Risk Factors for Acute Coronary Syndrome in Upper Gastrointestinal Bleeding Patients
Tianyu Chi1, Quchuan Zhao1, Peili Wang2
1Departments of Gastroenterology, Xuanwu Hospital Capital Medical University, Beijing, China.
Insights
Fibrinogen and red blood cell distribution width (RDW) are key risk factors for acute coronary syndrome (ACS) in patients with upper gastrointestinal bleeding (UGIB). Early identification aids in predicting and managing this critical condition.
Area of Science:
- Cardiology
- Gastroenterology
- Critical Care Medicine
Background:
- Upper gastrointestinal bleeding (UGIB) is a critical condition with significant mortality.
- Acute coronary syndrome (ACS) frequently co-occurs in UGIB patients.
- Identifying ACS risk factors in UGIB is crucial for patient management.
Purpose of the Study:
- To identify and analyze risk factors for ACS in patients experiencing UGIB.
- To evaluate the predictive performance of identified risk factors for ACS in UGIB.
Main Methods:
- Retrospective analysis of 676 UGIB patients.
- Propensity score matching (PSM) to create comparable ACS and non-ACS groups.
- Logistic regression and random forest analysis to identify risk factors.
Main Results:
- Syncope, coronary heart disease history, Glasgow Blatchford score, Rockall risk score, red blood cell distribution width (RDW), total bilirubin, fibrinogen, and hemoglobin were significant risk factors for ACS in UGIB.
- Fibrinogen, RDW, and hemoglobin were the top three risk factors identified by random forest analysis.
- Fibrinogen and RDW demonstrated strong discriminatory performance in ROC analysis, with fibrinogen showing higher specificity.
Conclusions:
- Fibrinogen and RDW are significant risk factors for ACS in UGIB.
- Coronary heart disease, syncope, hemoglobin, and total bilirubin also play important roles.
- Rockall and Glasgow Blatchford scores are valuable tools for risk prediction in these patients.
Background:
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.
Methods:
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.
Results:
After propensity score matching (PSM), the ACS group (n = 69) and non-ACS group (n = 276) were analyzed. Logistic regression analysis showed that syncope (P = 0.001), coronary heart disease history (P = 0.001), Glasgow Blatchford score (P ≤ 0.001), Rockall risk score (P = 0.004), red blood cell distribution width (RDW) (P ≤ 0.001), total bilirubin (TBil) (P = 0.046), fibrinogen (P ≤ 0.001), and hemoglobin (P = 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 (P = 0.326). However, according to specificity > 80%, the pAUC of fibrinogen was higher than that of RDW (0.126 vs. 0.088, P = 0.018).
Conclusion:
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.
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