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Iwasaki H, Shimura T, Yamada T, Nishigaki R, Okuda Y, Fukusada S, Ozeki T, Kitagawa M, Katano T, Tanaka M, Nishie H, Ozeki K, Kubota E, Tanida S, Kataoka H. Novel and Simple Criteria for Predicting Mortality of Peptic Ulcer Disease. Intern Med 2021; 60:2349-2356. [PMID: 33612689 PMCID: PMC8381175 DOI: 10.2169/internalmedicine.6945-20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Objective Conventional risk scores of peptic ulcer disease (PUD) are based on many parameters, and their application in clinical practice is therefore limited. The aim of this study was to establish simple and reliable criteria for predicting PUD-associated mortality. Methods A total of 499 patients with PUD were divided into 2 groups: the training cohort (n=333) and the validation cohort (n=166). To minimize selection bias due to missing values, we used imputed datasets generated by the multiple imputation method (training-cohort dataset, n=33,300; validation-cohort dataset, n=16,600). Results In the training-cohort dataset, the heart rate-to-systolic blood pressure ratio (HR/SBP) and serum albumin (s-Alb) level were significant independent predictive factors for mortality according to the multivariate analysis [HR/SBP, odds ratio (OR): 1.72; 95% confidence interval (CI), 1.06-2.80, p=0.028; s-Alb, OR: 0.23, 95% CI, 0.11-0.51, p<0.001]. The model comprising HR/SBP and s-Alb was able to detect mortality due to PUD with an area under the curve (AUC) of 0.855. In the validation-cohort dataset, this model also showed good efficacy with an AUC of 0.835. The novel criteria combining HR/SBP and s-Alb developed by a decision tree analysis showed 73.3% sensitivity and 87.6% specificity for predicting mortality in the total-cohort dataset. Our criteria were superior to the Glasgow Blatchford and Rockall scores and similar to the AIMS65 and Progetto Nazionale Emorragia Digestiva scores for predicting mortality. Conclusion The combination of the HR/SBP ratio and s-Alb level is a good predictor of mortality in patients with PUD.
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Affiliation(s)
- Hiroyasu Iwasaki
- Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Japan
| | - Takaya Shimura
- Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Japan
| | - Tomonori Yamada
- Department of Gastroenterology, Japanese Red Cross Nagoya Daini Hospital, Japan
| | - Ruriko Nishigaki
- Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Japan
| | - Yusuke Okuda
- Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Japan
| | - Shigeki Fukusada
- Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Japan
| | - Takanori Ozeki
- Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Japan
| | - Mika Kitagawa
- Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Japan
| | - Takahito Katano
- Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Japan
| | - Mamoru Tanaka
- Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Japan
| | - Hirotada Nishie
- Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Japan
| | - Keiji Ozeki
- Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Japan
| | - Eiji Kubota
- Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Japan
| | - Satoshi Tanida
- Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Japan
| | - Hiromi Kataoka
- Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Japan
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Park SH, Mun YG, Lim CH, Cho YK, Park JM. C-reactive protein for simple prediction of mortality in patients with acute non-variceal upper gastrointestinal bleeding: A retrospective analysis. Medicine (Baltimore) 2020; 99:e23689. [PMID: 33371112 PMCID: PMC7748191 DOI: 10.1097/md.0000000000023689] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Accepted: 11/15/2020] [Indexed: 01/26/2023] Open
Abstract
In upper gastrointestinal bleeding (UGIB), scoring systems using multiple variables were developed to predict patient outcomes. We evaluated serum C-reactive protein (CRP) for simple prediction of patient mortality after acute non-variceal UGIB.The associated factors for 30-day mortality was investigated by regression analysis in patients with acute non-variceal UGIB (N = 1232). The area under the receiver operating characteristics (AUROC) curve was analyzed with serum CRP in these patients and a prospective cohort (N = 435). The discriminant validity of serum CRP was compared to other prognostic scoring systems by means of AUROC curve analysis.Serum CRP was significantly higher in the expired than survived patients (median, 4.53 vs 0.49; P < .001). The odds ratio of serum CRP was 4.18 (2.10-9.27) in multivariate analysis. The odds ratio of high serum CRP was higher than Rockall score (4.15 vs 1.29), AIMS65 (3.55 vs 1.71) and Glasgow-Blatchford score (4.32 vs 1.08) in multivariate analyses. The AUROC of serum CRP at bleeding was 0.78 for 30-day mortality (P < .001). In the validation set, serum CRP was also significantly higher in the expired than survived patients, of which AUROC was 0.73 (P < .001). In predicting 30-day mortality, the AUROC with serum CRP was not inferior to that of other scoring systems.Serum CRP at bleeding can be simply used to identify the patients with high mortality after acute non-variceal UGIB.
