-Almaguer, Omar D.; Hernández-Velázquez, B.; Maldonado-Garza, Héctor Jesús

doi:10.1016/j.rgmxen.2016.08.003

Cited by 10 publications

(11 citation statements)

References 24 publications

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“…In previous reports, our group and others demonstrated the important role of serum albumin levels in the prognosis of patients with acute UGIB. [18][19][20][21] Serum albumin has shown to present a AUROC of 0.738 for the prediction of hospital mortality in the setting of UGIB, with normal levels of albumin (≥31 g/L) showing a high NPV (98.8%) for inhospital mortality. 21 In the present study we found that in elderly patients low serum albumin levels (<23.5 g/L) performed better in discriminating between those who died and those who survive (AUROC 0.812) with a high NPV (97.3%).…”

Section: Discussionmentioning

confidence: 99%

Nonvariceal upper gastrointestinal bleeding in elderly people: Clinical outcomes and prognostic factors

González-González

Monreal-Robles

García-Compeán

et al. 2017

J of Digest Diseases

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Section: Discussionmentioning

confidence: 99%

Nonvariceal upper gastrointestinal bleeding in elderly people: Clinical outcomes and prognostic factors

González-González

Monreal-Robles

García-Compeán

et al. 2017

J of Digest Diseases

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“…This can be due to higher frequency of hypoalbuminemia in patients with malnutrition and some chronic diseases (e.g. renal disease, cardiovascular disease and diabetes) [12,21,22,35]. In our study, the mean of serum albumin was lower in non-survival group comparing to survival group and the mean of total population was 3.54 which was lower than normal population.…”

Section: Discussionmentioning

confidence: 49%

“…As mentioned earlier, the resultant predictive accuracy in mortality was also slightly higher than the original version of AIMS65 (0.72 vs 0.67). Although different levels have been proposed for Albumin as a prognostic factor [21][22][23], we found that increasing the threshold may increase the likelihood of identifying high risk patients and safer discharge of low risk groups. In addition to lower cost resulting from discharging low risk patients, identifying high risk patients and performing urgent endoscopy (<8 hours) may also be related to reduced hospitalization periods and potentially lower costs [39].…”

Section: Discussionmentioning

confidence: 61%

“…Relatively, modifying these scoring systems by adding risk factors that independently predict adverse outcomes, have been investigated in several studies [10,11]. As mentioned earlier, hypoalbuminemia is considered to be a risk factor for more adverse outcome [12]; However an optimal cut off for maximizing the predictive ability of albumin seems to be different in studies [21][22][23]. In this way, our second objective was to investigate whether changing albumin threshold from <3 to <3.5 can increase the accuracy of AIMS65 or not.…”

Section: Introductionmentioning

confidence: 99%

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Comparison of three risk scores to predict outcomes in upper gastrointestinal bleeding; modifying Glasgow-Blatchford with albumin

