Aim: Upper gastrointestinal bleeding is an important cause of mortality and morbidity. The aim of this study is to evaluate the risk factors of mortality in patients admitted to medical ICU with upper gastrointestinal bleeding. Methods: Patients admitted to medical ICU with upper GI bleeding or patients with new onset GIS bleeding during the ICU stay between January 2010-December 2016 were included. Patient datas were recorded from the hospitals database retrospectively. Results: There were 3990 patients between the study period. One hundred seventy six of these patients had gastrointestinal bleeding and enrolled the study. One hundred seventeen (66,5%) of 176 patients were male, 59 (33,5%) were female. Mean age of the patients was 63±16 years. While the number of the patients who underwent endoscopy procedure was 152 (86,4%); mortality rate of these patients was 46,1%; and 91,7% for the patients who did not undergo the endoscopy procedure. Mortality rates of patients with variceal and nonvariceal bleeding diagnose were 46% and 47,6%. Uremia, renal failure, increase of the leucocyte count during the follow up, coagulopathy, increased demand of erythrocyte suspension and lack of endoscopy procedure were determined as risk factors for mortality. Conclusion: Upper gastrointestinal bleeding in the intensive care unit is a situation which is with high mortality rate. Higher APACHE II Score, presence of comorbidities are determinants of prognosis.
Objective: The aim of this study was to investigate the general characteristics, management strategies for malnutrition, and clinical outcomes in hospitals according to age groups and examine the relationships between mortality and nutritional way of the patients followed by our nutrition support team. Methods: Totally, 411 patients were enrolled in this retrospective study. Demographic characteristics, reasons for hospitalization, comorbidities, wards the patients were staying, first day Nutritional Risk Screening 2002 scores, length of hospital stay, and clinical outcomes of the patients were recorded. Clinical parameters were compared between young patients and elders. Results: The median age was 75 years (18-96) [54.3% male, median length of hospital stay 23 days (0-261), in-hospital mortality rate 43.6%]. The median survival was lower in elders compared to young patients (42 vs. 76 days, P = .002). The median survival was higher in patients with oral feeding compared to those without oral feeding (63 vs. 41 days, P < .001). The median survival was lower in patients with parenteral than oral and/or enteral feeding (14 vs. 48 days, P < .001). Age (hazard ratio: 1.028, 95% CI: 1.010-1.046), sepsis (hazard ratio 4.365, 95% CI: 1.810-10.528), malnutrition in the first day of admission (hazard ratio: 2.223, 95% CI: 1.198-4.126), parenteral nutrition (hazard ratio: 2.458, 95% CI: 1.432-4.220), oral nutrition (hazard ratio: 0.090, 95% CI: 0.045-0.182), tube feeding (hazard ratio: 1.915, 95% CI: 1.015-3.614), and feeding by gastr ostom y/jej unost omy (hazard ratio: 0.113, 95% CI: 0.057-0.224) were found to be independently associated factors for hospital mortality (all parameters had P < .05). Conclusion: It was shown that the study population had high hospital mortality rate, and age, malnutrition, severe infection, and nutritional ways were independently correlated factors for hospital mortality.
Extra-intestinal involvement is a common manifestation in Inflammatory Bowel Disease (IBD). Joints are the most common site of involvement and the co-existence of IBD with spondylitis or peripheral arthritis (Asymmetric arthritis on lower extremity joints) is considered as Spondiloarthropathy (SpA), "enteropathic arthritis" or "arthritis related to IBD" according to the "European Spondiloartropathy Study Group" criteria.1,2 The pathogenesis of extra-intestinal findings in IBD is poorly understood. Current theories suggest the impairment of mucosal immunoregulatory mechanisms in IBD, resulting in the transport of luminal content antigens to the systemic circulation. Also, lack of intestinal mucosal barrier protection mechanism, mucosal secretion of immunoglobulin A (IgA) and defense mechanism of mucosa against foreign proteins ABSTRACT Objectives: This study aims to investigate whether clinical measures of disease activity and function in ankylosing spondylitis (AS) and inflammatory bowel disease (IBD) are associated with matrix metalloproteinase-3 (MMP-3), matrix metalloproteinase-9 (MMP-9) and tissue inhibitor of matrix metalloproteinase -1 (TIMP-1), and if MMPs can be more useful than C-reactive protein and erythrocyte sedimentation rate in predicting disease activity in AS. Patients and methods: MMP-3, MMP-9 and TIMP-1 levels were measured by ELISA in 20 patients with AS, 20 patients with IBD, 20 patients with IBD and AS (35 males, 25 females; mean age 38.1 years; range 19 to 62 years), and 20 healthy volunteers (10 males, 10 females; median age 38.5 years; range 24 to 63 years) as a control group. Bath Ankylosing Spondylitis Disease Activity Index, Truelove-Witts activity criteria for ulcerative colitis, and Crohn's Disease of Activity Index scoring systems were used. Results: Highest MMP-3 level was in IBD group (33.51±59.56 ng/mL, p<0.045). MMP-3 levels were significantly higher in patients with IBD and IBD+AS than in patients with AS (p<0.007 and p<0.035, respectively). Highest MMP-9 levels were in the control group (10.35±2.61 ng/mL, p<0.48). MMP-9 levels were higher in AS group patients than those in IBD and IBD+AS groups, but the difference was not statistically significant (p<0.494 and p<0.260, respectively). Highest TIMP-1 levels were in the IBD group (8.11 ng/mL, p<0.006). TIMP-1 levels of IBD group were significantly higher than both AS and IBD+AS groups (p<0.033 and p<0.008, respectively). A statistically significant correlation was detected between serum MMP-3 levels and disease activity and Bath Ankylosing Spondylitis Disease Activity Index score in patients with AS (r=0.841, p<0.05). Conclusion: We concluded that serum MMP-3 levels may be a better biomarker than C-reactive protein and erythrocyte sedimentation rate in showing disease activity in AS.Keywords: Ankylosing spondylitis; inflammatory bowel disease; metalloproteinase-3; metalloproteinase-9; tissue matrix metalloproteinase inhibitor-1.
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