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Affiliation(s)
- Se Hwan Park
- Division of Gastroenterology, Department of Internal Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea
| | - Yoon Gwon Mun
- Division of Gastroenterology, Department of Internal Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea
- Catholic Photomedicine Research Institute, Seoul, Korea
| | - Chul-Hyun Lim
- Division of Gastroenterology, Department of Internal Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea
- Catholic Photomedicine Research Institute, Seoul, Korea
| | - Yu Kyung Cho
- Division of Gastroenterology, Department of Internal Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea
- Catholic Photomedicine Research Institute, Seoul, Korea
| | - Jae Myung Park
- Division of Gastroenterology, Department of Internal Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea
- Catholic Photomedicine Research Institute, Seoul, Korea
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Bedel C, Korkut M, Avcı A, Uzun A. Immature Granulocyte Count and Percentage as New Predictors of Mortality in Patients with Upper Gastrointestinal Bleeding. Indian J Crit Care Med 2020; 24:794-798. [PMID: 33132562 PMCID: PMC7584826 DOI: 10.5005/jp-journals-10071-23563] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Aims Early identification of patients at risk of adverse outcomes may increase the survival rates in patients with upper gastrointestinal bleeding (UGIB), but this can be difficult to predict in emergencies. The aim of the study is to evaluate immature granulocyte (IG), which can be obtained from simple hemogram tests in patients with UGIB, in terms of clinical use and as a mortality marker. Materials and methods The patients diagnosed with UGIB between March 1, 2019, and September 30, 2019, were evaluated retrospectively. Demographic characteristics, causes of hemorrhage, clinical presentations, hemogram, and biochemistry values at ED admission and 30-day mortality status of the patients were examined. We divided the patients into groups according to their mortality status, and the groups were compared among themselves in terms of parameters. Results A total of 213 patients who met the inclusion criteria were included in the study. Of these patients, 139 (65.3%) were male and the mean age was 65.05 ± 16.7 years. Fifteen (7%) of them were in the nonsurvival group, while 198 (93%) were in the survival group. The efficacy of both the IG count (IGC) and IG% in predicting mortality was statistically significant (p = 0.002, p = 0.008, respectively). The sensitivity and specificity for the IGC were found as 60% and 84.4; for the IG%, they were found as 66.7% and 75.7%, respectively. Conclusion IGC and IG% are independent risk factors for the 30-day mortality status. These measurements are obtained from simple hemogram tests and may be useful for the evaluation of mortality in patients with UGIB. How to cite this article Bedel C, Korkut M, Avcı A, Uzun A. Immature Granulocyte Count and Percentage as New Predictors of Mortality in Patients with Upper Gastrointestinal Bleeding. Indian J Crit Care Med 2020;24(9):794-798.
