Comparisons of six endoscopy independent scoring systems for the prediction of clinical outcomes for elderly and younger patients with upper gastrointestinal bleeding.

OBJECTIVES: To compare the predictive ability of six pre-endoscopic scoring systems (ABC, AIMS65, GBS, MAP(ASH), pRS, and T-score) for outcomes of upper gastrointestinal bleeding (UGIB) in elderly and younger patients. METHODS: A retrospective study of 1260 patients, including 530 elderly patients (age [Formula: see text] 65) and 730 younger patients (age < 65) presenting with UGIB, was performed at Zhongda Hospital Southeast University, from January 2015 to December 2020. Six scoring systems were used. RESULTS: ABC had the largest areas under the curve (AUCs) of 0.827 (0.792-0.858), and 0.958 (0.929-0.987) for elderly and younger groups for predicting mortality respectively. The differences of the AUCs for predicting the outcome of mortality and rebleeding between the two groups were significant for ABC and pRS (p < 0.01). For intervention prediction, significant differences were observed only for pRS [AUC 0.623 (0.578-0.669) vs. 0.699 (0.646-0.752)] (p < 0.05) between the two groups. For intensive care unit (ICU) admission, the AUC for MAP (ASH) [0.791 (0.718-0.865) vs. 0.891 (0.831-0.950)] and pRS [0.610 (0.514-0.706) vs. 0.891 (0.699-0.865)] were more effective for the younger group (p < 0.05 and p < 0.01, respectively). For comparison of scoring systems in the same cohort, ABC was significantly higher than pRS: AUC 0.710 (0.699-0.853, p < 0.05) and T-score 0.670 (0.628-0.710, p < 0.01) for predicting mortality in the elderly group. In the younger group, ABC was significantly higher than GBS and T-score (p < 0.01). MAP(ASH) performs the best in predicting intervention in both groups. CONCLUSIONS: ABC and pRS are more accurate for predicting mortality and rebleeding in the younger cohort, and pRS may not be suitable for elderly patients. There was no difference between the two study populations for GBS, AIMS65, and T-score. Except for ICU admission, MAP(ASH) showed fair accuracy for both cohorts.

A rare case of duodenal angiodysplasia-a case report.

Gastrointestinal bleeding can be manifested as a variety of symptoms and, often, it is difficult to classify as upper or lower gastrointestinal bleeding on mere symptomatology. This is a case report of a similar kind of patient who initially was diagnosed with fresh per rectum bleeding, subsequently diagnosed as bleeding angiodysplasia in duodenal diverticulum by a series of investigations and management including urgent oesophageal-gastroduodenoscopy (OGD), laparotomy, followed by computerized tomography-angiogram. As diagnosis was established after laparotomy, the patient was kept intubated and IR selective embolization was performed. Keeping this case report in view, it can be suggested that bleeding vascular malformation in any part duodenum should be considered as a cause of massive upper GI bleeding. Furthermore, if operative intervention is indicated, it should be preceded by OGD, not only for a therapeutic purpose but also as an adjunct for guidance for the operative plan.

A randomised controlled trial: effect of the meticulous nursing model on the treatment compliance and quality of life of patients with upper gastrointestinal bleeding.

BACKGROUND: The purpose of this study was to analyze the effect of the meticulous nursing model on the treatment compliance and quality of life of patients with upper gastrointestinal bleeding (UGIB). METHODS: A total of 108 UGIB patients treated in Linyi Central Hospital from October 2018 to October 2019 were selected as the study subjects, and were randomly divided into a research group and reference group, with 54 cases in each group. The reference group received conventional nursing while the research group received meticulous nursing on this basis to compare the clinical intervention effect and the impact on quality of life in the 2 groups of patients. RESULTS: The Generic Quality of Life Inventory-74 (GQOLI-74) scores in the 2 groups of patients after intervention were significantly higher than those before intervention (P<0.001), and the score of the research group after intervention was significantly higher than that of the reference group (P<0.001). The Stanford Acute Stress Reaction Questionnaire (SASRQ) scores of the patients presented a trend opposite to GQOLI-74 (P<0.001). The number of fully satisfied cases in the research group was significantly higher than that in the reference group (P<0.05), while the number of dissatisfied cases was significantly lower than that in the reference group (P<0.05). The self-rating anxiety scale (SAS) scores in the 2 groups of patients after intervention were significantly lower than those before intervention (P<0.001), and the score of the research group after intervention was significantly lower than that of the reference group (P<0.001). The total clinical effective rate and treatment compliance of the research group were significantly higher than those of the reference group (P<0.05). CONCLUSIONS: The meticulous nursing model can effectively improve the quality of life of UGIB patients, reduce the psychological stress response, and improve clinical treatment compliance and nursing satisfaction with a definite effect, making it worthy of promotion and application. TRIAL REGISTRATION: Chinese Clinical Trial Registry ChiCTR2100048735.

Effect of upper gastrointestinal bleeding on prognosis of middle-aged patients with acute ischemic stroke: a retrospective study.

