Comparison of outcomes between variceal and non variceal gastrointestinal bleeding in patients with cirrhosis: Insights from a Nationwide Inpatient Sample

Farooq, Umer; Tarar, Zahid Ijaz; Franco, Diana; Kamal, Faisal; Abegunde, Ayokunle T.

doi:10.20524/aog.2022.0744

Cited by 5 publications

(5 citation statements)

References 32 publications

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“…Notably, the distinction between variceal and nonvariceal bleeding is not always clear-cut. For instance, one study comparing these two types of gastrointestinal bleeding reported higher mean age and mortality rates in the nonvariceal bleeding group [35].However, another study found no signi cant differences in clinical outcomes, including mortality, between patients admitted with variceal and nonvariceal gastrointestinal bleeding [25]. In our dataset, distinguishing between variceal and nonvariceal bleeding proved challenging due to limited information on the presence of varices, stemming from lower rates of endoscopic utilization in the elderly population.…”

Section: Discussionmentioning

confidence: 63%

“…Depending on the type of comorbidities, this association translated into varying degrees of short-term mortality elevation [23]. Variceal is uncertain risk factors according some research [24,25]. These ndings highlight the complexity and variability in the outcomes of patients with different types of gastrointestinal bleeding and with different types of complications.…”

Section: Discussionmentioning

confidence: 99%

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Prediction of 30-Day In-Hospital Mortality in Elderly UGIB Patients Using a Simplified Risk Score and Comparison with AIMS65 score

Xue,

Che,

Xie

et al. 2023

Preprint

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Background: Upper gastrointestinal bleeding (UGIB) in elderly patients is associated with substantial in-hospital morbidity and mortality. This study aimed to develop and validate a simplified risk score for predicting 30-day in-hospital mortality in this population. Methods: A retrospective analysis was conducted on data from 1899 UGIB patients aged ≥65 years admitted to a single medical center between January 2010 and December 2019. An additional cohort of 330 patients admitted from January 2020 to October 2021 was used for external validation. Variable selection was performed using five distinct methods, and models were generated using generalized linear models, random forest, support vector machine, and k-nearest neighbors approaches. The developed score, "ABCAP," incorporated Albumin <30 g/L, Blood Urea Nitrogen (BUN) >7.5 mmol/L, Cancer presence, Altered mental status, and Pulse rate >100/min, each assigned a score of 1. Internal and external validation procedures compared the ABCAP score with the AIMS65 score. Results: In internal validation, the ABCAP score demonstrated robust predictive capability with an area under the curve (AUC) of 0.878 (95% CI: 0.824-0.932), comparable to the AIMS65 score (AUC: 0.827, 95% CI: 0.751-0.904). External validation yielded an AUC of 0.799 (95% CI: 0.709-0.889) for the ABCAP score, slightly outperforming the AIMS65 score (AUC: 0.743, 95% CI: 0.647-0.838). The ABCAP score effectively stratified mortality risk into low (0-2 points), moderate (3 points), and high (4-5 points) categories. This score exhibited consistent accuracy across variceal and non-variceal UGIB subgroups. Conclusions: The ABCAP score incorporates easily obtained clinical variables and demonstrates promising predictive ability for 30-day in-hospital mortality in elderly UGIB patients. It allows effective mortality risk stratification and showed slightly better performance than the AIMS65 score. Further cohort validation is required to confirm generalizability.

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Section: Discussionmentioning

confidence: 63%

Section: Discussionmentioning

confidence: 99%

Prediction of 30-Day In-Hospital Mortality in Elderly UGIB Patients Using a Simplified Risk Score and Comparison with AIMS65 score

Xue,

Che,

Xie

et al. 2023

Preprint

View full text Add to dashboard Cite

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“…We used univariate regression analysis to compute unadjusted odds ratios (OR). Multivariate regression models were built by including all variables that were significantly associated with the outcome on univariable analysis with a cutoff P ‐value of 0.2 18 . Variables deemed clinically important to the outcome based on the literature review were included in the model irrespective of whether they were significantly associated with the outcome on univariable analysis (coronary artery disease [CAD], hepatitis C, hepatocellular carcinoma [HCC], and cirrhosis).…”

Section: Methodsmentioning

confidence: 99%

Analyzing the utility of renal replacement therapy to manage hepatorenal syndrome in alcoholic hepatitis without liver transplantation: a nationwide analysis

