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Objective:To establish a prediction model of acute upper gastrointestinal rebleeding (AUGIRB) for elderly patients by combining and applying multiple indicators.Methods:A retrospective observational study was conducted. The clinical data of 161 elderly patients (age ≥ 65 years old) who suffered from acute upper gastrointestinal bleeding (AUGIB) and who were hospitalized in Shanghai General Hospital from July 2018 to December 2020 were recorded. The patients were divided into the rebleeding group (31 cases) and the non-rebleeding group (130 cases) according to whether gastrointestinal rebleeding occurred. Univariate analysis was adopted to screen AUGIRB-related risk factors and Logistic regression analysis was used to screen independent predictors of AUGIRB so that a predictive model was constructed. Based on the area under the curve (AUC) of the receiver operator characteristic curve (ROC curve), the predictive ability of the prediction model for AUGIRB was evaluated, the optimal cut-off value was determined, and the odds ratio ( OR) and its 95% confidence interval (95% CI) were calculated. Bootstrap resampling technology was used to validate the predictive ability of the model. Results:Univariate Logistic analysis showed that oral anticoagulant drugs, oral antiplatelet drugs, albumin (ALB), platelet count (PLT), Glasgow-Blatchford bleeding score (GBS), D-dimer, fibrinogen (FIB), and international normalized ratio (INR) all had a significant effect on the occurrence of AUGIRB among elderly patients. Multivariate Logistic regression analysis showed that the oral antiplatelet drugs ( OR = 11.150, 95% CI was 1.888-65.852, P < 0.05) and GBS score ( OR = 2.503, 95% CI was 1.523-4.114, P < 0.05) were the independent risk factors of AUGIRB among elderly patients, while the ALB ( OR = 0.764, 95% CI was 0.626-0.932, P < 0.05) and FIB ( OR = 0.065, 95% CI was 0.011-0.370, P < 0.05) were the protective factors of AUGIRB among elderly patients. The AUC of the above four indexes joint prediction model was 0.979. The verification results of the model showed that the consistency index (C-index) of the model was 0.986. Conclusion:The prediction model fitted in this research has a high prediction accuracy and it also has a certain reference value for the judgment of elderly patients who suffer from AUGIRB.
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Objective@#To evaluate the accuracy of the new non-invasive liver disease model platelet-albumin-bilirubin index (PALBI) in the diagnosis of patients with acute upper gastrointestinal hemorrhage (AUGIB) due to cirrhosis.@*Methods@#277 patients with AUGIB due to cirrhosis were analyzed retrospectively. The data of platelet, total bilirubin, albumin, creatinine, international standardized ratio and etiology of cirrhosis were collected. Univariate and multivariate logistic regression analysis was used to identify independent risk factors for death in patients with cirrhosis complicated by AUGIB. Analysis of variance was used to compare the differences between the model for end-stage liver disease (MELD) and PALBI grades. Pearson correlation analysis was used to assess the association between MELD and PALBI. The operating characteristic curve (ROC) was used to compare the predictive power of both for short-term and long-term mortality in patients with cirrhosis complicated by AUGIB.@*Results@#The short-term and long-term mortality rates of patients with cirrhosis complicated by AUGIB were 13.7% and 23.5%, respectively. The average hospital stay was (9.1±3.9)days. The high MELD score and high PALBI index were confirmed as independent risk factors of death by single factor and multiple factors [odds ratio (OR)=1.17, 4.43; P<0.05]; the Pearson correlation analysis showed there was a positive correlation between MELD score and PALBI index (r=0.735, P<0.05). The PALBI score was scored in MELD-a patients, further subdivided into PALBI-1a and PALBI-1b. There were statistical difference in the 1-year mortality rate between the two groups (7.0% vs 17.8%, χ2=4.033, P<0.05). The ROC curve was used to compare the predictive power of MELD and PALBI for short-term mortality. The area under curve (AUC) of PALBI was 0.767 (95% CI: 0.712-0.815), while the AUC of the MELD score was 0.651 (95% CI: 0.591-0.707), with statistically significant difference (Z=2.328, P<0.05). The predictive power of PALBI and MELD for long-term mortality were 0.731(95% CI: 0.674-0.782), 0.754 (95% CI: 0.699-0.804), but the difference was not statistically significant (Z=0.828, P>0.05).@*Conclusions@#PALBI has a better predictive effect on patients with cirrhosis complicated by AUGIB than MELD scores. PALBI can achieve a more precise prognosis classification for patients with MELD-a, and maintain a good prediction ability on the short-term (within 30 days of hospitalization and discharge) and long-term (within 1 year after discharge) mortality of patients. As a new liver disease model, PALBI can be used as an effective non-invasive means to judge the prognosis of patients with liver cirrhosis complicated by AUGIB .
