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Wu Z, Peng G, Chen Z, Xiao X, Huang Z. Non-linear relationship between red blood cell distribution width and gastrointestinal bleeding risk in stroke patients: results from multi-center ICUs. Front Neurol 2024; 15:1346408. [PMID: 39006233 PMCID: PMC11239355 DOI: 10.3389/fneur.2024.1346408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 06/19/2024] [Indexed: 07/16/2024] Open
Abstract
Background The red blood cell distribution width (RDW) is closely linked to the prognosis of multiple diseases. However, the connection between RDW and gastrointestinal bleeding (GIB) in stroke patients is not well understood. This study aimed to clarify this association. Methods This retrospective study involved 11,107 hospitalized patients from 208 hospitals in the United States, admitted between January 1, 2014, and December 31, 2015. We examined clinical data from 7,512 stroke patients in the intensive care unit (ICU). Multivariate logistic regression assessed the link between RDW and in-hospital GIB in stroke patients. Generalized additive model (GAM) and smooth curve fitting (penalty spline method) were utilized to explore the non-linear relationship between RDW and GIB in stroke patients. The inflection point was calculated using a recursive algorithm, and interactions between different variables were assessed through subgroup analyses. Results Among the 11,107 screened stroke patients, 7,512 were included in the primary analysis, with 190 identified as having GIB. The participants had a mean age of (61.67 ± 12.42) years, and a median RDW of 13.9%. Multiple logistic analysis revealed RDW as a risk factor for in-hospital GIB in stroke patients (OR = 1.28, 95% CI 1.21, 1.36, p < 0.05). The relationship between RDW and in-hospital GIB in stroke patients was found to be non-linear. Additionally, the inflection point of RDW was 14.0%. When RDW was ≥14.0%, there was a positive association with the risk of GIB (OR: 1.24, 95% CI: 1.16, 1.33, p < 0.0001). Conversely, when RDW was <14.0%, this association was not significant (OR: 1.02, 95% CI: 0.97-1.07, p = 0.4040). Conclusion This study showed a substantial non-linear link between RDW and the risk of GIB in stroke patients. Maintaining the patient's RDW value below 14.0% could lower the risk of in-hospital GIB.
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Affiliation(s)
- Zhanxing Wu
- Department of Emergency Medicine, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People's Hospital, Shenzhen, China
| | - Ganggang Peng
- Department of Emergency Medicine, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People's Hospital, Shenzhen, China
| | - Zhongqing Chen
- Department of Emergency Medicine, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People's Hospital, Shenzhen, China
| | - Xiaoyong Xiao
- Department of Emergency Medicine, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People's Hospital, Shenzhen, China
| | - Zhenhua Huang
- Department of Emergency Medicine, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People's Hospital, Shenzhen, China
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Chen Z, Lin W, Zhang F, Cao W. Risk Factors and Prognosis Analysis of Upper Gastrointestinal Bleeding in Patients With Acute Severe Cerebral Stroke. J Clin Gastroenterol 2024; 58:440-446. [PMID: 37341702 PMCID: PMC10994183 DOI: 10.1097/mcg.0000000000001877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Accepted: 05/22/2023] [Indexed: 06/22/2023]
Abstract
GOALS We aim to explore the relationship between the use of proton pump inhibitors (PPIs) and upper gastrointestinal bleeding (UGIB). We develop a nomogram model to predict mortality in critically ill stroke patients. STUDY This is a retrospective study based on the MIMIC IV database. We extracted clinical information including demographic data, comorbidities, and laboratory indicators. Univariate and multivariable logistic regressions were used to assess and identify risk factors for the occurrence of UGIB and for the in-hospital mortality of critically ill stroke patients. The resulting model was used to construct a nomogram for predicting in-hospital mortality. RESULTS Five thousand seven hundred sixteen patients from the MIMIC-IV database were included in our analysis. UGIB occurred in 109 patients (1.9%), whereas the PPI use rate was as high as 60.6%. Chronic liver disease, sepsis, shock, anemia, and increased level of urea nitrogen were independent risk factors for the occurrence of UGIB in severe stroke patients. We identified age, heart failure, shock, coagulopathy, mechanical ventilation, continuous renal replacement therapy, antiplatelet drugs, anticoagulation, simplified acute physiology score-II, and Glasgow coma score as independent risk factors for in-hospital mortality in severe stroke patients. The C-index for the final nomograms was 0.852 (95% confidence interval: 0.840, 0.864). CONCLUSIONS We found that the overall rate of UGIB in severe stroke patients is low, whereas the rate of PPI usage is high. In our study, PPI was not identified as a risk factor for the occurrence of UGIB and UGIB was not associated with all-cause mortality. More clinical trials are needed to evaluate the benefits of using PPI in critically ill stroke patients.
