Inhospital and delayed mortality after upper gastrointestinal bleeding: an analysis of risk factors in a prospective series

Jiménez-Rosales, Rita; Valverde-López, Francisco; Vadillo-Calles, Francisco; Martínez-Cara, Juan Gabriel; Hierro, Mercedes López de; Redondo–Cerezo, Eduardo

doi:10.1080/00365521.2018.1454509

Cited by 25 publications

(31 citation statements)

References 25 publications

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“…10 In this study, there was significant difference between the studied patients as regard blood pressure. Our findings agree with those of Gado et al, 11 and Jiménez et al 12 They found that hemodynamic instability at admission, Child class C, blood in GI tract at the index endoscopy, rebleeding within five days of endoscopy, and in-hospital complications were independent predictors of mortality.…”

Section: Discussionsupporting

confidence: 93%

“…We had 12 patients presented with early rebleeding; we found that leucocytosis, increased ALT, AST, bilirubin, INR, prothrombin activity, and serum creatinine and decreased albumin associated with increased risk of rebleeding. This finding was in agreement with Jiménez et al, 12 who found that low systolic blood pressure, high creatinine, and albumin levels were independent factors associated with rebleeding. In our study increased Child, MELD, AIMS56, and Sofa scores were risk factors for early rebleeding, as was stated by Goldis et al 13…”

Section: Early Rebleeding Risk Factorssupporting

confidence: 92%

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Prognostic Factors Associated with Mortality in Cirrhotic Patients with Bleeding Varices

Eldesouky

Tawfik

Hagras

et al. 2019

IJRSMS

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Objective Bleeding gastroesophageal varices are a cause of high mortality among cirrhotic patients. Aim The aim of this study was to study prognostic factors for mortality in cirrhosis associated with variceal bleeding. Patients and Methods This prospective study was conducted on 100 cirrhotic patients admitted to the Tanta University Hospital with an acute first variceal bleeding episode. Baseline clinical, laboratory, and endoscopic findings were recorded at presentation. Results During the first 6 weeks 15 patients died, 3 following the initial bleed and 12 after an early rebleed. At 6 months, a further 21 patients had died. Statistical analysis utilizing the baseline data revealed that high early death rate was associated with number of blood units transfused, lower systolic blood pressure, thrombocytopenia, increased serum creatinine and international normalized ratio (INR). High MELD, AIMS56, acute physiology and chronic health evaluation II (APACHE II) and ROCKall scores were risk factors for mortality. Risk factors for early rebleeding included presence of diabetes mellitus, leucocytosis, high Child score, model for end-stage liver disease (MELD), AIMS56, and sepsis-associated organ failure assessment (SOFA) scores. A high Child score, presence of ascites, and associations such as hepatic encephalopathy and spontaneous bacterial peritonitis, leucocytosis, elevated alanine transaminase, aspartate transaminase, bilirubin, INR, and creatinine as well as low albumin were associated with decreased survival. Conclusion High MELD, AIMS56, APACHE II, and ROCKall scores were risk factors for mortality after acute variceal bleeding. High death rate during the first 6 weeks is associated with anemia, hypotension, thrombocytopenia, increased serum creatinine, and INR. Decreased survival at 6 months is associated with increased Child score, presence of ascites and associations such as hepatic encephalopathy and spontaneous bacterial peritonitis.

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Section: Discussionsupporting

confidence: 93%

Section: Early Rebleeding Risk Factorssupporting

confidence: 92%

Prognostic Factors Associated with Mortality in Cirrhotic Patients with Bleeding Varices

Eldesouky

Tawfik

Hagras

et al. 2019

IJRSMS

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“…In a prospective analysis of risk factors for in-hospital and delayed mortality after UGI bleeding, patients who died had lower platelet counts on presentation and cirrhosis. 60 In a retrospective study on inpatients who underwent endoscopy for overt gastrointestinal bleeding (GIB) with a platelet count of 20 to <50 × 10 3 / mL compared to inpatients without cirrhosis, there were no differences in recurrent bleeding rates between the groups. An increased international normalized ratio (INR) >2, however, was a predictor of recurrent bleeding.…”

