scholarly journals Prediction and Prevention of Upper Gastrointestinal Bleeding after Cardiac Surgery: A Case Control Study

2012 ◽  
Vol 26 (6) ◽  
pp. 340-344 ◽  
Author(s):  
Mamatha Bhat ◽  
Martin Larocque ◽  
Marcos Amorim ◽  
Karl Herba ◽  
Myriam Martel ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Cardiac Surgery ◽  
Case Control Study ◽  
Cardiovascular Surgery ◽  
International Normalized Ratio ◽  
Case Control ◽  
Acid Suppression ◽  
Gi Bleeding ◽  
Control Study ◽  
Parsonnet Score

BACKGROUND: Gastrointestinal (GI) complications of cardiovascular surgery, particularly bleeding, occur frequently.OBJECTIVE: To determine factors that predict upper GI bleeding (UGIB) after cardiac surgery to improve prognostication and, thus, outcomes.METHODS: The present case-control study reviewed institutional records spanning 2002 to 2005 for consecutive patients who developed in-hospital UGIB following cardiovascular surgery. Each case was matched to two to three controls for age, sex and date of hospital admission. Demographics, pharmacotherapy (including use of in-hospital acid suppression), endoscopic findings and outcomes were recorded. After adjustment for possible confounders, including Parsonnet score and demographic parameters, conditional logistic regression analysis identified independent significant predictors of the subsequent development of UGIB.RESULTS: The study population consisted of 131 cases (mean [± SD] age 68.8±10.2 years, 69.5% male, mean Parsonnet score 24.6±14.2) and 387 matched controls (mean age 68.8±10.8 years, 70.0% male, mean Parsonnet score 20.9±14.2). UGIB events occurred a mean of 10.3±7.7 days after cardiac surgery. Duration of mechanical ventilation (OR 3.01 [95% CI 1.44 to 6.28]), elevation of international normalized ratio (OR 1.91 [95% CI 1.31 to 2.78]) and occurrence ofClostridium difficilecolitis before bleeding (OR 3.15 [95% CI 1.19 to 8.36]) were independent risk factors. Use of histamine type 2 receptor antagonists (H2RAs) (OR 0.65 [95% CI 0.38 to 1.12]) or proton pump inhibitors (PPIs) (OR 0.60 [95% CI 0.27 to 1.32]) demonstrated trends toward protecting against UGIB after cardiac surgery.CONCLUSIONS: GI bleeding events occurred approximately 10 days after cardiac surgery in patients with a complicated postoperative course. Significant predictors of subsequent bleeding included increased duration of mechanical ventilation and elevation of international normalized ratio; routine acid suppression with PPIs should be considered in such patients.C difficilecolitis also significantly predicted UGIB, and H2RAs should be considered for acid suppression. Neither H2RAs nor PPIs were effective in preventing UGIB, although the small number of patients limits definitive conclusions regarding the role of acid suppression.

scholarly journals Association between cardiometabolic disease and severe COVID-19: a nationwide case–control study of patients requiring invasive mechanical ventilation

BMJ Open ◽  
2021 ◽  
Vol 11 (2) ◽  
pp. e044486 ◽  
Author(s):  
Per Svensson ◽  
Robin Hofmann ◽  
Henrike Häbel ◽  
Tomas Jernberg ◽  
Per Nordberg
Keyword(s):  
Type 2 Diabetes ◽  
Mechanical Ventilation ◽  
Case Control Study ◽  
Invasive Mechanical Ventilation ◽  
Population Based ◽  
Case Control ◽  
Population Type ◽  
Susceptible Patient ◽  
Control Study