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Hu JN, Xu F, Hao YR, Sun CY, Wu KM, Lin Y, Zhong L, Zeng X. MH-STRALP: A scoring system for prognostication in patients with upper gastrointestinal bleeding. World J Gastrointest Surg 2024; 16:790-806. [PMID: 38577095 PMCID: PMC10989336 DOI: 10.4240/wjgs.v16.i3.790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 01/21/2024] [Accepted: 02/29/2024] [Indexed: 03/22/2024] Open
Abstract
BACKGROUND Upper gastrointestinal bleeding (UGIB) is a common medical emergency and early assessment of its outcomes is vital for treatment decisions. AIM To develop a new scoring system to predict its prognosis. METHODS In this retrospective study, 692 patients with UGIB were enrolled from two centers and divided into a training (n = 591) and a validation cohort (n = 101). The clinical data were collected to develop new prognostic prediction models. The endpoint was compound outcome defined as (1) demand for emergency surgery or vascular intervention, (2) being transferred to the intensive care unit, or (3) death during hospitalization. The models' predictive ability was compared with previously established scores by receiver operating characteristic (ROC) curves. RESULTS Totally 22.2% (131/591) patients in the training cohort and 22.8% (23/101) in the validation cohort presented poor outcomes. Based on the stepwise-forward Logistic regression analysis, eight predictors were integrated to determine a new post-endoscopic prognostic scoring system (MH-STRALP); a nomogram was determined to present the model. Compared with the previous scores (GBS, Rockall, ABC, AIMS65, and PNED score), MH-STRALP showed the best prognostic prediction ability with area under the ROC curves (AUROCs) of 0.899 and 0.826 in the training and validation cohorts, respectively. According to the calibration curve, decision curve analysis, and internal cross-validation, the nomogram showed good calibration ability and net clinical benefit in both cohorts. After removing the endoscopic indicators, the pre-endoscopic model (pre-MH-STRALP score) was conducted. Similarly, the pre-MH-STRALP score showed better predictive value (AUROCs of 0.868 and 0.767 in the training and validation cohorts, respectively) than the other pre-endoscopic scores. CONCLUSION The MH-STRALP score and pre-MH-STRALP score are simple, convenient, and accurate tools for prognosis prediction of UGIB, and may be applied for early decision on its management strategies.
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Affiliation(s)
- Jun-Nan Hu
- Department of Gastroenterology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai 200120, China
| | - Fei Xu
- Department of Gastroenterology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai 200120, China
| | - Ya-Rong Hao
- Department of Gastroenterology, Shanghai Changzheng Hospital, Navy Military Medical University, Shanghai 200003, China
| | - Chun-Yan Sun
- Department of Gastroenterology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai 200120, China
| | - Kai-Ming Wu
- Department of Gastroenterology, Shanghai Changzheng Hospital, Navy Military Medical University, Shanghai 200003, China
| | - Yong Lin
- Department of Gastroenterology, Shanghai Changzheng Hospital, Navy Military Medical University, Shanghai 200003, China
| | - Lan Zhong
- Department of Gastroenterology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai 200120, China
| | - Xin Zeng
- Department of Gastroenterology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai 200120, China
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Aziz MA, Bojja S, Aziz AA, Javed N, Patel H. Gastrointestinal Bleeding in Patients With Acute Ischemic Stroke: A Literature Review. Cureus 2024; 16:e53210. [PMID: 38425599 PMCID: PMC10902729 DOI: 10.7759/cureus.53210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/29/2024] [Indexed: 03/02/2024] Open
Abstract
Stroke is an infarction of the central nervous system (brain, spinal cord, or retina) that results from a disruption in cerebral blood flow either due to ischemia or hemorrhage. Complications of acute stroke are common and include pneumonia, urinary tract infection, myocardial infarction, deep vein thrombosis, and pulmonary embolism, among several others, all of which increase the risk of poor clinical outcomes. Gastrointestinal bleeding is a well-known complication that can occur during the acute phase of stroke. In this review, we have summarized the existing data regarding the incidence, pathophysiology, risk factors, morbidity, mortality, and management strategies for gastrointestinal bleeding in patients with acute ischemic stroke.
