Iqbal Umair, Siddique Osama, Jameel Ayesha, Anwar Hafsa, Chaudhary Ahmad
Bassett Medical Center, One Atwell Road, Cooperstown, NY 13326, USA.
Memorial Hospital of Rhode Island/Brown University, Providence, RI, USA.
Gastroenterology Res. 2017 Aug;10(4):238-243. doi: 10.14740/gr893w. Epub 2017 Aug 31.
Acute gastrointestinal bleeding (AGIB) is responsible for over 140,000 hospitalizations annually. Cardiovascular-related deaths account for 30% of the patients surviving the initial episode of AGIB. The purpose of this study was to identify the impact of elevated troponin on short-term mortality and length of stay (LOS) of these patients.
From July 2013 to July 2016, 290 patients admitted with a diagnosis of AGIB and who had cardiac troponin I measured within 24 h of presentation were retrospectively reviewed. Clinical variables including 30-day mortality, 30-day readmission and LOS were then compared between the groups of troponin elevation and no troponin elevation.
The overall 30-day mortality among patients with AGIB was 6.5% (19/290). Cardiac troponin was elevated in 10% of patients (29/290). Among patients with normal troponin, 5% (13/261) died within 30 days. In patients with troponin elevation, 21% died in the same period (6/29, P = 0.001). The LOS was also higher in patients with troponin elevation (6 vs. 5 days, P = 0.02). There was no difference in 30-day readmission among the two groups. Past history of coronary artery disease, congestive heart failure, hypertension, aspirin use and elevated creatinine was more common in patients with troponin elevation. On multivariate analysis, troponin elevation on presentation is associated with increased mortality (odds: 5.50, CI: 1.73 - 17.47, P = 0.004).
In patients admitted to the inpatient service with AGIB, elevated troponin I on presentation is associated with high short-term mortality and longer hospital stay.
急性胃肠道出血（AGIB）每年导致超过14万例住院病例。心血管相关死亡占AGIB初始发作后存活患者的30%。本研究的目的是确定肌钙蛋白升高对这些患者短期死亡率和住院时间（LOS）的影响。
回顾性分析2013年7月至2016年7月期间290例诊断为AGIB且在就诊后24小时内检测了心肌肌钙蛋白I的患者。然后比较肌钙蛋白升高组和未升高组之间的临床变量，包括30天死亡率、30天再入院率和住院时间。
AGIB患者的总体30天死亡率为6.5%（19/290）。10%的患者（29/290）心肌肌钙蛋白升高。在肌钙蛋白正常的患者中，5%（13/261）在30天内死亡。在肌钙蛋白升高的患者中，同期有21%死亡（6/29，P = 0.001）。肌钙蛋白升高患者的住院时间也更长（6天对5天，P = 0.02）。两组之间的30天再入院率没有差异。冠状动脉疾病、充血性心力衰竭、高血压、使用阿司匹林和肌酐升高的既往史在肌钙蛋白升高的患者中更常见。多因素分析显示，就诊时肌钙蛋白升高与死亡率增加相关（比值：5.50，CI：1.73 - 17.47，P = 0.004）。
在因AGIB入住住院病房的患者中，就诊时肌钙蛋白I升高与高短期死亡率和更长的住院时间相关。
