Méndez-Bailón Manuel, Jiménez-García Rodrigo, Muñoz-Rivas Nuria, Hernández-Barrera Valentín, de Miguel-Yanes José Maria, de Miguel-Díez Javier, Andrès Emmanuel, Lorenzo-Villalba Noel, López-de-Andrés Ana
Internal Medicine Department, Hospital Clínico San Carlos, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), 28040 Madrid, Spain.
Department of Public Health & Maternal and Child Health, Faculty of Medicine, Universidad Complutense de Madrid, 28040 Madrid, Spain.
J Clin Med. 2021 Feb 2;10(3):546. doi: 10.3390/jcm10030546.
Heart failure decompensation can be triggered by many factors, including anemia. In cases of iron deficiency anemia or iron deficiency without anemia, endoscopic studies are recommended to rule out the presence of gastrointestinal neoplasms or other associated bleeding lesions.
The aims of this study were to (i) examine trends in the incidence, clinical characteristics, and in-hospital outcomes of patients hospitalized with heart failure from 2002 to 2017 who underwent esophagogastroduodenoscopy (EGD) and/or colonoscopy, and to (ii) identify factors associated with in-hospital mortality (IHM) among patients with heart failure who underwent an EGD and/or a colonoscopy.
We conducted an observational retrospective epidemiological study using the Spanish National Hospital Discharge Database (SNHDD) between 2002 and 2017. We included hospitalizations of patients with a primary discharge diagnosis of heart failure. Cases were reviewed if there was an ICD-9-CM or ICD-10 procedure code for EGD or colonoscopy in any procedure field. Multivariable logistic regression models were constructed to identify predictors of IHM among HF patients who underwent an EGD or colonoscopy.
A total of 51,187 (1.32%) non-surgical patients hospitalized with heart failure underwent an EGD and another 72,076 (1.85%) patients had a colonoscopy during their admission. IHM was significantly higher in those who underwent an EGD than in those who underwent a red blood cell transfusion (OR 1.10; 95%CI 1.04-1.12). However, the use of colonoscopy seems to decrease the probability of IHM (OR 0.45; 95%CI 0.41-0.49). In patients who underwent a colonoscopy, older age seems to increase the probability of IHM. However, EGD was associated with a lower mortality (OR 0.60; 95% CI 0.55-0.64).
In our study, a decrease in the number of gastroscopies was observed in relation to colonoscopy in patients with heart failure. The significant ageing of the hospitalized HF population seen over the course of the study could have contributed to this. Both procedures seemed to be associated with lower in-hospital mortality, but in the case of colonoscopy, the risk of in-hospital mortality was higher in elderly patients with heart failure and associated neoplasms. Colonoscopy and EGD seemed not to increase IHM in patients with heart failure.
心力衰竭失代偿可由多种因素触发，包括贫血。对于缺铁性贫血或无贫血的缺铁患者，建议进行内镜检查以排除胃肠道肿瘤或其他相关出血性病变的存在。
本研究的目的是：（i）研究2002年至2017年因心力衰竭住院并接受食管胃十二指肠镜检查（EGD）和/或结肠镜检查的患者的发病率、临床特征及院内结局的趋势，以及（ii）确定接受EGD和/或结肠镜检查的心力衰竭患者的院内死亡率（IHM）相关因素。
我们使用西班牙国家医院出院数据库（SNHDD）在2002年至2017年间进行了一项观察性回顾性流行病学研究。我们纳入了以心力衰竭为主要出院诊断的患者住院病例。如果在任何手术字段中有EGD或结肠镜检查的ICD-9-CM或ICD-10手术代码，则对病例进行审查。构建多变量逻辑回归模型以确定接受EGD或结肠镜检查的心力衰竭患者中IHM的预测因素。
共有51187名（1.32%）因心力衰竭住院的非手术患者接受了EGD检查，另有72076名（1.85%）患者在住院期间接受了结肠镜检查。接受EGD检查的患者的IHM显著高于接受红细胞输血的患者（OR 1.10；95%CI 1.04-1.12）。然而，结肠镜检查的使用似乎降低了IHM的概率（OR 0.45；95%CI 0.41-0.49）。在接受结肠镜检查的患者中，年龄较大似乎增加了IHM的概率。然而，EGD与较低的死亡率相关（OR 0.60；95%CI 0.55-0.64）。
在我们的研究中，观察到心力衰竭患者中胃镜检查的数量相对于结肠镜检查有所减少。研究过程中住院心力衰竭患者的显著老龄化可能对此有所影响。两种检查似乎都与较低的院内死亡率相关，但就结肠镜检查而言，老年心力衰竭患者及相关肿瘤患者的院内死亡风险较高。结肠镜检查和EGD似乎不会增加心力衰竭患者的IHM。
