Haematological risk factors predicting clinical success in transarterial embolisation for acute gastrointestinal bleeding.

OBJECTIVES: Evaluate clinical outcomes in transarterial embolisation (TAE) for acute gastrointestinal bleeding (GIB) and determine risk factors for 30-day reintervention for rebleeding and mortality. METHODS: TAE cases were retrospectively reviewed between March 2010 and September 2020 at our tertiary centre. Technical success (angiographic haemostasis following embolisation) was measured. Uni- and multivariate logistic regression analysis were performed to identify risk factors for clinical success (absence of 30-day reintervention or mortality) following embolisation for active GIB or empirical embolisation for suspected bleeding. RESULTS: TAE was conducted in 139 patients (92 (66.2%) male; median age:73, range: 20-95 years) for acute upper GIB (n = 88) and lower GIB (n = 51). TAE was technically successful in 85/90 (94.4%) and clinically successful in 99/139 (71.2%); with 12 (8.6%) reintervention cases for rebleeding (median interval 2 days) and 31 (22.3%) cases of mortality (median interval 6 days). Reintervention for rebleeding was associated with haemoglobin drop > 40 g l-1 from baseline based on univariate analysis (p = 0.047). 30-day mortality was associated with pre-intervention platelet count < 150×109 l-1 (p < 0.001, OR 7.35, 95% CI 3.05-17.71) and INR > 1.4 (p < 0.001, OR 4.75, 95% CI 2.03-11.09) on multivariate logistic regression analysis. No associations were found for patient age, gender, antiplatelet/anticoagulation prior to TAE, or when comparing upper and lower GIB with 30-day mortality. CONCLUSION: TAE had excellent technical success for GIB with relatively high (1-in-5) 30-day mortality. INR > 1.4 and platelet count < 150×109 l-1 were individually associated with TAE 30-day mortality, and pre-TAE > 40 g l-1 haemoglobin decline with rebleeding requiring reintervention. ADVANCES IN KNOWLEDGE: Recognition and timely reversal of haematological risk factors may improve TAE periprocedural clinical outcomes.

A meta-analysis of water quality and aquatic macrophyte responses in 18 lakes treated with lanthanum modified bentonite (Phoslock(®)).

Lanthanum (La) modified bentonite is being increasingly used as a geo-engineering tool for the control of phosphorus (P) release from lake bed sediments to overlying waters. However, little is known about its effectiveness in controlling P across a wide range of lake conditions or of its potential to promote rapid ecological recovery. We combined data from 18 treated lakes to examine the lake population responses in the 24 months following La-bentonite application (range of La-bentonite loads: 1.4-6.7 tonnes ha(-1)) in concentrations of surface water total phosphorus (TP; data available from 15 lakes), soluble reactive phosphorus (SRP; 14 lakes), and chlorophyll a (15 lakes), and in Secchi disk depths (15 lakes), aquatic macrophyte species numbers (6 lakes) and aquatic macrophyte maximum colonisation depths (4 lakes) across the treated lakes. Data availability varied across the lakes and variables, and in general monitoring was more frequent closer to the application dates. Median annual TP concentrations decreased significantly across the lakes, following the La-bentonite applications (from 0.08 mg L(-1) in the 24 months pre-application to 0.03 mg L(-1) in the 24 months post-application), particularly in autumn (0.08 mg L(-1) to 0.03 mg L(-1)) and winter (0.08 mg L(-1) to 0.02 mg L(-1)). Significant decreases in SRP concentrations over annual (0.019 mg L(-1) to 0.005 mg L(-1)), summer (0.018 mg L(-1) to 0.004 mg L(-1)), autumn (0.019 mg L(-1) to 0.005 mg L(-1)) and winter (0.033 mg L(-1) to 0.005 mg L(-1)) periods were also reported. P concentrations following La-bentonite application varied across the lakes and were correlated positively with dissolved organic carbon concentrations. Relatively weak, but significant responses were reported for summer chlorophyll a concentrations and Secchi disk depths following La-bentonite applications, the 75th percentile values decreasing from 119 µg L(-1) to 74 µg L(-1) and increasing from 398 cm to 506 cm, respectively. Aquatic macrophyte species numbers and maximum colonisation depths increased following La-bentonite application from a median of 5.5 species to 7.0 species and a median of 1.8 m to 2.5 m, respectively. The aquatic macrophyte responses varied significantly between lakes. La-bentonite application resulted in a general improvement in water quality leading to an improvement in the aquatic macrophyte community within 24 months. However, because, the responses were highly site-specific, we stress the need for comprehensive pre- and post-application assessments of processes driving ecological structure and function in candidate lakes to inform future use of this and similar products.