He Lingjie, Zhang Jianwei, Zhang Shutian
Department of Gastroenterology, Beijing Friendship Hospital, Capital Medical University, National Clinical Research Center for Digestive Disease, Beijing Digestive Disease Center, Beijing Key Laboratory for Precancerous Lesion of Digestive Disease, Beijing, China.
Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Disease, The Key Laboratory of Remodeling-related Cardiovascular Disease, Ministry of Education, Beijing, China.
Saudi J Gastroenterol. 2018 May-Jun;24(3):177-182. doi: 10.4103/sjg.SJG_492_17.
BACKGROUND/AIMS: Patients with simultaneous upper gastrointestinal bleeding (UGIB) and acute myocardial infarction (AMI) have higher mortality than patients with either GIB or AMI. We aimed to assess the incidence and risk factors of in-hospital mortality in patients with UGIB and AMI.
A total of 243 patients with UGIB and AMI were enrolled during 2012-2017. Clinical and laboratory data were collected and analyzed for clinical characteristics and potential risk factors of in-hospital mortality.
Among the 243 patients, 60 in-hospital deaths were observed (in-hospital mortality rate of 24.7%). Patients who died were older than the survivors (78.7 ± 6.6 vs. 72.6 ± 10.5 years, P < 0.001). Compared with survivors, patients who died showed increased peak white blood cell (WBC) count (9.74 ± 4.72 vs. 7.60 ± 2.91 × 10/L, P= 0.002), serum creatinine levels [134 (106, 190) vs. 97 (79, 125) mmol/L, P= 0.014], peak blood urine nitrogen levels (16.31 ± 8.48 mmol/L vs. 9.86 ± 6.33 mmol/L, P < 0.001), and peak brain natriuretic peptide (BNP) amounts [13,250 (6071, 30,000) vs. 3598 (728, 12,842) pg/mL, P < 0.001]. Meanwhile, patients who died also displayed lower minimum hemoglobin levels (78.3 ± 21.1 vs. 86.3 ± 22.3 g/L, P= 0.018) and minimum platelet counts (184.3 ± 79.1 vs. 214.6 ± 80.1 × 10/L, P= 0.013). In multivariable logistic analysis, age [OR (95% CI) =1.118 (1.053-1.186), P < 0.001], peak WBC count [OR (95% CI) =1.252 (1.113-1.407), P < 0.001], minimum platelet count [OR (95% CI) = 0.994 (0.989-1.000), P= 0.032], and peak BNP levels [OR (95% CI) =3.880 (1.761-8.550), P= 0.001] were independent predictors of in-hospital mortality.
Patients with UGIB and AMI had a high in-hospital mortality, which was independently associated with age, peak WBC count, minimum platelet count, and peak BNP levels.
背景/目的：同时患有上消化道出血（UGIB）和急性心肌梗死（AMI）的患者比单纯患有GIB或AMI的患者死亡率更高。我们旨在评估UGIB和AMI患者院内死亡的发生率及危险因素。
2012年至2017年期间共纳入243例UGIB和AMI患者。收集临床和实验室数据，分析院内死亡的临床特征和潜在危险因素。
243例患者中，观察到60例院内死亡（院内死亡率为24.7%）。死亡患者比存活患者年龄更大（78.7±6.6岁对72.6±10.5岁，P<0.001）。与存活患者相比，死亡患者的白细胞（WBC）计数峰值升高（9.74±4.72对7.60±2.91×10/L，P=0.002）、血清肌酐水平[134（106，190）对97（79，125）mmol/L，P=0.014]、血尿素氮峰值水平（16.31±8.48mmol/L对9.86±6.33mmol/L，P<0.001）和脑钠肽（BNP）峰值水平[13,250（6071，30,000）对3598（728，12,842）pg/mL，P<0.001]。同时，死亡患者的最低血红蛋白水平（78.3±21.1对86.3±22.3g/L，P=0.018）和最低血小板计数（184.3±79.1对214.6±80.1×10/L，P=0.013）也较低。在多变量逻辑分析中，年龄[比值比（95%置信区间）=1.118（1.053-1.186），P<0.001]、WBC计数峰值[比值比（95%置信区间）=1.252（1.113-1.407），P<0.001]、最低血小板计数[比值比（95%置信区间）=0.994（0.989-1.000），P=0.032]和BNP峰值水平[比值比（95%置信区间）=3.880（1.761-8.550），P=0.001]是院内死亡的独立预测因素。
UGIB和AMI患者院内死亡率较高，且与年龄、WBC计数峰值、最低血小板计数和BNP峰值水平独立相关。
