Nonvariceal upper gastrointestinal tract bleeding – risk factors and the value of emergency endoscopy

Wierzchowski, Paweł; Dąbrowiecki, Stanisław; Szczęsny, Wojciech; Szmytkowski, Jakub

doi:10.5114/aoms.2013.36911

Cited by 10 publications

(14 citation statements)

References 19 publications

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“…Based on the results of this previous study, we propose that the updated CCI may also be useful for predicting prognosis in upper gastrointestinal mucosal disorder patients. In fact, Wierachowski et al reported that CCI was significantly higher in the death group compared to the survival group in case of gastrointestinal bleeding [16]. Therefore, we compared various risk scores, including the original CCI and the updated CCI in gastrointestinal mucosal disorder patients, to predict their prognosis.…”

Section: Score Development Process and Research Resultsmentioning

confidence: 99%

Comparison of various risk scores for the prognosis of hemorrhagic upper gastrointestinal mucosal disorder

et al. 2020

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Background: Various risk scores have been proposed that are useful for the management of upper gastrointestinal bleeding (UGIB), which is an important disease in emergency medicine. Few studies have examined the usefulness of Charlson Comorbidity index (CCI) in this disease, which evaluates the patient's general condition by scoring the patient's underlying disease. There have been no studies investigating the efficacy of CCI compared to other risk scores in the management of UGIB requiring endoscopic hemostasis. Methods: In addition to the Glasgow-Blatchford score, AIMS65 score, and Rockall score, we investigated the efficacy of the outcome prediction obtained by the original CCI and the updated CCI, scored only with respect to the underlying disease. We also examined the cutoff value when using the risk score. This retrospective study included 265 patients with hemorrhagic upper gastrointestinal mucosal lesions who underwent emergency endoscopic hemostasis during a 6-year period between 2011 and 2016 in our hospital. Results: The updated CCI and AIMS65 score correlated with prognosis in multivariate analysis (p = 0.002 and p = 0.003, respectively). In clinical practice, the prognosis might be worse if both updated CCI and AIMS65 score were 3 point or more. Conclusion: In addition to the AIMS65 score, the updated CCI can be a useful tool for managing upper gastrointestinal mucosal disorder bleeding that requires endoscopic hemostasis.

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Section: Score Development Process and Research Resultsmentioning

confidence: 99%

Comparison of various risk scores for the prognosis of hemorrhagic upper gastrointestinal mucosal disorder

et al. 2020

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“…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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“…An association between comorbidity as measured by the Charlson index and major bleeding has been previously described in patients undergoing percutaneous coronary intervention, 36 as well in other clinical settings. 37,38 Some of the components of the Charlson score are well-established predictors for bleeding (neoplasms, renal failure, stroke, hepatic disease). In addition, an important interrelation between frailty, comorbidity and other agingrelated variables has been consistently described.…”

Section: Discussionmentioning

confidence: 99%

“…• The functional capacity for basic activities of daily living was assessed by the Barthel index. 14 This is an ordinal scale with a total score of 0 to 100, where the intermediate ranges help evaluate the different degrees of dependency: total (0-20), severe (21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40), moderate (41-60), light (61-90) and independent (> 90). Instrumental activities were evaluated with the Lawton-Brody index.…”

Section: Baseline Geriatric Assessmentmentioning

confidence: 99%

Global Geriatric Assessment and In-Hospital Bleeding Risk in Elderly Patients with Acute Coronary Syndromes: Insights from the LONGEVO-SCA Registry

Arizá-Solé¹,

Guerrero²,

Formiga³

et al. 2018

Thromb Haemost

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Background Bleeding risk scores have shown a limited predictive ability in elderly patients with acute coronary syndromes (ACS). No study explored the role of a comprehensive geriatric assessment to predict in-hospital bleeding in this clinical setting. Methods The prospective multicentre LONGEVO-SCA registry included 532 unselected patients with non-ST segment elevation ACS (NSTEACS) aged 80 years or older. Comorbidity (Charlson index), frailty (FRAIL scale), disability (Barthel index and Lawton–Brody index), cognitive status (Pfeiffer test) and nutritional risk (mini nutritional assessment-short form test) were assessed during hospitalization. CRUSADE score was prospectively calculated for each patient. In-hospital major bleeding was defined by the CRUSADE classification. The association between geriatric syndromes and in-hospital major bleeding was assessed by logistic regression method and the area under the receiver operating characteristic curves (AUC). Results Mean age was 84.3 years (SD 4.1), 61.7% male. Most patients had increased troponin levels (84%). Mean CRUSADE bleeding score was 41 (SD 13). A total of 416 patients (78%) underwent an invasive strategy, and major bleeding was observed in 37 cases (7%). The ability of the CRUSADE score for predicting major bleeding was modest (AUC 0.64). From all aging-related variables, only comorbidity (Charlson index) was independently associated with major bleeding (per point, odds ratio: 1.23, p = 0.021). The addition of comorbidity to CRUSADE score slightly improved the ability for predicting major bleeding (AUC: 0.68). Conclusion Comorbidity was associated with major bleeding in very elderly patients with NSTEACS. The contribution of frailty, disability or nutritional risk for predicting in-hospital major bleeding was marginal.

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Nonvariceal upper gastrointestinal tract bleeding – risk factors and the value of emergency endoscopy

Cited by 10 publications

References 19 publications

Comparison of various risk scores for the prognosis of hemorrhagic upper gastrointestinal mucosal disorder

Comparison of various risk scores for the prognosis of hemorrhagic upper gastrointestinal mucosal disorder

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

Global Geriatric Assessment and In-Hospital Bleeding Risk in Elderly Patients with Acute Coronary Syndromes: Insights from the LONGEVO-SCA Registry

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