Comparison of three risk scores to predict outcomes in upper gastrointestinal bleeding; modifying Glasgow-Blatchford with albumin. ACTA ACUST UNITED AC. 2019;57:322-333. [PMID: 31268861 DOI: 10.2478/rjim-2019-0016]

The effect of miR-372-5p regulation on CDX1 and CDX2 in the gastric cancer cell line

OBJECTIVES

MicroRNA expression disruptions play an important function in the expansion of gastric cancer. Previous investigation has indicated that miR-372-5p doing as an oncogene in several malignancies. CDX1 and CDX2, as target genes of miR-372-5p, play the role of tumor suppressors and oncogenes in gastric cancer cells, respectively. The current investigation explored the effects of miR-372-5p regulation on CDX2 and CDX1 in AGS cell lines and studied their molecular mechanism.

METHODS

hsa-miR-372-5p miRCURY LNA miRNA Inhibitors and Mimic were transfected into AGS cell line. The cell viability and cell cycle calculation were defined by MTT assay and flow cytometry, respectively. The Expression levels of miR-372-5p, CDX1, CDX2 and transfection efficiency were measured using Real-time PCR. Statistical investigation p values <0.05 were considered to be meaningful.

RESULTS

miR-372-5p particularly was upregulated in control cells and also after transfection by mimic. While its expression was reduced by the inhibitor. Upregulation of miR-372-5p remarkably increased cell growth and led to accumulation in the G2/M phase, although the inhibitor decreased cell growth and accumulation in the S phase. Accordingly, upregulation of miR-372-5p increased CDX2 and decreased CDX1 expression. By inhibition of miR-372-5p, expression of CDX2 was decreased and expression of CDX1 was increased.

CONCLUSIONS

Up and down-regulation of miR-372-5P has a potential effect on the expression levels of its target genes, CDX1 and CDX22. Accordingly, the downregulation of miR-372-5p may be assumed as a possible therapeutic target in treating gastric cancer.

Early lactate clearance for predicting outcomes in patients with gastrointestinal bleeding

BACKGROUND

Acute gastrointestinal bleeding (GI bleeding) can range from mild symptoms to life-threatening conditions that require emergency intervention. Therefore, it is important to first identify the high-risk and low-risk patients in the emergency department (ED).

AIMS

This study aimed to investigate the usefulness of a three-hourly interval for determining the lactate clearance, which is shorter than the time interval in previous studies, in order to predict the prognosis early in patients with GI bleeding.

METHODS

This retrospective study involved patients who visited for complaining of GI bleeding symptoms. Initial lactate levels were measured upon arrival at the ED and measured again 3 h later after performing initial resuscitation. And 3-h lactate clearance was calculated. Lactate and 3-h lactate clearance for predicting outcomes were evaluated by the area under the receiver operating characteristic (AUROC) curve.

RESULTS

A total of 104 patients were enrolled and 21 patients (20.2%) died in the hospital. Multivariate logistic regression showed that 3-h lactate clearance was a significant predictor of in-hospital mortality. The AUROC of 3-h lactate clearance for predicting in-hospital mortality was 0.756. The sensitivity and specificity were 66.67% and 75.90%. On combining lactate clearance, total bilirubin, and PTT, the AUROC was 0.899 for predicting in-hospital mortality.

CONCLUSIONS

This study validated that lactate clearance at three-hourly intervals is useful for early prediction of mortality and prognosis in patients with GI bleeding. It is important to perform not only an initial lactate measurement, but also a follow-up lactate measurement after initial resuscitation to check the lactate clearance.

Predictors of rebleeding in patients with acute non-variceal upper gastrointestinal bleeding

BACKGROUND

There is a risk of rebleeding after acute non-variceal upper gastrointestinal bleeding (ANVUGIB), and rebleeding increases the risk of poor prognosis. At present, there is no effective predictive method for such rebleeding. The changes of red blood cell distribution width as well as hemoglobin and gastrin levels are all related to bleeding diseases, which can provide a reference for clinical improvement of relevant mechanisms and prediction of bleeding.

AIM

To investigate the relationship of the red blood cell distribution width (RDW), hemoglobin (Hb), and gastrin (GAS) with Glasgow-Blatchford score (GBS) and AIMS65 score in patients with ANVUGIB and to explore their predictive value for rebleeding.