BACKGROUND: Upper gastrointestinal bleeding (UGIB) is a common complication of acute ischemic stroke (AIS), but the effect of UGIB on the prognosis of middle-aged AIS patients is not clear. METHODS: Patients with AIS admitted to our hospital from January 2011 to December 2015 were eligible to be included in this study. All included patients were divided into UGIB and non-UGIB groups. Some clinical characteristics were retrospectively collected. Primary outcomes were all-cause mortality within 1, 3, and 5 years, as well as the incidence of stroke recurrence. Cox proportional hazards regression analyses were used to determine the effect of UGIB on 5-year mortality and the incidence of stroke recurrence. Logistic regression was also used to identify the predictors of UGIB in AIS patients. RESULTS: A total of 405 AIS patients were included in this study and then divided into UGIB and non-UGIB groups. The mean age of the UGIB group and non-UGIB group was 61.5±9.6 and 53.1±14.0 years, respectively (P<0.001). The baseline score of the National Institute of Health Stroke Scale (NIHSS) was significantly higher in the UGIB group than in the non-UGIB group (P<0.001). AIS patients in the UGIB group had a higher 1-, 3-, and 5-year mortality and a higher incidence of stroke recurrence (all P<0.001). Kaplan-Meier curves showed that AIS patients with UGIB had a higher 5-year mortality and a higher incidence of stroke recurrence (both P<0.001). Cox proportional hazards regression models indicated that the occurrence of UGIB, older age, a high NIHSS score, and stroke recurrence were related to a higher 5-year mortality. Similarly, the occurrence of UGIB, older age, a high NIHSS score, and hypertension increased the incidence of stroke recurrence. According to the multivariate logistic regression analysis, older age, a high NIHSS score, and previous anticoagulant use were identified as predictors of UGIB. CONCLUSIONS: UGIB has important effects on the prognosis of AIS patients. The incidence of UGIB increases with older age, a high NIHSS score, and previous anticoagulant use, which provides important evidence for the treatment and nursing of AIS patients.

Effect of multidisciplinary team care on the management of cirrhotic patients with upper gastrointestinal bleeding: a retrospective cohort study.

BACKGROUND: Multidisciplinary team care (MDTC) has been proposed to improve the prognosis and quality of life of patients through the collaboration of multiple disciplines. However, it is still unclear whether MDTC is effective in the management of cirrhotic patients with upper gastrointestinal bleeding (UGIB). METHODS: This was a retrospective cohort study enrolling cirrhotic patients with UGIB receiving traditional care or MDTC between July 2015 and December 2019. Clinical data and laboratory test results of enrolled patients were collected by 2 independent investigators. The primary outcomes were mortality and the incidence of rebleeding within 1 year. Furthermore, the quality of life of enrolled patients was chosen as the secondary outcome. Multivariable logistic regression was used to determine the risk factors of mortality and rebleeding, after adjusting for confounding variables by univariable logistic regression. Also, multivariable linear regression was used to determine the effects of MDTC on the quality of life of enrolled patients. RESULTS: This study finally included 206 cirrhotic patients with UGIB, with 101 patients in the traditional care group and 105 patients in the MDTC group. Compared with the traditional care group, patients in the MDTC group had significantly higher Child-Pugh and model for end-stage liver disease (MELD) scores (P=0.02 and 0.04, respectively). Furthermore, patients in the MDTC group had a significantly lower level of white blood cells (WBC) and a significantly higher level of aspartate transaminase (AST) compared to the traditional care group (P=0.01 and 0.02, respectively). Multivariable logistic regression then identified MDTC as a protective factor for rebleeding and mortality within 1 year. Higher MELD scores and more required units of packed red blood cells (RBC) were associated with a higher incidence of rebleeding and mortality. Additionally, patients in the MDTC group had less discomfort and depression than those in the traditional care group (both P<0.01), and MDTC was associated with improved quality of life according to the multivariable linear regression analysis. CONCLUSIONS: MDTC, compared with traditional care, reduced the incidence of rebleeding and mortality over the long term. It was also useful for relieving anxiety and improving the quality of life of patients.

Management for non-variceal upper gastrointestinal bleeding in elderly patients: the experience of a tertiary university hospital.

BACKGROUND: Peptic ulcer bleeding (PUB) is the main cause of non-variceal upper gastrointestinal bleeding (UGIB). Endoscopic treatment and acid suppression with proton-pump inhibitors (PPIs) are most important in the management of PUB and these treatments have reduced mortality. However, elderly patients sometimes have a poor prognostic outcome due to severe comorbidities. METHODS: A retrospective study was performed on 504 cases with acute non-variceal UGIB who were examined in our hospital, in order to reveal the risk factor of a poor outcome in elderly patients. RESULTS: Two hundred and thirty-four cases needed hemostasis; 11 cases had unsuccessful endoscopic treatments; 31 cases had re-bleeding after endoscopic hemostasis. Forty-three cases died within 30 days after the initial urgent endoscopy, but only seven cases died from bleeding. Elderly patients aged over 65 years had more severe comorbidities, and were prescribed non-steroidal anti-inflammatory drugs (NSAIDs), antiplatelet agents and/or anticoagulation agents, more frequently, compared with non-elderly patients. The significant risk factor of needing hemostatic therapy was the taking of two or more NSAIDs, antiplatelet agents and/or anticoagulation agents. The most important risk of a poor outcome in elderly patients was various kinds of severe comorbidities. And so, it is important to predict such an outcome in these cases. AIMS65 is a simple and relatively useful scoring system that predicts the risk of a poor outcome in UGIB. High-score patients via AIMS65 were associated with a high mortality rate because of death from comorbidities. CONCLUSIONS: The elderly patients in whom were prescribed two or more NSAIDs, antiplatelet agents and/or anticoagulation agents, should have UGIB prevented using a PPI. The most significant risk of a poor outcome in elderly patients was severe comorbidities. We recommend that elderly patients with UGIB should be estimated as having a poor outcome as soon as possible via the risk scoring system AIMS65.