scholarly journals Early Risk Score for Predicting Hypotension in Normotensive Patients with Non-Variceal Upper Gastrointestinal Bleeding

2019 ◽  
Vol 8 (1) ◽  
pp. 37 ◽  
Author(s):  
Byuk Ko ◽  
Youn-Jung Kim ◽  
Dae Jung ◽  
Chang Sohn ◽  
Dong Seo ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Gastrointestinal Bleeding ◽  
Prediction Model ◽  
Systolic Blood Pressure ◽  
Nasogastric Tube ◽  
Validation Cohort ◽  
Upper Gastrointestinal Bleeding ◽  
Area Under The Curve ◽  
Scoring Systems ◽  
Upper Gastrointestinal

Risk assessment for upper gastrointestinal bleeding (UGIB) is important; however, current scoring systems are insufficient. We aimed to develop and validate a prediction model for rapidly determining the occurrence of hypotension in non-variceal UGIB patients with normotension (systolic blood pressure ≥90 mmHg) at emergency department presentation. In this prospective observational cohort study, consecutive non-variceal UGIB patients between January 2012 and April 2017 were enrolled. We developed and validated a new prediction model through logistic regression, with the occurrence of hypotension <24 h as the primary outcome. Among 3363 UGIB patients, 1439 non-variceal UGIB patients were included. The risk factors for the occurrence of hypotension were lactate level, blood in nasogastric tube, and systolic blood pressure. The area under the curve (AUC) of the new scoring model (LBS—Lactate, Blood in nasogastric tube, Systolic blood pressure) in the development cohort was 0.74, higher than the value of 0.64 of the Glasgow–Blatchford score for predicting the occurrence of hypotension. The AUC of the LBS score in the validation cohort was 0.83. An LBS score of ≤2 had a negative predictive value of 99.5% and an LBS score of ≥7 had a specificity of 97.5% in the validation cohort. The new LBS score stratifies normotensive patients with non-variceal UGIB at risk for developing hypotension.

scholarly journals Upper endoscopy in patients with acute ST-elevation myocardial infarction (STEMI) and postthrombolysis upper gastrointestinal bleeding – results, therapeutic utility

2012 ◽  
Vol 18 (3) ◽  
pp. 146-150
Author(s):  
Irinel-Raluca Parepa ◽  
Andra-Iulia Suceveanu ◽  
A. P. Suceveanu ◽  
Laura Mazilu ◽  
B. Cîmpineanu ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Gastrointestinal Bleeding ◽  
Systolic Blood Pressure ◽  
Endoscopic Treatment ◽  
Upper Gastrointestinal Bleeding ◽  
Upper Endoscopy ◽  
Prognostic Information ◽  
Killip Class ◽  
Upper Gastrointestinal ◽  
Therapeutic Utility

Abstract Upper endoscopy is the “golden standard” for the diagnosis of upper gastrointestinal bleeding (UGB); it appreciates the persistence of bleeding in more than 90% of cases, it reveals the UGB lesion, gives prognostic information about re-bleeding risk and offers the possibility of endoscopic haemostasis. Uncomplicated STEMI by itself is not a contraindication for upper endoscopy [1,2]. The aim of our study was to observe the haemorrhagic lesions in STEMI patients with postthrombolysis UGB and to evaluate the safety and therapeutic utility of upper endoscopy in this category of patients. We performed upper endoscopy in STEMI patients with postthrombolytic UGB during a period of 4 years (1st of Jan 2008 - 31st of Dec 2011). Patients with systolic blood pressure (SBP) <100 mmHg, with Killip class>1, with unstable ECG and/or with severe associated conditions (respiratory distress, cerebrovascular stroke, consciousness disorders) were withdrawn from undergoing upper endoscopy, as well as patients who refused the investigation. During studied period, 618 STEMI patients underwent pharmacological coronary reperfusion. Postthrombolysis UGB occurred in 42 of them (6.79%). We could perform upper endoscopy in 30 patients (71.43%), the rest of 12 (28.57%) being withdrawn from endoscopy (6 patients with Killip class>1, 4 patients with systolic blood pressure<100mmHg, 2 patients refused the investigation). Incriminated haemorrhagic lesions were: erosive gastroduodenitis in 20 cases (66.67%) and duodenal ulcer in 10 cases (33.33%). As about therapeutic utility, amongst 30 patients investigated just 4 needed endoscopic treatment (haemoclips used in Forrest IB patients with duodenal ulcers). Endoscopy was a safe investigation in STEMI patients with postthrombolysis UGB. Erosive gastroduodenitis was incriminated as the source of bleeding in most of the cases. As it concerns the therapeutic utility of UE in STEMI patients with UGB, 13.33% of bleeding patients benefited from endoscopic treatment (mechanical haemmostasis).