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Affiliation(s)
| | - Srikaran Bojja
- Internal Medicine, BronxCare Health System, Icahn School of Medicine at Mount Sinai, New York City, USA
| | - Ahmed Ali Aziz
- Internal Medicine, Capital Health Regional Medical Center, Trenton, USA
| | - Nismat Javed
- Internal Medicine, BronxCare Health System, Icahn School of Medicine at Mount Sinai, New York City, USA
| | - Harish Patel
- Gastroenterology and Hepatology, BronxCare Health System, New York City, USA
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Qiu W, Liu C, Ye J, Wang G, Yang F, Pan Z, Hu W, Gao H. Age-to-Glasgow Coma Scale score ratio predicts gastrointestinal bleeding in patients with primary intracerebral hemorrhage. Front Neurol 2023; 14:1034865. [PMID: 36860571 PMCID: PMC9968863 DOI: 10.3389/fneur.2023.1034865] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 01/20/2023] [Indexed: 02/15/2023] Open
Abstract
Objective Recent clinical studies have demonstrated that advanced age and low initial Glasgow Coma Scale (GCS) score were independent predictors of gastrointestinal bleeding (GIB) in patients with primary intracerebral hemorrhage (ICH). However, used singly, age and GCS score have their respective shortcomings in predicting the occurrence of GIB. This study aimed to investigate the association between the age-to-initial GCS score ratio (AGR) and the risk of GIB following ICH. Methods We conducted a single-center, retrospective observational study of consecutive patients presenting with spontaneous primary ICH at our hospital from January 2017 through January 2021. Patients who fulfilled the inclusion and exclusion criteria were categorized into GIB and non-GIB groups. Univariate and multivariate logistic regression analyses were implemented to identify the independent risk factors for the occurrence of GIB, and a multicollinearity test was performed. Furthermore, one-to-one matching was conducted to balance important patient characteristics by the groups' propensity score matching (PSM) analysis. Results A total of 786 consecutive patients fulfilled the inclusion/exclusion criteria for the study, and 64 (8.14%) patients experienced GIB after primary ICH. Univariate analysis revealed that patients with GIB were significantly older [64.0 (55.0-71.75) years vs. 57.0 (51.0-66.0) years, p = 0.001] and had a higher AGR [7.32 (5.24-8.96) vs. 5.40 (4.31-7.11), p < 0.001] and a lower initial GCS score [9.0 (7.0-11.0) vs. 11.0 (8.0-13.0), p < 0.001]. The multicollinearity test revealed that no multicollinearity was observed in the multivariable models. Multivariate analysis showed that the AGR was a significant independent predictor of GIB [odds ratio (OR) 1.155, 95% confidence interval (CI) 1.041-1.281, p = 0.007], as well as prior anticoagulation or antiplatelet therapy (OR 0.388, 95% CI 0.160-0.940, p = 0.036) and MV used >24 h (OR 0.462, 95% CI 0.252-0.848, p = 0.013). Receiver operating curve (ROC) analysis illustrated that the optimal cutoff value for the AGR as a predictor for GIB in patients with primary ICH was 6.759 [the area under the curve (AUC) was 0.713 with a corresponding sensitivity of 60.94% and specificity of 70.5%, 95% CI 0.680-0.745, p < 0.001]. After 1:1 PSM, the matched GIB group had significantly higher AGR levels compared with the matched non-GIB group [7.47(5.38-9.32) vs. 5.24(4.24-6.40), p <0.001]. The ROC analysis indicated an AUC of 0.747 (the sensitivity was 65.62%, and the specificity was 75.0%, 95% CI 0.662-0.819, p < 0.001) for AGR levels as an independent predictor of GIB in patients with ICH. In addition, AGR levels were statistically correlated with unfunctional 90-day outcomes. Conclusion A higher AGR was associated with an increased risk of GIB and unfunctional 90-day outcomes in patients with primary ICH.