METHODS

A prospective cohort study was conducted on 122 ANVUGIB patients admitted to our hospital from August 2018 to February 2021, and they were divided into either a rebleeding group (n = 31) or a no-rebleeding group (n = 91) according to whether rebleeding occurred 7 d after onset. Baseline data, RDW, Hb, GAS, GBS score, and AIMS65 score were compared between the two groups. Pearson correlation analysis was performed to explore the relationship of each index with GBS and AIMS65 scores, and multi-factor logistic regression analysis was performed to identify the influencing factors of rebleeding. The receiver operating characteristic (ROC) curve and the area under the curve (AUC) were used to analyze the value of each index in predicting rebleeding, and to compare the incidence of rebleeding in patients with different levels of each index.

RESULTS

The proportion of patients with gastrointestinal bleeding in the rebleeding group was higher than that of the no-rebleeding group. The RDW, GAS, and GBS and AIMS65 scores were higher and Hb was lower in the rebleeding group than in the no-rebleeding group (P < 0.05). RDW and GAS were positively correlated with GBS and AIMS65 scores, and Hb was negatively correlated with GBS and AIMS65 scores (P < 0.05). Multivariate logistic regression analysis showed that after controlling for past gastrointestinal bleeding, GBS, and AIMS65 score, RDW, Hb, and GAS were still influencing factors of rebleeding (P < 0.05). The performance of RDW and Hb combined with GAS for predicting rebleeding (AUC = 0.850) was better than that of RDW (0.721), Hb (0.721), or GAS (0.806) alone. The rebleeding rate in patients with high levels of RDW and GAS was higher than that of patients with low levels, but patients with high levels of Hb had a lower rebleeding rate than those with low levels (P < 0.05).

CONCLUSION

RDW, Hb, and GAS are related to the risk of disease and rebleeding in patients with ANVUGIB. Combined detection of them may be a reliable method to assess the risk of disease and predict rebleeding.

Nursing Value Analysis and Risk Assessment of Acute Gastrointestinal Bleeding Using Multiagent Reinforcement Learning Algorithm

Gastrointestinal bleeding (GIB) indicates an issue in the digestive system. Blood can be found in feces or vomiting; however, it is not always visible, even if it makes the stool appear darkish or muddy. The bleeding can range in harshness from light to severe and can be dangerous. It is advised that nursing value analysis and risk assessment of patients with GIB is essential, but existing risk assessment techniques function inconsistently. Machine learning (ML) has the potential to increase risk evaluation. For evaluating risk in patients with GIB, scoring techniques are ineffective; a machine learning method would help. As a result, we present а unique machine learning-based nursing value analysis and risk assessment framework in this research to construct a model to evaluate the risk of hospital-based interventions or mortality in individuals with GIB and make a comparison to that of other rating systems. Initially, the dataset is collected, and preprocessing is done. Feature extraction is done using local binary patterns (LBP). Classification is performed using a fuzzy support vector machine (FSVM) classifier. For risk assessment and nursing value analysis, machine learning-based prediction using a multiagent reinforcement algorithm is employed. For improving the performance of the proposed system, we use spider monkey optimization (SMO) algorithm. The performance metrics like classification accuracy, area under the receiver-operating characteristic curve (AUROC), area under the curve (AUC), sensitivity, specificity, and precision are analyzed and compared with the traditional approaches. In individuals with GIB, the suggested technique had a good-excellent prognostic efficacy, and it outperformed other traditional models.

Evaluating the impact of frailty on periprocedural adverse events and mortality among patients with GI bleeding

BACKGROUND AND AIMS

Frailty is a known predictor of mortality and adverse events in the inpatient setting; however, it has not been studied as a modality to assess risk among patients undergoing endoscopy for GI bleeding (GIB). We aimed to determine the association between frailty status and risk of adverse events in hospitalized patients with GIB who underwent endoscopy.

METHODS

We performed a cohort study using the 2016 and 2017 National Inpatient Sample database, using International Classification of Diseases diagnostic codes to identify adult patients with GIB who underwent endoscopic procedures within 2 days of admission and the Hospital Frailty Risk Score to classify patients as frail or nonfrail. Univariable and multivariable logistic regression models were constructed to assess the predictors of periprocedural adverse events, and marginal standardization analysis was performed to assess for possible interaction between age and frailty.