A prospective comparison of 3 scoring systems in upper gastrointestinal bleeding

2013 ◽  
Vol 31 (5) ◽  
pp. 775-778 ◽  
Author(s):  
Cheng-Hsien Wang ◽  
Yu-Wei Chen ◽  
Yui-Rwei Young ◽  
Chia-Jung Yang ◽  
I-Chuan Chen
Keyword(s):  
Gastrointestinal Bleeding ◽  
Upper Gastrointestinal Bleeding ◽  
Scoring Systems ◽  
Prospective Comparison ◽  
Upper Gastrointestinal

scholarly journals Prediction model of emergency mortality risk in patients with acute upper gastrointestinal bleeding: a retrospective study

PeerJ ◽  
2021 ◽  
Vol 9 ◽  
pp. e11656
Author(s):  
Lan Chen ◽  
Han Zheng ◽  
Saibin Wang
Keyword(s):  
Emergency Department ◽  
Gastrointestinal Bleeding ◽  
Upper Gastrointestinal Bleeding ◽  
Area Under The Curve ◽  
Decision Curve Analysis ◽  
Acute Upper Gastrointestinal Bleeding ◽  
Bleeding Score ◽  
Selection Operator ◽  
Upper Gastrointestinal ◽  
D Dimer

Background Upper gastrointestinal bleeding is a common presentation in emergency departments and carries significant morbidity worldwide. It is paramount that treating physicians have access to tools that can effectively evaluate the patient risk, allowing quick and effective treatments to ultimately improve their prognosis. This study aims to establish a mortality risk assessment model for patients with acute upper gastrointestinal bleeding at an emergency department. Methods A total of 991 patients presenting with acute upper gastrointestinal bleeding between July 2016 and June 2019 were enrolled in this retrospective single-center cohort study. Patient demographics, parameters assessed at admission, laboratory test, and clinical interventions were extracted. We used the least absolute shrinkage and selection operator regression to identify predictors for establishing a nomogram for death in the emergency department or within 24 h after leaving the emergency department and a corresponding nomogram. The area under the curve of the model was calculated. A bootstrap resampling method was used to internal validation, and decision curve analysis was applied for evaluate the clinical utility of the model. We also compared our predictive model with other prognostic models, such as AIMS65, Glasgow-Blatchford bleeding score, modified Glasgow-Blatchford bleeding score, and Pre-Endoscopic Rockall Score. Results Among 991 patients, 41 (4.14%) died in the emergency department or within 24 h after leaving the emergency department. Five non-zero coefficient variables (transfusion of plasma, D-dimer, albumin, potassium, age) were filtered by the least absolute shrinkage and selection operator regression analysis and used to establish a predictive model. The area under the curve for the model was 0.847 (95% confidence interval [0.794–0.900]), which is higher than that of previous models for mortality of patients with acute upper gastrointestinal bleeding. The decision curve analysis indicated the clinical usefulness of the model. Conclusions The nomogram based on transfusion of plasma, D-dimer, albumin, potassium, and age effectively assessed the prognosis of patients with acute upper gastrointestinal bleeding presenting at the emergency department.

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