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Affiliation(s)
- Weizhi Qiu
- Department of Neurosurgery, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, China,Department of Neurosurgery, The Second Affiliated Clinical Medical College of Fujian Medical University, Quanzhou, China
| | - Chubin Liu
- Department of Neurosurgery, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, China,Department of Neurosurgery, The Second Affiliated Clinical Medical College of Fujian Medical University, Quanzhou, China
| | - Jinfu Ye
- Department of Anesthesiology, The Second Hospital of Jinjiang, Quanzhou, China
| | - Gang Wang
- Department of Neurosurgery, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, China,Department of Neurosurgery, The Second Affiliated Clinical Medical College of Fujian Medical University, Quanzhou, China,Department of Neurosurgery, Lanzhou University Second Hospital, Lanzhou, China
| | - Fuxing Yang
- Department of Neurosurgery, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, China,Department of Neurosurgery, The Second Affiliated Clinical Medical College of Fujian Medical University, Quanzhou, China
| | - Zhigang Pan
- Department of Neurosurgery, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, China,Department of Neurosurgery, The Second Affiliated Clinical Medical College of Fujian Medical University, Quanzhou, China
| | - Weipeng Hu
- Department of Neurosurgery, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, China,Department of Neurosurgery, The Second Affiliated Clinical Medical College of Fujian Medical University, Quanzhou, China,Weipeng Hu ✉
| | - Hongzhi Gao
- Department of Neurosurgery, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, China,Department of Neurosurgery, The Second Affiliated Clinical Medical College of Fujian Medical University, Quanzhou, China,*Correspondence: Hongzhi Gao ✉
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Lin Y, Chen MF, Zhang H, Li RM, Chen LW. The risk factors for postoperative cerebral complications in patients with Stanford type a aortic dissection. J Cardiothorac Surg 2019; 14:178. [PMID: 31640724 PMCID: PMC6805587 DOI: 10.1186/s13019-019-1009-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Accepted: 09/30/2019] [Indexed: 01/01/2023] Open
Abstract
Background Postoperative cerebral complications (PCC) are common and serious postoperative complications for patients with Stanford type A aortic dissection (AAD). The aim of this study was to evaluate the risk factors for PCC in these patients and to provide a scientific basis for effective prevention of PCC. Methods In this retrospective case-control study, 125 patients with AAD who underwent thoracotomy in our department from October 2017 to October 2018 in the department of cardiovascular surgery, Fujian Medical University Union Hospital were divided into two groups: patients with PCC (n = 12), and patients without PCC (n = 113). The general clinical data, the types of corrective surgeries, the intraoperative situations, the postoperative complications, and the midterm outcomes of the patients were analyzed. Results The patients with PCC were significantly older than the patients without PCC (P = 0.016), and the incidence of the preoperative cerebral disease history in the patients with PCC was significantly higher than those of the PCC (−) group (P = 0.024). The Euro SCORE II of patients with PCC was dramatically higher than the patients without PCC (P = 0.005). There were significant differences between the two groups in terms of the duration of cardiopulmonary bypass (CPB) (P = 0.010) and the length of moderate hypothermic circulatory arrest (MHCA) combined with selective cerebral perfusion (SCP) (P = 0.000). The monitoring of rcSO2 indicated that there was significant difference between the two groups in terms of the bilateral baseline (P = 0.000). Patients with PCC were observed to have experienced significantly longer intubation times (P = 0.000), ICU stays (P = 0.001), and postoperative hospital stays (P = 0.009), and they also had dramatically higher rates of pulmonary infection (P = 0.000), multiple organ dysfunction syndrome (P = 0.041) and tracheotomy (P = 0.022) after surgeries. The duration of MHCA+SCP (OR:9.009, P = 0.034) and the average baseline value of rcSO2 (OR:0.080, P = 0.009) were ultimately identified as significant risk factors. Conclusions PCC has a serious influence on the prognoses of patients following surgical treatment with AAD. The duration of MHCA+SCP and the average baseline value of rcSO2 were the independent risk factors for PCC.
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Affiliation(s)
- Yong Lin
- Department of Cardiovascular Surgery, Fujian Medical University Union Hospital, No. 29 Xinquan Road, Fuzhou City, 350001, Fujian Province, People's Republic of China.
