Rising Events and Improved Outcomes of Gastrointestinal Bleed With Shock in USA: A 12-year National Analysis.

OBJECTIVE: Limited information is available based on single-center studies on trends of incidence and outcomes in gastrointestinal (GI) bleed with shock. METHODS: We analyzed data from 2002 to 2013 National Inpatient Sample. Using ICD-9 codes we identified 6.4 million hospital discharges of GI bleed from National Inpatient Sample database. Events were analyzed based on type of GI bleed, in-hospital mortality, hemodynamic status, and use of blood products. RESULTS: GI bleed with shock results in higher hospital mortality (20.77% with shock vs. 2.6% without shock). Between 2002 and 2013, there has been an increase in the percentage of upper and lower GI bleed with shock (1.35% to 4.92% and 1.49% to 3.06%) along with a reduction in mortality in both upper GI bleed with shock (26.9% to 13.8%) and lower GI bleed with shock (54.7% to 19.7%). Consistent with the rise in GI bleed with shock was an increase in blood product utilization. Packed red blood cell (pRBC) transfusion was associated with reduction in mortality in both nonvariceal upper GI bleed with shock (18.3% without pRBC vs. 13.9% receiving pRBC) and lower GI bleed with shock (36.05% without pRBC vs. 22.13% receiving pRBC), but did not affect mortality in variceal upper GI bleed with shock (31.79% vs. 32.22%). CONCLUSIONS: GI bleed with shock carries a higher mortality and have been steadily increasing from 2002 to 2013. pRBC transfusion was associated in improved mortality in GI bleed with shock except variceal bleed.

Risk of Ischemic Heart Disease in Patients With Sjögren's Syndrome.

BACKGROUND: Ischemic heart disease (IHD) has emerged as a major cause of morbidity and mortality in patients with autoimmune conditions such as systemic lupus erythematosus and rheumatoid arthritis, but the risk of IHD in Sjögren's syndrome (SjS) is unknown. To fill this knowledge gap, we estimated the prevalence and risk of IHD with SjS compared to controls from the general population using the Healthcare Cost and Utilization Project National Inpatient Sample 2011 database. MATERIALS AND METHODS: The Healthcare Cost and Utilization Project administrative longitudinal database contains encounter-level information on inpatient stays, emergency department visits and ambulatory surgery in all U.S. hospitals. We conducted a cross-sectional study among the inpatient population diagnosed with SjS and matched 1:4 with controls for age, sex and hospital region. Odds ratio for IHD was calculated as cases compared to controls. The contribution of various risk factors to IHD was also evaluated by logistic regression. RESULTS: Analysis demonstrated that 7,154 of 13,086 cases (54.7%) of SjS had IHD compared to 27,367 of 52,448 controls (52.2%). The adjusted odds ratio for IHD in those with SjS was 0.898 (95% CI: 0.844-0.955). Patients with SjS were significantly more likely to have hypertension, diabetes, apnea and lipid disorders. CONCLUSIONS: To our knowledge, this is the largest population-based study investigating the risk of IHD in patients with SjS. We found a modest, though statistically significant, decrease in the risk of IHD in SjS compared to controls.

Nonsteroidal antiinflammatory drug use and lung cancer: a metaanalysis.

STUDY OBJECTIVE: Studies done both in laboratory animals and humans suggest that nonsteroidal antiinflammatory drug (NSAID) use may reduce the risk of developing lung cancer. Many epidemiologic studies exploring this association lacked sufficient power to draw definitive conclusions. We conducted a metaanalysis to examine the effect of NSAID use on the risk of lung cancer. DESIGN: We searched the literature using MEDLINE, CANCERLIT, related conference abstracts, and bibliographies of selected studies. The estimators of relative risk (RR) and associated variances, adjusted for the greatest number of confounders, were abstracted and included in the metaanalysis. Combined estimators of RR were calculated using either fixed or random-effect models. Metaanalyses were performed on 14 studies (the number of cases ranged from 81 to 2,560) that examined the association between lung cancer and NSAIDs. Further, subgroup analyses were performed on the nine studies that had adjusted for the effects of smoking. RESULTS: The combined estimate of RR was 0.79 (95% confidence interval [CI], 0.66 to 0.95) when all the studies were included in the analysis, and was 0.68 (95% CI, 0.55 to 0.85) when the analysis was limited to the subgroup of studies adjusted for smoking. The combined estimates for case-control studies and cohort studies within this subgroup were 0.63 (95% CI, 0.47 to 0.86) and 0.78 (95% CI, 0.62 to 0.98), respectively. We also observed that small cell lung cancer was more inversely associated with NSAID use (RR, 0.48; 95% CI, 0.30 to 0.75) than non-small cell lung cancer (RR, 0.66; 95% CI, 0.56 to 0.79). CONCLUSION: The findings of this study support an inverse association between NSAID use and risk of lung cancer, but do not suggest a causal relationship.