AimsThe risks associated with diabetes, obesity and hypertension for severe COVID-19 may be confounded and differ by sociodemographic background. We assessed the risks associated with cardiometabolic factors for severe COVID-19 when accounting for socioeconomic factors and in subgroups by age, sex and region of birth.Methods and resultsIn this nationwide case–control study, 1.086 patients admitted to intensive care with COVID-19 requiring mechanical ventilation (cases), and 10.860 population-based controls matched for age, sex and district of residency were included from mandatory national registries. ORs with 95% CIs for associations between severe COVID-19 and exposures with adjustment for confounders were estimated using logistic regression. The median age was 62 years (IQR 52–70), and 3003 (24.9%) were women. Type 2 diabetes (OR, 2.3 (95% CI 1.9 to 2.7)), hypertension (OR, 1.7 (95% CI 1.5 to 2.0)), obesity (OR, 3.1 (95% CI 2.4 to 4.0)) and chronic kidney disease (OR, 2.5 (95% CI 1.7 to 3.7)) were all associated with severe COVID-19. In the younger subgroup (below 57 years), ORs were significantly higher for all cardiometabolic risk factors. The risk associated with type 2 diabetes was higher in women (p=0.001) and in patients with a region of birth outside European Union(EU) (p=0.004).ConclusionDiabetes, obesity and hypertension were all independently associated with severe COVID-19 with stronger associations in the younger population. Type 2 diabetes implied a greater risk among women and in non-EU immigrants. These findings, originating from high-quality Swedish registries, may be important to direct preventive measures such as vaccination to susceptible patient groups.Trial registration numberClinicaltrial.gov (NCT04426084).

scholarly journals Risk factors for the development of significant postoperative bleeding after pediatric cardiac surgery with cardiopulmonary bypass: A nested case-control study

2017 ◽  
Vol 6 (3) ◽  
pp. 5
Author(s):  
JuanCarlos Núñez-Enríquez ◽  
IsabelZnaya Ramírez-Flores ◽  
Maribel Ibarra-Sarlat ◽  
Vivian Neme-Bechara ◽  
Alejandro Herrera-Landero ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Case Control Study ◽  
Postoperative Bleeding ◽  
Case Control ◽  
Pediatric Cardiac Surgery ◽  
Nested Case Control ◽  
Control Study

The role of computed tomography in the diagnostic pathway of acute mesenteric ischemia: a nested case-control study

2020 ◽  
Vol 61 (11) ◽  
pp. 1444-1451
Author(s):  
Henning Mothes ◽  
Vetlana Mueller-Mau ◽  
Lukas Lehmkuhl ◽  
Thomas Lehmann ◽  
Utz Settmacher ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Cardiac Surgery ◽  
Ct Scan ◽  
Contrast Medium ◽  
Mesenteric Ischemia ◽  
Case Control Study ◽  
Acute Mesenteric Ischemia ◽  
Case Control ◽  
Intestinal Pneumatosis ◽  
Control Study

Background Computed tomography (CT) can be used as the primary screening modality for the evaluation of patients suspected of having acute mesenteric ischemia known to show high sensitivity and specificity rates. Purpose To prove the value of CT in patients with pathological abdominal findings following cardiac surgery. Material and Methods In a retrospective case-control study, 12 different CT scan parameters of patients with or without mesenteric ischemia following cardiac surgery were compared using univariate and logistic regression analyses. Results Of 14,176 patients, 133 (0.9%) received an abdominal CT scan during postoperative care due to pathological abdominal findings. Sixty-eight patients were diagnosed with acute mesenteric ischemia. In-hospital mortality was 73.5% for this group. CT parameters with the highest specificity for indicating colonic ischemia were intestinal (99%) or porto-venous (96%) pneumatosis, abnormal contrast medium enhancement (89%), and occlusion of the proximal inferior mesenteric artery (81%). All of those parameters showed low sensitivity levels in the range of 15%–23%. A statistically significant association between acute mesenteric ischemia and CT appearance was obtained for contrast medium enhancement (odds ratio [OR] 12.2, 95% confidence interval [CI] 1.5–99.2) and intestinal pneumatosis (OR 21.0, 95% CI 2.7–165.2) only. Conclusion The typical CT criteria indicating mesenteric ischemia lose their accuracy in patients under critical clinical conditions. As CT remains the first-line diagnostic imaging modality for abnormal abdominal findings following cardiac surgery, negative signs should not prevent early laparotomy if clinical suspicion remains high.

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