| | - Mei-Fang Chen
- Department of Cardiovascular Surgery, Fujian Medical University Union Hospital, No. 29 Xinquan Road, Fuzhou City, 350001, Fujian Province, People's Republic of China
| | - Hui Zhang
- Department of Cardiovascular Surgery, Fujian Medical University Union Hospital, No. 29 Xinquan Road, Fuzhou City, 350001, Fujian Province, People's Republic of China
| | - Ruo-Meng Li
- Department of Cardiovascular Surgery, Fujian Medical University Union Hospital, No. 29 Xinquan Road, Fuzhou City, 350001, Fujian Province, People's Republic of China
| | - Liang-Wan Chen
- Department of Cardiovascular Surgery, Fujian Medical University Union Hospital, No. 29 Xinquan Road, Fuzhou City, 350001, Fujian Province, People's Republic of China
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Role of Helicobacter pylori in Upper Gastrointestinal Bleeding Among Ischemic Stroke Hospitalizations: A Nationwide Study of Outcomes. GASTROINTESTINAL DISORDERS 2019. [DOI: 10.3390/gidisord1030029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Introduction: Helicobacter pylori (H. pylori) is a well-recognized risk factor for upper gastrointestinal bleeding (UGIB). The exposure to tissue plasminogen activator (tPA), anti-platelets, and anticoagulants increases the risk of UGIB in acute ischemic stroke (AIS) patients, the risk stratification of H. pylori infection is not known. In this retrospective cross-sectional study, we aimed to evaluate the relationship between H. pylori and GIB in patients hospitalized with AIS. Methods: In the nationwide data, hospitalization for AIS was identified by primary diagnosis using International Classification of Diseases, clinical modification (ICD-9-CM) codes. Subgroup of patients with GIB and H. pylori were identified in AIS cohort. A stepwise multivariable logistic regression model was fitted to evaluate the outcome of upper GIB and role of H. Pylori in UGIB. Results: Overall 4,224,924 AIS hospitalizations were identified, out of which 18,629 (0.44%) had UGIB and 3122 (0.07%) had H. pylori. The prevalence of H. pylori-induced UGIB among UGIB in AIS was 3.05%. The prevalence of UGIB was markedly elevated among the H. pylori infection group (18.23% vs. 0.43%; p < 0.0001) compared to the non-H. pylori group. In multivariable regression analysis, H. pylori was associated with markedly elevated odds of UGIB (aOR:27.75; 95%CI: 21.07–36.55; p < 0.0001). Conclusion: H. pylori infection had increased risk-adjusted occurrence of UGIB amongst the AIS hospitalized patients. H. pylori testing may improve risk stratification for UGIB and lower the health care cost burden in stroke hospitalization.
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Zou Y, Zhang W, Huang C, Zhu Y. Clinical significance of neutrophil to lymphocyte ratio and platelet to lymphocyte ratio in acute cerebral hemorrhage with gastrointestinal hemorrhage, and logistic regression analysis of risk factors. Exp Ther Med 2019; 18:1533-1538. [PMID: 31410106 DOI: 10.3892/etm.2019.7778] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2018] [Accepted: 06/06/2019] [Indexed: 12/13/2022] Open
Abstract
The aim of the present study was to determine the predictive value of the neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) in patients with acute cerebral hemorrhage with or without gastrointestinal hemorrhage. Risk factors of gastrointestinal hemorrhage in patients with acute cerebral hemorrhage were also assessed. A total of 335 patients with acute cerebral hemorrhage admitted to our hospital between January 2012 and January 2017 were enrolled. The 86 patients who experienced gastrointestinal hemorrhage during hospitalization were selected as the observation group, while the 249 remaining cases were assigned to the negative control group. The neutrophil, white blood cell and platelet count, as well as the NLR and PLR of each subject were recorded. Furthermore, sex, age, blood pressure, the site of cerebral hemorrhage, the amount of bleeding, the Glasgow Coma Scale (GCS) score and presence of hematosepsis were also recorded and assessed as potential risk factors for gastrointestinal hemorrhage in patients with acute cerebral hemorrhage. The NLR and PLR were markedly higher in the observation group compared with those in the negative control group. Furthermore, the NLR and PLR in the observation group were negatively associated with the 90-day overall survival of patients with acute cerebral hemorrhage and gastrointestinal hemorrhage. In the negative control group, only the PLR was negatively associated with overall survival. Logistic regression analysis indicated that a cerebral hemorrhage volume of >30 ml, lower GCS score and hematosepsis were independently associated with gastrointestinal hemorrhage in patients with acute cerebral hemorrhage (P<0.05). A high NLR and PLR indicated an elevated risk of gastrointestinal hemorrhage in patients with acute cerebral hemorrhage. A higher NLR and PLR were also negatively associated with overall survival and prognosis of patients with cerebral hemorrhage. In addition, a cerebral hemorrhage volume of >30 ml, lower GCS score and hematosepsis were independent risk factors of gastrointestinal hemorrhage in patients with acute cerebral hemorrhage.
