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Background/Aims@#Few studies have measured the accuracy of prognostic scores for upper gastrointestinal bleeding (UGIB) among cancer patients. Thereby, we compared the prognostic scores for predicting major outcomes in cancer patients with UGIB. Secondarily, we developed a new model to detect patients who might require hemostatic care. @*Methods@#A prospective research was performed in a tertiary hospital by enrolling cancer patients admitted with UGIB. Clinical and endoscopic findings were obtained through a prospective database. Multiple logistic regression analysis was performed to gauge the power of each score. @*Results@#From April 2015 to May 2016, 243 patients met the inclusion criteria. The AIMS65 (area under the curve [AUC] 0.85) best predicted intensive care unit admission, while the Glasgow-Blatchford score best predicted blood transfusion (AUC 0.82) and the low-risk group (AUC 0.92). All scores failed to predict hemostatic therapy and rebleeding. The new score was superior (AUC 0.74) in predicting hemostatic therapy. The AIMS65 (AUC 0.84) best predicted in-hospital mortality. @*Conclusions@#The scoring systems for prognostication were validated in the group of cancer patients with UGIB. A new score was developed to predict hemostatic therapy. Following this result, future prospective research should be performed to validate the new score.
ABSTRACT
Background & AimsPatient infected with the SARS-COV2 usually report fever and respiratory symptoms. However, multiple gastrointestinal (GI) manifestations such as diarrhea and abdominal pain has been described. The aim of this study was to evaluate the prevalence of GI, liver function test (LFT) abnormalities, and mortality of COVID-19 patients. MethodsWe performed a systematic review and meta-analysis of published studies that included cohort of patients infected with SARS-COV2 from December 1st, 2019 to July 1st, 2020. We collected data from the cohort of patients with COVID-19 by conducting a literature search using PubMed, Embase, Scopus, and Cochrane according to the preferred reporting Items for Systematic Reviews and MetaAnalyses (PRISMA) guidelines. We analyzed pooled data on the prevalence of overall and individual gastrointestinal symptoms, LFTs abnormalities and performed subanalyses to investigate the relationship between gastrointestinal symptoms, geographic location, fatality, and ICU admission. ResultsThe available data of 17,802 positive patients for SARS-COV2 from 120 studies were included in our analysis. The most frequent manifestations were diarrhea (13.3%, 95% CI 12-16), nausea (9.1%, 95% CI 9-13) and elevated LFTs (23.7%, 95% CI 21- 27). The overall and GI fatality were 7.2% (95% CI 6 -10), and 1% (95% CI 1- 4) respectively. Subgroup analysis showed non statistically significant associations between GI symptoms/LFTs abnormalities and ICU admissions (OR=3.41, 95% CI 0.87 - 13.4). The GI mortality rate was 0.58% in China and 3.5% in the United States (95% CI 2 - 5). ConclusionDigestive symptoms and LFTs abnormalities are common in COVID-19 patients. Our subanalysis shows that the presence of gastrointestinal and liver manifestations does not appear to affect mortality, or ICU admission rate. However, the mortality rate was higher in the United States compared to China.
ABSTRACT
OBJECTIVES: Variceal (VUGIB) and nonvariceal (NVUGIB) upper gastrointestinal bleeding are prevalent causes of hospitalization. Cost estimates are needed to determine the impact of their contemporary treatments (endoscopic hemostasis and high-dose proton pump inhibition). We determined the costs of upper gastrointestinal bleeding with or without complications (rebleeding). METHODS: Charges and length of stay (LOS) were obtained from the United States Nation-wide Inpatient Sample. We defined NVUGIB using Diagnosis Related Groups, and VUGIB using International Classification of Diseases, Ninth Revision, Clinical Modification codes. RESULTS: Hospitalization costs with and without complications were $5632 and $3402 for NVUGIB, and $23,207 and $6612 for VUGIB, respectively; similarly, mean LOS were 4.4 and 2.7 days, and 15.2 and 3.8 days. CONCLUSION: We present hospitalization costs and LOS for VUGIB and NVUGIB with and without complications. The reliability of our estimates rests with the size and the national representativeness of the databases used, and should prove helpful for cost analyses for UGIB requiring updated national estimates.