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Affiliation(s)
- Cihan Bedel
- Department of Emergency Medicine, Health Science University Antalya Training and Research Hospital, Antalya, Turkey
| | - Mustafa Korkut
- Department of Emergency Medicine, Health Science University Antalya Training and Research Hospital, Antalya, Turkey
| | - Ali Avcı
- Department of Emergency Medicine, Karaman State Hospital, Karaman, Turkey
| | - Ahmet Uzun
- Department of Emergency Medicine, Karabük University Training and Research Hospital, Karabük, Turkey
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Usefulness of the Delta Neutrophil Index to Predict 30-Day Mortality in Patients with Upper Gastrointestinal Bleeding. Shock 2018; 48:427-435. [PMID: 28394786 DOI: 10.1097/shk.0000000000000878] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
PURPOSE The delta neutrophil index (DNI), reflecting the fraction of circulating immature granulocytes, is associated with increased mortality in patients with systemic inflammation. It is rapidly and easily measured while performing a complete blood count. This study aimed to determine whether the DNI can predict short-term mortality in patients presenting to the emergency department (ED) with upper gastrointestinal hemorrhage (UGIH). METHODS We retrospectively identified consecutive patients (>18 years old) with UGIH admitted to the ED from January 1, 2015 to February 28, 2016. The diagnosis of UGIH was confirmed using clinical, laboratory, and endoscopic findings. The DNI was determined on each day of hospitalization. The outcome of interest was 30-day mortality. RESULTS Overall, 432 patients with UGIH met our inclusion criteria. The multivariate Cox regression model demonstrated that higher DNI values on days 0 (hazard ratio [HR], 1.09; 95% confidence interval [CI], 1.02-1.17; P = 0.012) and 1 (HR, 1.15; 95% CI, 1.06-1.24; P = 0.001) were strong independent predictors of short-term mortality. Further, a DNI >1% at ED admission was associated with an increased risk (HR, 40.9; 95% CI, 20.8-80.5; P < 0.001) of 30-day mortality. The optimal cut-off value for DNI on day 1 was 2.6%; this was associated with an increased hazard of 30-day mortality following UGIH (HR, 7.85; 95% CI, 3.59-17.15; P < 0.001). CONCLUSION The DNI can be measured rapidly and simply at ED admission without additional cost or time burden. Increased DNI values independently predict 30-day mortality in patients with UGIH.
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Kwak MS, Cha JM, Han YJ, Yoon JY, Jeon JW, Shin HP, Joo KR, Lee JI. The Clinical Outcomes of Lower Gastrointestinal Bleeding Are Not Better than Those of Upper Gastrointestinal Bleeding. J Korean Med Sci 2016; 31:1611-6. [PMID: 27550490 PMCID: PMC4999404 DOI: 10.3346/jkms.2016.31.10.1611] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Accepted: 06/28/2016] [Indexed: 01/01/2023] Open
Abstract
The incidence of lower gastrointestinal bleeding (LGIB) is increasing; however, predictors of outcomes for patients with LGIB are not as well defined as those for patients with upper gastrointestinal bleeding (UGIB). The aim of this study was to identify the clinical outcomes and the predictors of poor outcomes for patients with LGIB, compared to outcomes for patients with UGIB. We identified patients with LGIB or UGIB who underwent endoscopic procedures between July 2006 and February 2013. Propensity score matching was used to improve comparability between LGIB and UGIB groups. The clinical outcomes and predictors of 30-day rebleeding and mortality rate were analyzed between the two groups. In total, 601 patients with UGIB (n = 500) or LGIB (n = 101) were included in the study, and 202 patients with UGIB and 101 patients with LGIB were analyzed after 2:1 propensity score matching. The 30-day rebleeding and mortality rates were 9.9% and 4.5% for the UGIB group, and 16.8% and 5.0% for LGIB group, respectively. After logistic regression analysis, the Rockall score (P = 0.013) and C-reactive protein (CRP; P = 0.047) levels were significant predictors of 30-day mortality in patients with LGIB; however, we could not identify any predictors of rebleeding in patients with LGIB. The clinical outcomes for patients with LGIB are not better than clinical outcomes for patients with UGIB. The clinical Rockall score and serum CRP levels may be used to predict 30-day mortality in patients with LGIB.
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Affiliation(s)
- Min Seob Kwak
- Department of Internal Medicine, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Korea
| | - Jae Myung Cha
- Department of Internal Medicine, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Korea.