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Affiliation(s)
- Yu Zou
- Department of Neurosurgery, The First People's Hospital of Wujiang District, Suzhou, Jiangsu 215200, P.R. China
| | - Wei Zhang
- Department of Neurosurgery, The First People's Hospital of Wujiang District, Suzhou, Jiangsu 215200, P.R. China
| | - Chuanjun Huang
- Department of Neurosurgery, The First People's Hospital of Wujiang District, Suzhou, Jiangsu 215200, P.R. China
| | - Yangqing Zhu
- Department of Neurosurgery, The First People's Hospital of Wujiang District, Suzhou, Jiangsu 215200, P.R. China
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Abstract
Gastrointestinal bleeding (GIB) is a common complication that occurs after stroke, and GIB may negatively affect patient prognosis. In this study, we aimed to examine:(1) the risk factors of GIB in acute cerebral infarction patients;(2) association between GIB and 1-year mortality in patients with acute cerebral infarction.Patients with acute cerebral infarction were divided into 2 groups based on the occurrence of GIB during acute stroke stage. Patient characteristics, clinical presentation, stroke risk factors, comorbidities, laboratory data, medication, and outcomes were investigated to analyze the associations between the variables and the probability of having GIB. In addition, patients in the study were matched individually by age, gender. A 1:1 matched case-control method and conditional logistic regression models for single and multiple factors were used to assess the risk factors of GIB in acute cerebral infarction patients.Clinical data of patients with acute cerebral infarction were reviewed and analyzed during the years 2015 and 2016. Finally, 1662 patients with acute cerebral infarction were included in this study, of whom 139 (8.5%) patients had GIB at admission. Multivariate logistic regression analysis revealed that the independent risk factors for GIB in patients with acute cerebral infarction were advanced age (OR = 1.030, P = .009), low Glasgow Coma Scale (GSC) score (OR = 0.850, P = .014), infection (OR = 4.693, P < .001), high NIHSS score (OR = 1.114, P = .001), and posterior circulation infarction (OR = 4.981, P = .010). The case-control study ultimately included 136 case-control pairs. Stepwise conditional regression analyses revealed that the independent risk factors for GIB in patients with acute cerebral infarction were low Glasgow Coma Scale (GSC) score (RR = 0.645, P = .011), infection (RR = 15.326, P = .001), and posterior circulation infarction (RR = 6.129, P = .045). The group with GIB had a higher rate of mortality and disability level (mRS grade ≥ 4) than the group without GIB (P < .001) within 1 year after stroke. In addition, independent risk factors of death within 1 year after stroke in patients were GIB (OR = 6.096, P < .001), infection (OR = 4.493, P < .001), mRS grade ≥ 4 (OR = 4.129, P < .001), and coronary heart disease (OR = 3.718, P = .001).GIB is a common complication after ischemic stroke. These identified factors may help clinicians identify risks of GIB before it develops. GIB is associated with increased risk of 1-year mortality and poor functional outcome in acute cerebral infarction patients.
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Siddiqui MT, Bilal M, Gollapudi LA, Mehta D, Umar S, Barsa J, Nabors C, Schorr-Lesnick B, Lebovics E, Tewari V. Endoscopy Is Relatively Safe in Patients with Acute Ischemic Stroke and Gastrointestinal Hemorrhage. Dig Dis Sci 2019; 64:1588-1598. [PMID: 30519853 DOI: 10.1007/s10620-018-5399-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2018] [Accepted: 11/27/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Gastrointestinal hemorrhage (GIH) is reported to occur in 1-8% of patients admitted with acute ischemic stroke (AIS). AIS is considered to be a relative contraindication to GIE. AIMS Evaluate the outcomes of gastrointestinal endoscopy (GIE) in patients hospitalized with AIS and GIH. METHODS Patients hospitalized with AIS and GIH were included from the National Inpatient Sample 2005-2014. Primary outcome measure was in-hospital mortality in patients with AIS and GIH who underwent gastrointestinal endoscopy. Secondary outcomes were (1) resource utilization as measured by length of stay (LOS) and total hospitalization costs and (2) to identify independent predictors of undergoing GIE in patients with AIS and GIH. Confounders were adjusted for by using multivariable regression analysis. RESULTS A total of 75,756 hospitalizations were included in the analysis. Using a multivariate analysis, the in-hospital mortality was significantly lower in patients who underwent GIE as compared to those who did not [aOR: 0.4, P < 0.001]. Patients who underwent GIE also had significantly shorter adjusted mean LOS [adjusted mean difference in LOS: 0.587 days, P < 0.001]. Patients with AIS and GIH who did not undergo GIE had significantly higher adjusted total hospitalization costs. [Mean adjusted difference in total hospitalization costs was $5801 (P < 0.001).] Independent predictors of undergoing GIE in this population were male gender, age > 65 years, Asian or Pacific race, hypovolemic shock, need for blood transfusion and admission to urban non-teaching hospital. CONCLUSIONS Gastrointestinal endoscopy can be safely performed in a substantial number of patients with AIS and GIH.