Section: Non-variceal Gastrointestinal Bleedingmentioning

confidence: 99%

<p>Clinical Implications of Thrombocytopenia for the Cirrhotic Patient</p>

Sigal¹,

Sherman

Jesudian

2020

HMER

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Thrombocytopenia is a frequent complication in patients with cirrhosis. As many as 84% of patients with cirrhosis have thrombocytopenia, and it is an independent variable indicative of advanced disease and poor prognosis. Although there is great concern that it may aggravate bleeding during surgical procedures, there is limited evidence to inform decisions regarding the treatment of cirrhotic patients with thrombocytopenia undergoing invasive procedures. Finally, there is evidence that platelets play a significant role in liver regeneration. In this report, the clinical implications of thrombocytopenia in cirrhotic patients are reviewed. The utility of platelet counts in the prognosis of cirrhosis and relationship to complications of advanced liver disease, including portal hypertension, esophageal varices, and hepatocellular carcinoma. The impact of low platelet counts on bleeding complications during invasive procedures is outlined. Finally, the role of platelets and potential adverse impact in liver regeneration is reviewed.

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“…Mora et al [12] confirmed that hematocrit is a risk factor for GIB and a predictor of poor prognosis. Jiménez et al [13] found that low plasma albumin level was a risk factor for GIB and death in hospitalized patients. Moreover, several studies had mentioned that serum ALT is a risk factor for upper GIB and death within 60 days [14].…”

Section: Discussionmentioning

confidence: 99%

“…Likewise, subsequent studies have confirmed that it can evaluate the risk of bleeding within 30 days after discharge, or even within 1 year, and the study population has been extended to all patients receiving dual antiplatelet therapy after PCI [21]. Systolic blood pressure [22], plasma albumin [13,22], hematocrit [12,23]and ALT [14]included in the model were applied as predictors of death because of GIB by other risk score, so the model may also has a certain ability to predict the mortality of GIB.…”

Section: Discussionmentioning

confidence: 99%

Gastrointestinal Bleeding in Patients Admitted to Cardiology: risk factors and a new risk score

Zhang

Liu

Wang

et al. 2020

Preprint

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Background: Although the early use of a risk stratification score in gastrointestinal bleeding(GIB) is recommended, there has been no risk score for GIB in patients admitted to cardiology so far.Objective:To describe the risk factors of GIB and develop a new risk score model in patients admitted to cardiology. Methods: A total of 633 inpatients with GIB from January 2014 to December 2018 were recruited, 4,231 inpatients with non-GIB recruited as the control group. Multivariate logistic regression was used to describe the risk factors of GIB,A new risk score model was developed in the derivation cohort. Accuracy to predict GIB was assessed by the area under the receiver operating characteristic (AUROC) curve in the validation cohort.Results: Male, coronary heart disease, hypertension, stroke, systolic blood pressure, hematocrit, plasma albumin and alanine aminotransferase(ALT) were associated with GIB . The model had a high predictive accuracy (AUROC 0.816; 95%CI, 0.792-0.839), which was supported by the validation cohort (AUROC 0.841; 95% CI, 0.807~0.874). Besides,the prediction of the model better than HAS-BLED score(AUROC 0.557; 95%CI, 0.513~0.602) and CRUSADE score(AUROC 0.791; 95%CI, 0.757~0.825), respectively. Among the inpatients with a score 0-3, 4-7, and ≥8 points, the incidence of GIB, the proportion of inpatients requiring suspended red blood cells transfusion, length of stay and in-hospital mortality all increased gradually(P< 0.001). Conclusions: Male, coronary heart disease, hypertension, stroke, systolic blood pressure, hematocrit, plasma albumin and ALT are associated with GIB. The new risk score model is an accurate risk score that predicts GIB in patients admitted to cardiology.

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Inhospital and delayed mortality after upper gastrointestinal bleeding: an analysis of risk factors in a prospective series

Abstract: Comorbidities were risk factors for delayed mortality, whereas albumin levels were a protective factor for in-hospital and delayed deaths. Six months mortality is proportionately as important as in-hospital mortality. Half of the delayed deaths might be preventable.

Cited by 25 publications

References 25 publications

Prognostic Factors Associated with Mortality in Cirrhotic Patients with Bleeding Varices

Prognostic Factors Associated with Mortality in Cirrhotic Patients with Bleeding Varices

<p>Clinical Implications of Thrombocytopenia for the Cirrhotic Patient</p>

Gastrointestinal Bleeding in Patients Admitted to Cardiology: risk factors and a new risk score

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