|
|
|
|
|
| Risk factor analysis for myocardial injury and prognosis related to gastrointestinal bleeding |
| Jiang Hui, Zhang Nan, Cao Meng-meng, Zhu Hua-dong |
| Civil Aviation General Hospital， Beijing 100070, China |
|
|
|
|
Abstract Objective Myocardial injury may be induced in the patients with gastrointestinal bleeding (GIB). The occurrence of myocardial injury increases the risk of death. This study aims to investigate the risk factors of myocardial injury and the risk factors related to prognosis in the patients with GIB, in order to improve the understanding of clinicians and improve the prognosis of patients with GIB. Methods Patients with GIB admitted from January 1, 2014 to December 31, 2015 were analyzed retrospectively in the emergency department of a tertiary hospital. According to the diagnosis of myocardial injury, the patients were divided into myocardial injury group and non-myocardial injury group. Demographic data, clinical characteristics, laboratory data, treatment outcomes, and other data of patients in different groups were first analyzed by univariate analysis, and then Logistic regression analysis was used to investigate possible risk factors for myocardial injury and risk factors related to prognosis in patients with GIB. Results Of 219 patients with GIB, 160 patients had no myocardial injury and 59 patients had myocardial injury. Among them, age>65 years, coronary heart disease, heart failure, hemorrhagic shock, creatinine, albumin, lactic acid were risk factors for myocardial injury with GIB. Multivariate Logistic regression analysis found that age >65 years (OR=2.141, 95%CI1.060-4.324, P=0.034), combined heart failure (OR=6.928, 95%CI1.469-32.671, P=0.014), hemorrhagic shock (OR=2.156, 95%CI1.026-4.531, P=0.043), and reduced albumin (OR=0.939, 95%CI0.886-0.995, P=0.032) may be an independent risk factor for GIB complicated with myocardial injury. Conclusion GIB patients complicated with myocardial injury are more common in older age and are at higher risk of heart failure, hemorrhagic shock, and hypoalbuminemia.
|
|
|
| About author:: Jiang Hui, E-mail：1356060803@qq.com |
|
|
|
| ［1］Peery AF, Dellon ES, Lund J, et al. Burden of gastrointestinal disease in the United States: 2012 update［J］. Gastroenterology, 2012, 143(5): 1179-1187.
［2］Laine L, Yang H, Chang SC, et al. Trends for incidence of hospitalization and death due to GI complications in the United States from 2001 to 2009［J］. Am J Gastroenterol, 2012, 107(8): 1190-1195.
［3］van Leerdam ME, Vreeburg EM, Rauws EA, et al. Acute upper GI bleeding: did anything change time trend analysis of incidence and outcome of acute upper GI bleeding between 1993/1994 and 2000［J］. Am J Gastroenterol, 2003, 98(7): 1494-1499.
［4］Rotondano G. Epidemiology and diagnosis of acute nonvariceal upper gastrointestinal bleeding［J］. Gastroenterol Clin North Am, 2014, 43(4): 643-663.
［5］Bhatti N, Amoateng-Adjepong Y, Qamar A, et al. Myocardial infarction in critically ill patients presenting with gastrointestinal hemorrhage: retrospective analysis of risks and outcomes［J］. Chest, 1998, 114(4): 1137-1142.
［6］Vasile VC, Babuin L, Rio Perez JA, et al. Long-term prognostic significance of elevated cardiac troponin levels in critically ill patients with acute gastrointestinal bleeding［J］. Crit Care Med, 2009, 37(1): 140-147.
［7］沈卫峰, 张奇, 张瑞岩. 2015年急性ST段抬高型心肌梗死诊断和治疗指南解析［J］. 国际心血管病杂志, 2015, (4): 217-219.
［8］Babuin L, Vasile VC, Rio Perez JA, et al. Elevated cardiac troponin is an independent risk factor for short- and long-term mortality in medical intensive care unit patients［J］. Crit Care Med, 2008, 36(3): 759-765.
［9］Kelley WE, Januzzi JL, Christenson RH. Increases of cardiac troponin in conditions other than acute coronary syndrome and heart failure［J］. Clin Chem, 2009, 55(12): 2098-2112.
［10］Ahmed AN, Blonde K, Hackam D, et al. Prognostic significance of elevated troponin in non-cardiac hospitalized patients: a systematic review and meta-analysis［J］. Ann Med, 2014, 46(8): 653-663.
［11］Iser DM, Thompson AJ, Sia KK, et al. Prospective study of cardiac troponin I release in patients with upper gastrointestinal bleeding［J］. J Gastroenterol Hepatol, 2008, 23(6): 938-942.
［12］Wu IC, Yu FJ, Chou JJ, et al. Predictive risk factors for upper gastrointestinal bleeding with simultaneous myocardial injury［J］. Kaohsiung J Med Sci, 2007, 23(1): 8-16.
［13］Bellotto F, Fagiuoli S, Pavei A, et al. Anemia and ischemia: myocardial injury in patients with gastrointestinal bleeding［J］. Am J Med, 2005, 118(5): 548-551.
［14］Liang CC, Wang SM, Kuo HL, et al. Upper gastrointestinal bleeding in patients with CKD［J］. Clin J Am Soc Nephrol, 2014, 9(8): 1354-1359.
［15］González-González JA, Vázquez-Elizondo G, Monreal-Robles R, et al. Hypoalbuminemia in the outcome of patients with non-variceal upper gastrointestinal bleeding［J］. Rev Gastroenterol Mex, 2016, 81(4): 183-189.
［16］Jiménez-Rosales R, Valverde-López F, Vadillo-Calles F, et al. Inhospital and delayed mortality after upper gastrointestinal bleeding: an analysis of risk factors in a prospective series［J］. Scand J Gastroenterol, 2018， 53(6):714-720.
［17］González-González JA, Monreal-Robles R, Garcia-Compean D, et al. Nonvariceal upper gastrointestinal bleeding in elderly people: clinical outcomes and prognostic factors［J］. J Dig Dis, 2017, 18(4): 212-221.
［18］Tung CF, Chow WK, Chang CS, et al. The prevalence and significance of hypoalbuminemia in non-variceal upper gastrointestinal bleeding［J］. Hepatogastroenterology, 2007, 54(76): 1153-1156.
［19］Lin S, Konstance R, Jollis J, et al. The utility of upper endoscopy in patients with concomitant upper gastrointestinal bleeding and acute myocardial infarction［J］. Dig Dis Sci, 2006, 51(12): 2377-2383. |
|
|
|
Address: 1 North 2nd Street,
Zhongguancun, 