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Affiliation(s)
| | - Mohammad Bilal
- Division of Gastroenterology and Hepatology, University of Texas Medical Branch, Galveston, TX, 77555, USA
| | | | - Dhruv Mehta
- Department of Gastroenterology, New York Medical College, Valhalla, NY, 10595, USA
| | - Shifa Umar
- Division of Gastroenterology, Hepatology and Nutrition, Allegheny Health Network, Pittsburgh, PA, 15212, USA
| | - Jonathan Barsa
- Department of Gastroenterology, New York Medical College, Valhalla, NY, 10595, USA
| | - Christopher Nabors
- Department of Internal Medicine, New York Medical College, Valhalla, NY, 10595, USA
| | - Beth Schorr-Lesnick
- Department of Gastroenterology, New York Medical College, Valhalla, NY, 10595, USA
| | - Edward Lebovics
- Department of Gastroenterology, New York Medical College, Valhalla, NY, 10595, USA
| | - Virendra Tewari
- Department of Gastroenterology, New York Medical College, Valhalla, NY, 10595, USA
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Zhang C, Huang C, Wang M, Kong X, Liu G, Wang J. Correlation Analysis between Traditional Chinese Medicine Syndromes and Gastrointestinal Bleeding after Percutaneous Coronary Intervention. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2018; 2018:7356546. [PMID: 29955236 PMCID: PMC6000832 DOI: 10.1155/2018/7356546] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Revised: 02/22/2018] [Accepted: 03/08/2018] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To explore the characters of traditional Chinese medicine (TCM) syndromes after percutaneous coronary intervention (PCI) and to provide syndrome study theoretical evidence for TCM differentiation treatment after PCI through retrospective study. METHODS Patients with coronary heart disease (CHD) who underwent PCI in Cardiovascular Intervention Center of Wangjing Hospital during Dec. 2012 to Dec. 2014 and met the inclusion criteria were enrolled. Retrospective study was then conducted based on patients' clinical document and angiography data to explore the distribution pattern of TCM syndromes. RESULTS 801 patients were recruited in the study. TCM syndromes in descending order of their incidence were Qi deficiency and blood stasis syndrome, heart blood stasis syndrome, Qi and Yin deficiency syndrome, phlegm and blood stasis syndrome, Qi stagnation and blood stasis syndrome, Yang asthenia syndrome, heart and kidney yin deficiency syndrome to cold congeal, and blood stasis syndrome in a more to less order. Qi deficiency and blood stasis syndrome was in the most (occurring in 298 patients, 37.20%); Qi and Yin deficiency syndrome occurred in 163 patients (20.35%); heart blood stasis syndrome was shown in 126 patients (15.73%); phlegm and blood stasis syndrome was shown in 95 patients (11.86%). CONCLUSION Qi deficiency and blood stasis syndrome was closely associated with post-PCI bleeding, implying that this syndrome might serve as a powerful predictor of GI bleeding as well as a potential supplement to the current predicting and scoring system of bleeding such as CRUSADE.
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Affiliation(s)
- Chenhao Zhang
- Wangjing Hospital, China Academy of Chinese Medical Sciences, Beijing 100102, China
| | - Chaolian Huang
- Wangjing Hospital, China Academy of Chinese Medical Sciences, Beijing 100102, China
| | - Mingming Wang
- Beijing First Hospital of Integrated Chinese and Western Medicine, Beijing 100026, China
| | - Xiaolin Kong
- Wangjing Hospital, China Academy of Chinese Medical Sciences, Beijing 100102, China
| | - Guannan Liu
- Wangjing Hospital, China Academy of Chinese Medical Sciences, Beijing 100102, China
| | - Jie Wang
- Guanganmen Hospital, China Academy of Chinese Medical Sciences, Beijing 100053, China
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Chou YF, Weng WC, Huang WY. Association between gastrointestinal bleeding and 3-year mortality in patients with acute, first-ever ischemic stroke. J Clin Neurosci 2017; 44:289-293. [DOI: 10.1016/j.jocn.2017.06.068] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Revised: 06/19/2017] [Accepted: 06/21/2017] [Indexed: 11/28/2022]
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Ji R, Shen H, Pan Y, Wang P, Liu G, Wang Y, Li H, Singhal AB, Wang Y. Risk score to predict gastrointestinal bleeding after acute ischemic stroke. BMC Gastroenterol 2014; 14:130. [PMID: 25059927 PMCID: PMC4120715 DOI: 10.1186/1471-230x-14-130] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2014] [Accepted: 07/16/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Gastrointestinal bleeding (GIB) is a common and often serious complication after stroke. Although several risk factors for post-stroke GIB have been identified, no reliable or validated scoring system is currently available to predict GIB after acute stroke in routine clinical practice or clinical trials. In the present study, we aimed to develop and validate