Risk factors of upper gastrointestinal hemorrhage with acute coronary syndrome
Nana Wang1, Tiegang Li2, Qiang Du1
1Endocrinology Department, Shengjing Hospital of China Medical University, Shenyang 110004, China.
Insights
Elderly patients with upper gastrointestinal hemorrhage (UGH) face increased risks of acute coronary syndrome (ACS) due to factors like diabetes and smoking. These conditions also significantly elevate mortality rates in UGH patients with ACS.
Area of Science:
- Cardiology
- Gastroenterology
- Geriatrics
Background:
- Upper gastrointestinal hemorrhage (UGH) in elderly patients presents a higher mortality risk when complicated by acute coronary syndrome (ACS).
- Identifying risk factors for ACS occurrence post-UGH is crucial for improving patient outcomes.
Purpose of the Study:
- To determine the specific risk factors associated with an increased incidence of ACS in elderly patients following UGH.
- To identify key predictors of mortality in elderly patients experiencing both UGH and ACS.
Main Methods:
- A population-based nested case-control study was conducted using hospital data from 2009-2014.
- Included 3217 elderly patients with UGH, with 152 cases identified and matched with 604 controls.
- Multivariate conditional logistic regression models were employed to analyze risk factors for ACS and mortality.
Main Results:
- Diabetes, smoking, vasopressin/terlipressin use, liver cirrhosis, low hemoglobin, and a history of ACS were significant risk factors for developing ACS after UGH.
- Diabetes, smoking, and lower hemoglobin levels were independently associated with increased mortality in elderly patients with UGH and ACS.
Conclusions:
- Diabetes, smoking, vasopressin/terlipressin use, liver cirrhosis, hemoglobin levels, and prior ACS history are identified as risk factors for ACS in elderly UGH patients.
- Diabetes, smoking, and lower hemoglobin levels are critical determinants of mortality in this patient cohort.
Background:
Research showed that the mortality of upper gastrointestinal hemorrhage (UGH) complicated with acute coronary syndrome (ACS) was higher than single UGH in elderly patients. This study aimed to determine the risk factors that associated with an increased risk of ACS occurrence after UGH.
Methods:
A population-based nested case-control study was conducted analyzing the hospital information system database of Shengjing Hospital of China Medical University from September 1, 2009 to December 31, 2014. We included 3217 elderly patients who experienced a UGH, among which 152 cases were identified and matched 604 selected controls. Multivariate conditional logistic regression models were used to characterize risk factors associated with ACS occurrence and death after UGH.
Results:
Diabetes (odds ratio (OR) = 1.84, 95% confidence interval (CI) 1.13-2.71, P = 0.039), smoking (OR = 1.87, 95% CI 1.19-2.73, P = 0.028), vasopressin or terlipressin use (OR = 1.51, 95% CI 1.02-2.14, P = 0.043), liver cirrhosis (OR = 2.43, 95% CI 1.45-4.38, P = 0.013), hemoglobin level (OR = 2.36, 95% CI 1.65-3.79, P = 0.014) and history of ACS (OR = 1.98, 95% CI 1.13-3.49, P = 0.017) increased risk of ACS incidence in elderly patients with UGH. Moreover, diabetes (OR = 2.14, 95% CI 1.15-4.21, P = 0.041), smoking (OR = 2.93, 95% CI 1.17-5.31, P = 0.043) and hemoglobin levels (OR = 1.95, 95% CI 1.24-3.16, P = 0.038) were independent variables for the mortality underwent UGH with ACS in elderly patients.
Conclusions:
History of diabetes, vasopressin or terlipressin use, smoking, liver cirrhosis, hemoglobin level and history of ACS are risk factors to develop ACS in elderly patients with UGH. Importantly, diabetes, smoking and lower hemoglobin level are key variables for mortality.
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