| | - Yong Jae Han
- Department of Internal Medicine, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Korea
| | - Jin Young Yoon
- Department of Internal Medicine, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Korea
| | - Jung Won Jeon
- Department of Internal Medicine, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Korea
| | - Hyun Phil Shin
- Department of Internal Medicine, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Korea
| | - Kwang Ro Joo
- Department of Internal Medicine, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Korea
| | - Joung Il Lee
- Department of Internal Medicine, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Korea
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Oweira H, Lahdou I, Daniel V, Opelz G, Schmidt J, Zidan A, Mehrabi A, Sadeghi M. Early post-operative acute phase response in patients with early graft dysfunction is predictive of 6-month and 12-month mortality in liver transplant recipients. Hum Immunol 2016; 77:952-960. [PMID: 27476050 DOI: 10.1016/j.humimm.2016.07.234] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Revised: 07/25/2016] [Accepted: 07/26/2016] [Indexed: 02/08/2023]
Abstract
UNLABELLED Early allograft dysfunction (EAD) after liver transplantation is mostly a reversible event caused by factors related to ischemia/reperfusion (I/R) injury. EAD represents a hepatic injury associated with pre- and early post-transplant inflammatory cytokine responses. Aim of the present study was to evaluate the prognostic and diagnostic value of CRP in liver transplant recipients with EAD. MATERIALS AND METHODS Forty-seven patients with EAD were compared with 115 non-EAD patients. Pre- and post-transplant parameters were analyzed. EAD was defined based on postoperative liver function tests such as INR, bilirubin and liver enzymes. Statistical analysis was performed using SPSS version 18.0. RESULTS Pre-transplant liver enzyme were not significantly different in the two groups. At day 3, 5 and 10 post-transplant CRP was significantly higher in patients with EAD than in non-EAD patients (p⩽0.001 for all investigations) and remained consistently high in patients with EAD and low in non-EAD patients. EAD patients with high CRP at post-transplant days 3 and 5 showed lower survival at 6-month and 12-month post-transplant than patients with low CRP. CONCLUSION Our results indicate a prognostic and diagnostic value of CRP in patients with early graft dysfunction and predict 6-month and 12-month mortality in liver transplant recipients.
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Affiliation(s)
- Hani Oweira
- Department of Visceral Surgery, University of Heidelberg, Heidelberg, Germany; Zürich Surgical Center, Vascular and Visceral Surgery, Kappelistr. 7, CH-8002 Zürich, Switzerland.
| | - Imad Lahdou
- Transplantation Immunology, University of Heidelberg, Germany.
| | - Volker Daniel
- Transplantation Immunology, University of Heidelberg, Germany.
| | - Gerhard Opelz
- Transplantation Immunology, University of Heidelberg, Germany.
| | - Jan Schmidt
- Department of Visceral Surgery, University of Heidelberg, Heidelberg, Germany; Zürich Surgical Center, Vascular and Visceral Surgery, Kappelistr. 7, CH-8002 Zürich, Switzerland.
| | - Ahmed Zidan
- Department of Visceral Surgery, University of Heidelberg, Heidelberg, Germany; Department of HPB and Liver Transplantation Surgery, Rajhy Liver Hospital, Assiut University Hospital, Assuit, Egypt.
| | - Arianeb Mehrabi
- Department of Visceral Surgery, University of Heidelberg, Heidelberg, Germany.
| | - Mahmoud Sadeghi
- Department of Visceral Surgery, University of Heidelberg, Heidelberg, Germany.
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Tomizawa M, Shinozaki F, Hasegawa R, Shirai Y, Motoyoshi Y, Sugiyama T, Yamamoto S, Ishige N. Elevated C-reactive protein level predicts lower gastrointestinal tract bleeding. Biomed Rep 2016; 4:711-714. [PMID: 27284411 DOI: 10.3892/br.2016.654] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Accepted: 04/08/2016] [Indexed: 12/11/2022] Open
Abstract
Lower gastrointestinal (GI) bleeding can be caused by colorectal polyps or cancer. The aim of the present study was to identify blood test variables and medications that can predict lower GI bleeding, which would allow for appropriate colonoscopy. The medical records of patients who underwent colonoscopy from September 2014 to September 2015 were retrospectively analyzed. The selected patients included 278 men (mean age, 67.0±11.5 years) and 249 women (mean age, 69.6±12.0 years). The diagnosis, medications, and blood test variables were compared between patients with and without bleeding. Logistic regression analysis was performed to determine the factors associated with lower GI bleeding. The presence of colorectal polyp and cancer was associated with lower GI bleeding (P=0.0044) with an odds ratio of 6.71 (P=0.0148). No lower GI bleeding was observed in patients taking non-steroidal anti-inflammatory drugs (NSAIDs), corticosteroids, or anticoagulants. The C-reactive protein (CRP) levels were significantly higher in patients with lower GI bleeding (P=0.0227). The Hb levels were lower in patients with lower GI bleeding, however this finding was not statistically significant (P>0.05). No blood test variable was associated with lower GI bleeding. Elevated CRP was associated with lower GI bleeding, while there was no association between the medications and lower GI bleeding.