a risk model (acute ischemic stroke associated gastrointestinal bleeding score, the AIS-GIB score) to predict in-hospital GIB after acute ischemic stroke. METHODS The AIS-GIB score was developed from data in the China National Stroke Registry (CNSR). Eligible patients in the CNSR were randomly divided into derivation (60%) and internal validation (40%) cohorts. External validation was performed using data from the prospective Chinese Intracranial Atherosclerosis Study (CICAS). Independent predictors of in-hospital GIB were obtained using multivariable logistic regression in the derivation cohort, and β-coefficients were used to generate point scoring system for the AIS-GIB. The area under the receiver operating characteristic curve (AUROC) and the Hosmer-Lemeshow goodness-of-fit test were used to assess model discrimination and calibration, respectively. RESULTS A total of 8,820, 5,882, and 2,938 patients were enrolled in the derivation, internal validation and external validation cohorts. The overall in-hospital GIB after AIS was 2.6%, 2.3%, and 1.5% in the derivation, internal, and external validation cohort, respectively. An 18-point AIS-GIB score was developed from the set of independent predictors of GIB including age, gender, history of hypertension, hepatic cirrhosis, peptic ulcer or previous GIB, pre-stroke dependence, admission National Institutes of Health stroke scale score, Glasgow Coma Scale score and stroke subtype (Oxfordshire). The AIS-GIB score showed good discrimination in the derivation (0.79; 95% CI, 0.764-0.825), internal (0.78; 95% CI, 0.74-0.82) and external (0.76; 95% CI, 0.71-0.82) validation cohorts. The AIS-GIB score was well calibrated in the derivation (P = 0.42), internal (P = 0.45) and external (P = 0.86) validation cohorts. CONCLUSION The AIS-GIB score is a valid clinical grading scale to predict in-hospital GIB after AIS. Further studies on the effect of the AIS-GIB score on reducing GIB and improving outcome after AIS are warranted.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Yongjun Wang
- Tiantan Comprehensive Stroke Center, Tiantan Hospital, Capital Medical University, No,6 Tiantanxili, Dongcheng District, Beijing 100050, China.
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Chen CM, Hsu HC, Chang CH, Lin CH, Chen KH, Hsieh WC, Chang WM. Age-based prediction of incidence of complications during inpatient stroke rehabilitation: a retrospective longitudinal cohort study. BMC Geriatr 2014; 14:41. [PMID: 24684939 PMCID: PMC4229986 DOI: 10.1186/1471-2318-14-41] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2013] [Accepted: 03/26/2014] [Indexed: 11/16/2022] Open
Abstract
Background Stroke complications can occur not only in the acute ward but also during the subsequent rehabilitation period. However, existing studies have not adequately addressed the incidence of various complications among stroke in patients undergoing rehabilitation using a longitudinal method. We aimed to investigate the longitudinal impact of age on complication rates in patients undergoing inpatient stroke rehabilitation at different disease stages. Methods Five hundred and sixty-eight first-time stroke patients transferred to the rehabilitation ward between July 2002 and June 2012 were included in the study. Patients were stratified into age groups for comparison: <65 years (young), 65 years to <75 years (younger old), and ≥75 years (older old). In total, 30 different complication types were recorded for analysis. Results Constipation, shoulder pain, symptomatic urinary tract infection (UTI), and fever were common complications during initial stay in the rehabilitation ward, and incidence was >10% in all three age groups. The frequency of incidence of upper gastrointestinal bleeding (UGIB) was higher in the younger old (17.9%) and older old (20.6%) groups than in the young group (4.1%) during initial stay in the rehabilitation ward (p < 0.001). The incidence of UGIB was higher in the younger old (8.04%) and older old (8.33%) groups than in the young group (0.19%) during subsequent stay in the rehabilitation ward (p = 0.011). The incidence of symptomatic UTI was higher in the younger old (21.0%) and older old (20.0%) groups than in the young group (11.5%) during initial stay in the rehabilitation ward (p = 0.019). The incidence of symptomatic UTI was higher in the older old group (29.17%) than in the younger old (9.21%) and young (3.14%) groups during subsequent stay in the rehabilitation ward (p < 0.001). Conclusions Age does not affect every complication type. UGIB and symptomatic UTI occurred more frequently in stroke patients aged ≥65 years during their stay in the rehabilitation ward.
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Affiliation(s)
- Chien-Min Chen
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Chiayi, No,6, W, Sec,, Jiapu Rd,, Puzih City, Chiayi County 613, Taiwan.
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