Chi Tianyu, Zhao Quchuan, Wang Peili
Departments of Gastroenterology, Xuanwu Hospital Capital Medical University, Beijing, China.
Cardiovascular Center, Xi Yuan Hospital of China Academy of Chinese Medical Sciences, Beijing, China.
Gastroenterol Res Pract. 2021 Mar 8;2021:8816805. doi: 10.1155/2021/8816805. eCollection 2021.
Upper gastrointestinal bleeding (UGIB) is a common critical disease with a certain fatality rate. Acute coronary syndrome (ACS), another critical ill condition, is a regular occurrence in the UGIB. We identified risk factors for ACS in UGIB.
676 patients diagnosed with UGIB were enrolled retrospectively. We assessed the occurrence of ACS in UGIB patients and identified the risk factors for ACS by logistic regression analysis and random forest analysis.
After propensity score matching (PSM), the ACS group ( = 69) and non-ACS group ( = 276) were analyzed. Logistic regression analysis showed that syncope ( = 0.001), coronary heart disease history ( = 0.001), Glasgow Blatchford score ( ≤ 0.001), Rockall risk score ( = 0.004), red blood cell distribution width (RDW) ( ≤ 0.001), total bilirubin (TBil) ( = 0.046), fibrinogen ( ≤ 0.001), and hemoglobin ( = 0.001) had important roles in ACS patients. With Mean Decrease Gini (MDG) sequencing, fibrinogen, RDW, and hemoglobin were ranked the top three risk factors associated with ACS. In ROC analysis, fibrinogen (AUC = 0.841, 95% CI: 0.779-0.903) and RDW (AUC = 0.826, 95% CI: 0.769-0.883) obtained good discrimination performance. According to sensitivity > 80%, the pAUC of fibrinogen and RDW were 0.077 and 0.101, respectively, and there was no significant difference ( = 0.326). However, according to specificity > 80%, the pAUC of fibrinogen was higher than that of RDW (0.126 vs. 0.088, = 0.018).
Fibrinogen and RDW were important risk factors for ACS in UGIB. Additionally, combination with coronary heart disease, syncope, hemoglobin, and TBil played important roles in the occurrence of ACS. Meanwhile, it was also noted that Rockall score and Glasgow Blatchford score should be performed to predict the risk.
上消化道出血（UGIB）是一种常见的危重病，具有一定的死亡率。急性冠状动脉综合征（ACS）是另一种危重病，在UGIB中经常发生。我们确定了UGIB中ACS的危险因素。
回顾性纳入676例诊断为UGIB的患者。我们评估了UGIB患者中ACS的发生情况，并通过逻辑回归分析和随机森林分析确定了ACS的危险因素。
在倾向评分匹配（PSM）后，对ACS组（n = 69）和非ACS组（n = 276）进行分析。逻辑回归分析显示，晕厥（P = 0.001）、冠心病史（P = 0.001）、格拉斯哥布莱奇福德评分（P≤0.001）、罗卡尔风险评分（P = 0.004）、红细胞分布宽度（RDW）（P≤0.001）、总胆红素（TBil）（P = 0.046）、纤维蛋白原（P≤0.001）和血红蛋白（P = 0.001）在ACS患者中起重要作用。通过平均减少基尼系数（MDG）排序，纤维蛋白原、RDW和血红蛋白被列为与ACS相关的前三大危险因素。在ROC分析中，纤维蛋白原（AUC = 0.841，95%CI：0.779 - 0.903）和RDW（AUC = 0.826，95%CI：0.769 - 0.883）获得了良好的区分性能。根据敏感性>80%，纤维蛋白原和RDW的pAUC分别为0.077和0.101，差异无统计学意义（P = 0.326）。然而，根据特异性>80%，纤维蛋白原的pAUC高于RDW（0.126对0.088，P = 0.018）。
纤维蛋白原和RDW是UGIB中ACS的重要危险因素。此外，合并冠心病、晕厥、血红蛋白和TBil在ACS的发生中起重要作用。同时，还指出应进行罗卡尔评分和格拉斯哥布莱奇福德评分以预测风险。