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Affiliation(s)
- Minoru Tomizawa
- Department of Gastroenterology, National Hospital Organization Shimoshizu Hospital, Yotsukaido, Chiba 284-0003, Japan
| | - Fuminobu Shinozaki
- Department of Radiology, National Hospital Organization Shimoshizu Hospital, Yotsukaido, Chiba 284-0003, Japan
| | - Rumiko Hasegawa
- Department of Surgery, National Hospital Organization Shimoshizu Hospital, Yotsukaido, Chiba 284-0003, Japan
| | - Yoshinori Shirai
- Department of Surgery, National Hospital Organization Shimoshizu Hospital, Yotsukaido, Chiba 284-0003, Japan
| | - Yasufumi Motoyoshi
- Department of Neurology, National Hospital Organization Shimoshizu Hospital, Yotsukaido, Chiba 284-0003, Japan
| | - Takao Sugiyama
- Department of Rheumatology, National Hospital Organization Shimoshizu Hospital, Yotsukaido, Chiba 284-0003, Japan
| | - Shigenori Yamamoto
- Department of Pediatrics, National Hospital Organization Shimoshizu Hospital, Yotsukaido, Chiba 284-0003, Japan
| | - Naoki Ishige
- Department of Neurosurgery, National Hospital Organization Shimoshizu Hospital, Yotsukaido, Chiba 284-0003, Japan
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Lanas A, Goldstein JL, Chan FKL, Wilcox CM, Peura DA, Li C, Sands GH, Scheiman JM. Risk factors associated with a decrease ≥2 g/dL in haemoglobin and/or ≥10% haematocrit in osteoarthritis patients taking celecoxib or a nonselective NSAID plus a PPI in a large randomised controlled trial (CONDOR). Aliment Pharmacol Ther 2012; 36:485-92. [PMID: 22804104 DOI: 10.1111/j.1365-2036.2012.05213.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2012] [Revised: 02/12/2012] [Accepted: 06/20/2012] [Indexed: 12/19/2022]
Abstract
BACKGROUND Nonsteroidal anti-inflammatory drugs are associated with gastrointestinal (GI) damage. The Celecoxib vs. Omeprazole and Diclofenac for At-Risk Osteoarthritis and Rheumatoid Arthritis Patients (CONDOR) trial showed that a haemoglobin drop ≥2 g/dL adjudicated as either of defined or presumed GI origin was the most frequent component/event for the composite GI primary end point. This adverse event is potentially clinically relevant in long-term NSAID treatment. AIM To define potential risk factors associated with a decrease in haemoglobin/haematocrit. METHODS Post hoc analysis of the CONDOR trial was conducted in the intention-to-treat population. Clinically significant blood loss was defined as: (i) a haemoglobin drop ≥2 g/dL and/or a haematocrit drop ≥10%; and (ii) blood loss adjudicated as either of defined or presumed GI origin. Fifteen risk factors were evaluated by stepwise logistic regression. Each factor had to be significant at <0.20 α to be included in the model. RESULTS A total of 64/3774 (1.7%) osteoarthritis (OA) patients had decreased haemoglobin/haematocrit and were adjudicated to the GI endpoint. Significant risk factors, at the 0.20 α level found to be associated with clinically significant blood loss in OA patients included [odds ratio (80% CI)] baseline C-reactive protein (CRP) levels [2.27 (1.46-3.53)], history of gastritis and history of GI intolerance [1.55 (1.06-2.28)], positive Helicobacter pylori at screening [1.54 (1.07-2.22)], increasing age [1.17 (1.04-1.32)] and body mass index [BMI; 1.03 (1.00-1.06)]. CONCLUSIONS Monitoring for decreases in haemoglobin should be considered for all OA patients and especially those with an increased age, BMI, history of gastritis and GI intolerance, CRP levels >1 mg/dL and/or positive H. pylori status, as this may affect their clinical management.
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Affiliation(s)
- A Lanas
- CIBERehd. IIS Aragón, Universidad de Zaragoza, Zaragoza, Spain.
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