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Objective To evaluate the accuracy of the new non-invasive liver disease model platelet-albumin-bilirubin index (PALBI) in the diagnosis of patients with acute upper gastrointestinal hemorrhage (AUGIB) due to cirrhosis.Methods 277 patients with AUGIB due to cirrhosis were analyzed retrospectively.The data of platelet,total bilirubin,albumin,creatinine,international standardized ratio and etiology of cirrhosis were collected.Univariate and multivariate logistic regression analysis was used to identify independent risk factors for death in patients with cirrhosis complicated by AUGIB.Analysis of variance was used to compare the differences between the model for end-stage liver disease (MELD) and PALBI grades.Pearson correlation analysis was used to assess the association between MELD and PALBI.The operating characteristic curve (ROC) was used to compare the predictive power of both for short-term and long-term mortality in patients with cirrhosis complicated by AUGIB.Results The short-term and long-term mortality rates of patients with cirrhosis complicated by AUGIB were 13.7％ and 23.5％,respectively.The average hospital stay was (9.1 ± 3.9) days.The high MELD score and high PALBI index were confirmed as independent risk factors of death by single factor and multiple factors [odds ratio (OR) =1.17,4.43;P ＜0.05];the Pearson correlation analysis showed there was a positive correlation between MELD score and PALBI index (r =0.735,P ＜ 0.05).The PALBI score was scored in MELD-a patients,further subdivided into PALBI-1a and PALBI-1b.There were statistical difference in the 1-year mortality rate between the two groups (7.0％ vs 17.8％,x2 =4.033,P ＜ 0.05).The ROC curve was used to compare the predictive power of MELD and PALBI for short-term mortality.The area under curve (AUC) of PALBI was 0.767 (95％ CI:0.712-0.815),while the AUC of the MELD score was 0.651 (95％ CI:0.591-0.707),with statistically significant difference (Z =2.328,P ＜ 0.05).The predictive power of PALBI and MELD for long-term mortality were 0.731 (95％ CI:0.674-0.782),0.754 (95％ CI:0.699-0.804),but the difference was not statistically significant (Z =0.828,P ＞ 0.05).Conclusions PALBI has a better predictive effect on patients with cirrhosis complicated by AUGIB than MELD scores.PALBI can achieve a more precise prognosis classification for patients with MELD-a,and maintain a good prediction ability on the short-term (within 30 days of hospitalization and discharge) and long-term (within 1 year after discharge) mortality of patients.As a new liver disease model,PALBI can be used as an effective non-invasive means to judge the prognosis of patients with liver cirrhosis complicated by AUGIB.
