Division of Cardiovascular Intensive Care, Nippon Medical School Hospital, 1-1-5, Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan.
Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan.
Heart Vessels. 2021 Sep;36(9):1327-1335. doi: 10.1007/s00380-021-01822-1. Epub 2021 Mar 8.
Gastrointestinal (GI) bleeding worsens the outcomes of critically ill patients in the intensive care unit (ICU). Owing to a lack of corresponding data, we aimed to investigate whether GI bleeding during cardiovascular-ICU (C-ICU) admission in acute cardiovascular (CV) disease patients is a risk factor for subsequent CV events. Totally, 492 consecutive C-ICU patients (40.9% acute coronary syndrome, 22.8% heart failure) were grouped into GI bleeding (n = 27; 12 upper GI and 15 lower GI) and non-GI bleeding (n = 465) groups. Thirty-nine patients died or developed CV events during hospitalization, and 453 were followed up from the date of C-ICU discharge to evaluate subsequent major adverse CV events. The GI bleeding group had a higher Acute Physiology and Chronic Health Evaluation II score (20.2 ± 8.2 vs. 15.1 ± 6.8, p < 0.001), higher frequency of mechanical ventilator use (29.6% vs. 13.1%, p = 0.039), and longer C-ICU admission duration (8 [5-16] days vs. 5 [3-8] days, p < 0.001) than the non-GI bleeding group. The in-hospital mortality rate did not differ between the groups. Of those who were followed-up, CV events after C-ICU discharge were identified in 34.6% and 14.3% of patients in the GI and non-GI bleeding groups, respectively, during a median follow-up period of 228 days (log rank, p < 0.001). GI bleeding was an independent risk factor for subsequent CV events (adjusted hazard ratio: 2.23, 95% confidence interval: 1.06-4.71; p = 0.035). GI bleeding during C-ICU admission was independently associated with subsequent CV events in such settings.
胃肠道（GI）出血会使重症监护病房（ICU）中危重病患者的预后恶化。由于缺乏相应的数据，我们旨在研究急性心血管（CV）疾病患者在心血管 ICU（C-ICU）入院期间是否发生 GI 出血是随后发生 CV 事件的危险因素。总共纳入 492 例连续 C-ICU 患者（急性冠状动脉综合征 40.9%，心力衰竭 22.8%），分为 GI 出血组（n=27；12 例上 GI 出血，15 例下 GI 出血）和非 GI 出血组（n=465）。39 例患者在住院期间死亡或发生 CV 事件，453 例患者从 C-ICU 出院日期开始随访，以评估随后发生的主要不良 CV 事件。GI 出血组的急性生理学和慢性健康评估 II 评分较高（20.2±8.2 与 15.1±6.8，p<0.001），机械通气使用率较高（29.6%与 13.1%，p=0.039），C-ICU 住院时间较长（8[5-16]天与 5[3-8]天，p<0.001）。两组患者住院死亡率无差异。在随访的患者中，C-ICU 出院后 CV 事件分别在 GI 出血组和非 GI 出血组患者中发生 34.6%和 14.3%，中位随访时间为 228 天（对数秩检验，p<0.001）。GI 出血是随后发生 CV 事件的独立危险因素（调整后的危险比：2.23，95%置信区间：1.06-4.71；p=0.035）。在这种情况下，C-ICU 入院期间的 GI 出血与随后发生的 CV 事件独立相关。
