Predictors of mortality and endoscopic intervention in patients with upper gastrointestinal bleeding in the intensive care unit

作     者：Vijaya L.Rao Nina Gupta Eric Swei Thomas Wagner Andrew Aronsohn KGautham Reddy Neil Sengupta 

作者机构：Section of GastroenterologyHepatology and NutritionDepartment of Internal MedicineUniversity of Chicago MedicineChicagoILUSA Department of Internal MedicineUniversity of Chicago MedicineChicagoILUSA 

出 版 物：《Gastroenterology Report》 (胃肠病学报道（英文）)

年 卷 期：2020年第8卷第4期

页      面：299-305,I0002页

核心收录：

学科分类：1002[医学-临床医学] 100201[医学-内科学(含：心血管病、血液病、呼吸系病、消化系病、内分泌与代谢病、肾病、风湿病、传染病)] 10[医学] 

主　　题：upper gastrointestinal bleeding esophagogastroduodenoscopy intensive care unit 

摘      要：Background:The outcomes of patients undergoing esophagogastroduodenoscopy(EGD)in the intensive care unit(ICU)for upper gastrointestinal bleeding(UGIB)are not well *** aims were to determine predictors of 30-day mortality and endoscopic intervention,and assess the utility of existing clinical-prediction tools for UGIB in this ***:Patients hospitalized in an ICU between 2008 and 2015 who underwent EGD were identified using a validated,machine-learning *** regression was used to determine factors associated with 30-day mortality and endoscopic *** under receiver-operating characteristics(AUROC)analysis was used to evaluate established UGIB scoring systems in predicting mortality and endoscopic intervention in patients who presented to the hospital with ***:A total of 606 patients underwent EGD for UGIB while admitted to an *** median age of the cohort was 62 years and 55.9%were *** analysis revealed that predictors associated with 30-day mortality included American Society of Anesthesiologists(ASA)class(odds ratio[OR]4.1,95%confidence interval[CI]2.2-7.9),Charlson score(OR 1.2,95%CI 1.0-1.3),and duration from hospital admission to EGD(OR 1.04,95%CI 1.01-1.07).Rockall,Glasgow-Blatchford,and AIMS65 scores were poorly predictive of endoscopic intervention(AUROC:0.521,0.514,and 0.540,respectively)and in-hospital mortality(AUROC:0.510,0.568,and 0.506,respectively).Conclusions:Predictors associated with 30-day mortality include ASA classification,Charlson score,and duration in the hospital prior to *** risk tools are poorly predictive of clinical outcomes,which highlights the need for a more accurate risk-stratification tool to predict the benefit of intervention within the ICU population.