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Introduction: Acute gastrointestinal (GI) bleeding is a lifethreatening emergency that remains a common cause ofhospitalization worldwide. The aetiology of acute uppergastrointestinal bleed (UGIB) varies with each geographicalregion. Study aimed to analyse clinical profile, endoscopicprofile and in-hospital mortality in patients with acute uppergastrointestinal bleeding.Material and methods: This was a retrospective analysisconducted in a Tertiary care centre in Bangalore. In this studywe analysed the records of consecutive patients admitted withUpper Gastro-Intestinal bleeding over period of three yearsfrom January 2016 till January 2019.Results: We analysed two thirty consecutive patientsdiagnosed with acute upper gastrointestinal bleeding, 77.4%patients were males and 22.6% were females, mean age ofpresentation was 49.10 years. Most of the patients, oneseventy-three (75%) were between the age group of 31-70 years. Melena was the most common symptom 80.4%followed by hematemesis 47%. History of chronic alcoholintake was noted in ninety three (40.4%) and smoking in sixtyfive (28.3%), medication history depicted that sixteen (6.92%)patients were on NSAIDS; fifteen (6.49%) patients were onanti-platelet drugs, five (2.1%) patients were on steroids, one(0.4%) patient was on Newer Oral Anti Coagulants.Conclusion: The present study reported peptic ulcer diseaseas the most common cause of upper GI bleeding, followedby portal hypertension related bleeding. The most commonendoscopic lesions reported were esophageal varices,followed by duodenal ulcer. Upper G.I endoscopy is animportant modality in both diagnosis and therapy in upperG.I bleed, concomitant medical and Endoscopic therapy mayreduce mortality, morbidity and also the need for surgery/interventional radiology assisted haemostasis.
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Objective To retrospectively analyze the emergency treatment in 141 patients with high-risk of acute upper gastrointestinal bleeding(AUGIB) in order to improve the effi cacy of treatment. In addition, to evaluate the predictive values in accuracy terms of AIMS65, Glasgow-Blachford(GBS) and Pre-Rockall scores for risk stratifi cation in AUGIB by comparison among them. Methods Data of 141 patients with AUGIB admitted from Nov.1,2013 to May 31,2017 in our emergency department(ED) were retrospectively analyzed. All patients at fi rst were treated with pharmacologic therapy in emergency room, and some of them underwent endoscopic remedy, intervention or surgery as a last resort. The scores of AIMS65, Glasgow-Blachford(GBS) and Pre-Rockall scores were calculated respectively, and the in-hospital 30-day death and re-bleeding were taken as the study endpoints. Comparison of clinical value among the three scores was carried out by plotting their ROC and calculating the AUC. Results Of them, 65.25% patients underwent endoscopy, and the leading cause of bleeding was peptic ulcer (64.12%). Endoscopic hemostatic clips were used in 8 cases, endoscopic sclerotic therapy in 4 cases, balloon tamponade in 4 cases, TEA (therapeutic embolization approach) in 9 cases, TIPS (trans-internal jugular vein for making hepatic portal vein shunt by stent) in 3 cases, and surgical intervention in 2 cases. Re-bleeding rate was 14.18%, death rate 11.35%. AIMS65 and Pre-Rockall were better than GBS in predicting in-hospital 30-day mortality. There was no difference in predicting re-bleeding among these three scores. Conclusions Medicines combined with endoscopy, various interventions and surgical operation can effectively treat high-risk patients with AUGIB. Both AIMS65 and Pre-Rockall are able to predict mortality accurately with easy practice. Both are suitable in ED to stratify the risk of AUGIB.
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Objective:To explore the role of clinical pharmacists in the use of antiplatelet drugs in the patients with PCI in periop-erative period in order to improve the clinical treatment effect and reduce the incidence of adverse drug reactions. Methods:According to the latest antiplatelet drug treatment guidelines and the related literatures, the causes of acute upper gastrointestinal bleeding induced by triple antiplatelet drugs were analyzed in one case of postoperative patients with PCI, and the rationality of the drug use and the treatment of bleeding were discussed, and the related suggestions were put forward for clinics. Results:In order to ensure the clinical safety and the rational use of drugs, the patients with high risk of bleeding and high thrombosis events should carefully select new anti-platelet drugs, and anti ischemic drugs with good efficacy and low bleeding risk were the first choices. Conclusion:In order to ensure medication safety and effectiveness, clinical pharmacists should actively participate in clinical rational drug use through giving relative suggestions and playing active roles in the rational use of antiplatelet drugs.