Shafaghi¹,

Gharibpoor

Mahdipour

et al. 2019

Romanian Journal of Internal Medicine

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Introduction. Management of upper gastrointestinal bleeding (UGIB) is of great importance. In this way, we aimed to evaluate the performance of three well known scoring systems of AIMS65, Glasgow-Blatchford Score (GBS) and Full Rockall Score (FRS) in predicting adverse outcomes in patients with UGIB as well as their ability in identifying low risk patients for outpatient management. We also aimed to assess whether changing albumin cutoff in AIMS65 and addition of albumin to GBS add predictive value to these scores. Methods. This was a retrospective study on adult patients who were admitted to Razi hospital (Rasht, Iran) with diagnosis of upper gastrointestinal bleeding between March 21, 2013 and March 21, 2017. Patients who didn’t undergo endoscopy or had incomplete medical data were excluded. Initially, we calculated three score systems of AIMS65, GBS and FRS for each patient by using initial Vital signs and lab data. Secondary, we modified AIMS65 and GBS by changing albumin threshold from <3.5 to <3.0 in AIMS65 and addition of albumin to GBS, respectively. Primary outcomes were defined as in hospital mortality, 30-day rebleeding, need for blood transfusion and endoscopic therapy. Secondary outcome was defined as composition of primary outcomes excluding need for blood transfusion. We used AUROC to assess predictive accuracy of risk scores in primary and secondary outcomes. For albumin-GBS model, the AUROC was only calculated for predicting mortality and secondary outcome. The negative predictive value for AIMS65, GBS and modified AIMS65 was then calculated. Result. Of 563 patients, 3% died in hospital, 69.4% needed blood transfusion, 13.1% needed endoscopic therapy and 3% had 30-day rebleeding. The leading cause of UGIB was erosive disease. In predicting composite of adverse outcomes all scores had statistically significant accuracy with highest AUROC for albumin-GBS. However, in predicting in hospital mortality, only albumin-GBS, modified AIMS65 and AIMS65 had acceptable accuracy. Interestingly, albumin, alone, had higher predictive accuracy than other original risk scores. None of the four scores could predict 30-day rebleeding accurately; on the contrary, their accuracy in predicting need for blood transfusion was high enough. The negative predictive value for GBS was 96.6% in score of ≤2 and 85.7% and 90.2% in score of zero in AIMS65 and modified AIMS65, respectively. Conclusion. Neither of risk scores was highly accurate as a prognostic factor in our population; however, modified AIMS65 and albumin-GBS may be optimal choice in evaluating risk of mortality and general assessment. In identifying patient for safe discharge, GBS ≤ 2 seemed to be advisable choice.

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“…Serum albumin is shown to be a predictor of mortality in upper gastrointestinal bleeding. There were also some other studies which reported that hypoalbuminemia occurs during gastric bleeding [42]. The other protein with altered level was Hspb1.…”

Section: Discussionmentioning

confidence: 76%

Therapeutic effects of hydro-alcoholic extract of Achillea wilhelmsii C. Koch on indomethacin-induced gastric ulcer in rats: a proteomic and metabolomic approach

Koushki

Yekta

Amiri-Dashatan

et al. 2019

BMC Complement Altern Med

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Background: Gastric ulcer is one of the most prevalent diseases worldwide. In Iranian folk medicine, Achillea wilhelmsii (AW) is used as a treatment for gastric ulcer. Previous reports also mentioned Antiulcerogenic properties for this herbal plant. This study investigated the therapeutic effects of Achillea wilhelmsii C. Koch extract on indomethacin-induced gastric lesion in rats, from both proteomic and metabolomic perspectives. Methods: The rats were divided into 4 groups. Gastric ulceration was induced by a single dose of indomethacin (45 mg/kg) by oral gavage. An amount of 800 mg/kg of AW extract was administered orally. Serum and tissue samples were collected for further investigations. The metabolomic study was performed by 1 H-NMR CPMG spectrometry. Proteomic analysis was also executed by using two dimensional gel electrophoresis (2DE) followed by liquid chromatography coupled to tandem mass spectrometry (LC-ESI/MS/MS). Real time PCR was used to confirm some of the genes. Results: The macroscopic and microscopic investigations confirmed the effectiveness of the AW extract. There was a panel of metabolites which showed alteration during gastric lesion development. The levels of some of these metabolite reversed nearly to their control values after the administration of AW extract. There were also changes in the levels of some proteins including Alb, Fabp5, Hspb1, Tagln, Lgals7, Csta and Myl9 which were reversed after AW administration. Conclusions: Our findings suggested that Achillea wilhelmsii C. Koch extract could be a potential therapy to be used for indomethacin-induced gastric lesion treatment in the future. However, further investigations are needed to confirm the results.

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Hypoalbuminemia in the outcome of patients with non-variceal upper gastrointestinal bleeding

Cited by 10 publications

References 24 publications

Nonvariceal upper gastrointestinal bleeding in elderly people: Clinical outcomes and prognostic factors

Nonvariceal upper gastrointestinal bleeding in elderly people: Clinical outcomes and prognostic factors

Comparison of three risk scores to predict outcomes in upper gastrointestinal bleeding; modifying Glasgow-Blatchford with albumin

Therapeutic effects of hydro-alcoholic extract of Achillea wilhelmsii C. Koch on indomethacin-induced gastric ulcer in rats: a proteomic and metabolomic approach

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