RESULTS

A total of 757,920 patients met inclusion criteria, of which 44.4% (336,895) were identified as frail and 55.6% (421,025) as nonfrail; 49.2% of frail patients had composite periprocedural adverse events compared with 25.5% of nonfrail patients (P < .001). Frail patients notably had more cardiovascular (32.1% vs 17.1%, P < .001), pulmonary (18.5% vs 4.3%, P < .001), GI (10.1% vs 6.1%, P < .001), and infectious (9.9% vs .7%, P < .001) adverse events compared with nonfrail patients. Frail patients also had higher all-cause inpatient mortality rates (4.8% vs .5%, P < .001). On multivariable analysis, positive frailty status was associated with a 2.13 times increased likelihood of having composite periprocedural adverse events.

CONCLUSIONS

In hospitalized patients undergoing endoscopy for GIB, frailty status is associated with increased periprocedural adverse events including all-cause mortality. The use of frailty assessments can thus further guide clinical decision-making when considering endoscopy and risk of adverse events in adult patients with GI hemorrhage.

Novel and Simple Criteria for Predicting Mortality of Peptic Ulcer Disease

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.

Clinical algorithms for the prevention of variceal bleeding and rebleeding in patients with liver cirrhosis

Portal hypertension (PH), a common complication of liver cirrhosis, results in development of esophageal varices. When esophageal varices rupture, they cause significant upper gastrointestinal bleeding with mortality rates up to 20% despite state-of-the-art treatment. Thus, prophylactic measures are of utmost importance to improve outcomes of patients with PH. Several high-quality studies have demonstrated that non-selective beta blockers (NSBBs) or endoscopic band ligation (EBL) are effective for primary prophylaxis of variceal bleeding. In secondary prophylaxis, a combination of NSBB + EBL should be routinely used. Once esophageal varices develop and variceal bleeding occurs, standardized treatment algorithms should be followed to minimize bleeding-associated mortality. Special attention should be paid to avoidance of overtransfusion, early initiation of vasoconstrictive therapy, prophylactic antibiotics and early endoscopic therapy. Pre-emptive transjugular intrahepatic portosystemic shunt should be used in all Child C10-C13 patients experiencing variceal bleeding, and potentially in Child B patients with active bleeding at endoscopy. The use of carvedilol, safety of NSBBs in advanced cirrhosis (i.e. with refractory ascites) and assessment of hepatic venous pressure gradient response to NSBB is discussed. In the present review, we give an overview on the rationale behind the latest guidelines and summarize key papers that have led to significant advances in the field.

Outcomes of Upper Gastrointestinal Bleeding Based on Time to Endoscopy: A Retrospective Study

Introduction Non-variceal upper gastrointestinal bleeding (UGIB) is a major burden on the health care system. The timing of endoscopy has been an ongoing debate and data on the association of early endoscopy with a better or worse clinical outcome are conflicting. In our study, we aimed to identify the benefits versus the risks of performing an urgent endoscopy in regards to the number of endoscopic interventions, length of hospital stay, number of packed red blood cells (PRBCs) transfused, and mortality.  Methodology This is a retrospective record-based study. A total of 806 charts were reviewed and 251 patients with the signs and symptoms of UGIB on presentation were included in the study. Patients with variceal bleeding, lower gastrointestinal bleeding, insignificant bleeds with no drop in H/H, GI bleed not being the presenting complaint on admission, and patients on anticoagulation were excluded. Results Out of the patients who underwent an urgent esophagogastroduodenoscopy (EGD), 26.2% needed a second-look EGD 48 hours after the first EGD when compared to 4% and 2% in the early (12-24 hours) and late (>24 hours) endoscopy groups, respectively. In patients who underwent urgent EGD, 23% had active bleeding and it was statistically significant when compared to the other groups. The active bleeding limited the visualization during the endoscopy, which led to a repeat EGD in the urgent EGD group. If an endoscopic intervention was received, patients having EGD >24 hours received a smaller number of interventions. There was no statistical difference in the Blatchford scores between the three groups, indicating that the groups were similar in morbidity. No difference in mortality, hospital length of stay, or number of blood transfusions received, surgical or interventional radiology-guided interventions was found between the three groups. Conclusion Patients who underwent urgent endoscopy had more procedures, with no difference in mortality, number of units of blood transfused, or length of hospitalization when compared to the early or late endoscopy groups.