Farooq,

Tarar,

El Alayli

et al. 2023

J of Gastro and Hepatol

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BackgroundHepatorenal syndrome (HRS) frequently complicates alcoholic hepatitis (AH) and portends poor survival in this population. Published literature indicates mixed benefits from renal replacement therapy (RRT) for HRS refractory to medical management. Therefore, we sought to assess the utilization of RRT in AH and clinical outcomes at a national level.MethodsUsing the International Classification of Diseases, Tenth Revision (ICD‐10) codes, we identified adult patients with AH with a coexisting diagnosis of HRS from the National Readmission Database 2016 through 2019. Mortality, morbidity, and resource utilization were compared. We compared proportions using the Fisher exact test and computed adjusted P‐values based on multivariate regression analysis. Analyses were performed using Stata, version 14.2, considering a two‐sided P < 0.05 as statistically significant.ResultsA total of 73 203 patients with AH were included in the analysis (mean age 46.2 years). A total of 3620 individuals had HRS diagnosis (5%), of which 14.7% (n: 532) underwent RRT. HRS patients receiving RRT had a higher mortality rate than those who did not (adjusted odds ratio [aOR] 1.8, 95% confidence interval [CI]: 1.3–2.6, P: 0.01), along with higher resource utilization. Only those patients with HRS who underwent liver transplantation (LT) experienced a mortality reduction (24.4% for those not receiving RRTs and 36.5% for those receiving RRT).ConclusionsRRT is associated with higher mortality and morbidity when offered to patients with AH and HRS, who do not undergo LT. Therefore, our results suggest careful selection of AH patients when deciding to initiate RRT for HRS.

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“…We first identified patients 18 years or older who were admitted for a non-variceal upper GI bleed using International Classification of Diseases, 10th Revision (ICD-10) codes (K20.81, K20.91, K21.01, K22.1, K25.0, K25.4, K26.0, K26.4, K27.0, K27.4, K29.01, K29.31, K29.41, K29.51, K29.61, K29.71, K29.81, K29.91, K31.811, K31.82). NIS classifies the first two diagnosis codes as the reason for hospital admission [ 15 , 16 ]. We eliminated patients who were admitted for variceal bleed using ICD-10 codes (I85.01, I85.11) and hemorrhagic shock (R57.1) due to the urgent need for endoscopic intervention.…”

Section: Methodsmentioning

confidence: 99%

Effect of Patient Age on Timing of Inpatient Esophagogastroduodenoscopy and Outcomes for Non-variceal Upper GI Bleeds

Mittal¹,

Afridi²,

Khrais³

et al. 2023

Cureus

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Background Esophagogastroduodenoscopy (EGD) is typically performed within 24 hours of presentation for patients admitted to a hospital for patients presenting with a non-variceal upper gastrointestinal bleed (UGIB). To date, no studies have been performed to identify the impact of patient age on the timing of inpatient EGD and patient outcomes in non-variceal UGIB. Our aim was to assess the differences in the timing of EGD, blood transfusion requirements, development of hemorrhagic shock, development of acute renal failure, mortality, length of stay, and total hospital charges for patients aged 18-59 and those aged 60 and older. Methods Admissions for non-variceal UGIB were identified from the National (Nationwide) Inpatient Sample (NIS) database from 2016 and 2017. Patients who initially presented with hemorrhagic shock were excluded. Patients were divided into two age groups, those aged 18-59 and those aged 60 or older. We classified EGDs as early and delayed. Since the NIS database identifies days as midnight to midnight, we categorized early EGDs as those performed on day 0 and day 1. Delayed EGD were categorized as those performed on days 2 and 3. Multivariate logistic regression was performed on propensity-matched data to compare EGD timing, blood transfusion requirements, development of post-hospitalization hemorrhagic shock, development of acute renal failure, and mortality. The following patient and hospital variables were used in regression models: race, sex, insurance status, income quartile, mortality risk score, illness severity score, admission month, admission day, type of admission, region, bed size, and hospital teaching status. Finally, weighted two-sample T-tests were used to compare the length of stay and total hospitalization cost. Results A total of 12,449 weighted cases of inpatient non-variceal UGIB were included in this study. Patients aged 60 and older were more likely to die during the hospitalization (OR= 1.661, 95%CI: 1.108-2.490, p= 0.014), require blood transfusion (OR= 1.257, 95%CI: 1.131-1.396, p<0.001), and develop acute renal failure (OR= 1.672, 95%CI: 1.447-1.945, p<0.001). Patients aged 60 and older were also less likely to receive an early EGD (OR= 0.850, 95%CI: 0.752-0.961, p= 0.009). Total hospital costs (95%CI: -1397.77 - -4005.68, p<0.001) and length of stay (95%CI: -0.428 - -0.594, p<0.001) were both lower in patients aged 18-59 years. There was no difference in the development of post-hospitalization hemorrhagic shock between the two groups (OR= 0.984, 95%CI: 0.707-1.369, p= 0.923). Conclusions Patients aged 60 and older were less likely to have an early EGD and more likely to have worse outcomes. They had increased rates of inpatient mortality, blood transfusion requirements, development of acute renal failure, increased total hospital costs, and longer lengths of stay. There were no differences in the development of post-hospitalization hemorrhagic shock between the two groups.

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Comparison of outcomes between variceal and non variceal gastrointestinal bleeding in patients with cirrhosis: Insights from a Nationwide Inpatient Sample

Cited by 5 publications

References 32 publications

Prediction of 30-Day In-Hospital Mortality in Elderly UGIB Patients Using a Simplified Risk Score and Comparison with AIMS65 score

Prediction of 30-Day In-Hospital Mortality in Elderly UGIB Patients Using a Simplified Risk Score and Comparison with AIMS65 score

Analyzing the utility of renal replacement therapy to manage hepatorenal syndrome in alcoholic hepatitis without liver transplantation: a nationwide analysis

Effect of Patient Age on Timing of Inpatient Esophagogastroduodenoscopy and Outcomes for Non-variceal Upper GI Bleeds

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