Draper Karen V, Huang Robert J, Gerson Lauren B
Division of Medicine, Stanford University School of Medicine, Stanford, California, USA.
Division of Gastroenterology, California Pacific Medical Center, San Francisco, California, USA.
Gastrointest Endosc. 2014 Sep;80(3):435-446.e1. doi: 10.1016/j.gie.2014.03.040. Epub 2014 Jun 26.
Patients with left ventricular assist devices (LVADs) are at increased risk of GI bleeding (GIB), primarily from GI angiodysplastic lesions (GIAD).
To perform meta-analysis of the medical literature in order to determine prevalence and risk factors for GIB.
A literature search was performed to identify studies reporting GIB in LVAD patients. We extracted rates of prevalence, rebleeding, and overall mortality from each study. Pooled event rates and odds ratios (ORs) with 95% confidence intervals (CIs) were calculated.
Meta-analysis of 17 case-control and cohort studies.
A total of 1839 LVAD patients of whom 1697 (92%) had continuous-flow LVADs.
The pooled prevalence of GIB in LVAD patients was 23% (95% CI, 20.5%-27%). Subgroup analysis demonstrated that older age (standard difference in means (SDm), 0.69; 95% CI, 0.23-1.15), and elevated creatinine (SDm, 0.65; 95% CI, 0.12-1.18, P = .02) were associated with GIB. Risk factors not associated with GIB included LVAD as destination therapy (OR 1.85; 95% CI, 0.8-4.3), prior history of GIB (OR 2.22; 95% CI, 0.83-5.96), hypertension (OR 1.6; 95% CI, 0.87-2.97), and/or the presence of a continuous-flow LVAD (OR 4.5; 95% CI, 2.1-9.5). Recurrence of GIB occurred in 9.3% (95% CI, 7%-12%), with a GIB mortality rate of 23% (95% CI, 16%-32%). The pooled event rates were 48% (95% CI, 39%-57%) for upper GIB, 22% (95% CI, 16%-31%) for lower GIB, and 15% (95% CI, 8%-25%) for small-bowel bleeding. GIAD in the proximal GI tract were the most common cause of GIB (29%).
Lack of information regarding endoscopic therapy and follow-up in most studies.
The prevalence of GIB is increased in patients with continuous-flow LVADs, primarily secondary to the presence of GIAD.
植入左心室辅助装置（LVAD）的患者发生胃肠道出血（GIB）的风险增加，主要源于胃肠道血管发育异常病变（GIAD）。
对医学文献进行荟萃分析，以确定GIB的患病率和危险因素。
进行文献检索，以识别报告LVAD患者GIB情况的研究。我们从每项研究中提取患病率、再出血率和总死亡率。计算合并事件发生率和95%置信区间（CI）的比值比（OR）。
对17项病例对照研究和队列研究进行荟萃分析。
共有1839例LVAD患者，其中1697例（92%）植入了连续血流LVAD。
LVAD患者中GIB的合并患病率为23%（95%CI，20.5%-27%）。亚组分析表明，年龄较大（平均标准差（SDm），0.69；95%CI，0.23-1.15）和肌酐升高（SDm，0.65；95%CI，0.12-1.18，P = 0.02）与GIB相关。与GIB无关的危险因素包括将LVAD作为终末期治疗（OR 1.85；95%CI，0.8-4.3）、既往GIB病史（OR 2.22；95%CI，0.83-5.96）、高血压（OR 1.6；95%CI，0.87-2.97）和/或存在连续血流LVAD（OR 4.5；95%CI，2.1-9.5）。GIB复发率为9.3%（95%CI，7%-12%），GIB死亡率为23%（95%CI，16%-32%）。上消化道GIB的合并事件发生率为48%（95%CI，39%-57%），下消化道GIB为22%（95%CI，16%-31%），小肠出血为15%（95%CI，8%-25%）。上消化道近端的GIAD是GIB最常见的原因（29%）。
大多数研究缺乏关于内镜治疗和随访的信息。
连续血流LVAD患者中GIB的患病率增加，主要继发于GIAD的存在。
