Bacteremia in cirrhotic patients with upper gastrointestinal bleeding

At admission hemodynamic instability is associated with increased mortality and rebleeding rate in acute gastrointestinal bleeding: a systematic review and meta-analysis

Background

Acute gastrointestinal bleeding (GIB) is a life-threatening event. Around 20-30% of patients with GIB will develop hemodynamic instability (HI).

Objectives

We aimed to quantify HI as a risk factor for the development of relevant end points in acute GIB.

Design

A systematic search was conducted in three medical databases in October 2021.

Data sources and methods

Studies of GIB patients detailing HI as a risk factor for the investigated outcomes were selected. For the overall results, pooled odds ratios (ORs) with 95% confidence intervals (CIs) were calculated based on a random-effects model. Subgroups were formed based on the source of bleeding. The Quality of Prognostic Studies tool was used to assess the risk of bias.

Results

A total of 62 studies were eligible, and 39 were included in the quantitative synthesis. HI was found to be a risk factor for both in-hospital (OR: 5.48; CI: 3.99-7.52) and 30-day mortality (OR: 3.99; CI: 3.08-5.17) in upper GIB (UGIB). HI was also associated with higher in-hospital (OR: 3.68; CI: 2.24-6.05) and 30-day rebleeding rates (OR: 4.12; 1.83-9.31) among patients with UGIB. The need for surgery was also more frequent in hemodynamically compromised UGIB patients (OR: 3.65; CI: 2.84-4.68). In the case of in-hospital mortality, the risk of bias was high for 1 (4%), medium for 13 (48%), and low for 13 (48%) of the 27 included studies.

Conclusion

Hemodynamically compromised patients have increased odds of all relevant untoward end points in GIB. Therefore, to improve the outcomes, adequate emergency care is crucial in HI.

Registration

PROSPERO registration number: CRD42021285727.

Octreotide acetate combined with somatostatin upregulates miR-1291 and downregulates miR-331-3p in patients with cirrhosis and upper gastrointestinal bleeding

OBJECTIVE

This study aimed to explore the efficacy of octreotide acetate combined with somatostatin (OA + SS) for the treatment of patients with cirrhosis and upper gastrointestinal bleeding (UGIB).

METHODS

A total of 118 patients with cirrhosis and UGIB in our hospital were enrolled from June 2018 to September 2019. Fifty-seven were treated with OA alone (Group A) whereas 61 were treated with OA + SS (Group B).

RESULTS

The therapeutic effects, inflammatory cytokines, liver function indices, and relative expression levels of miR-1291 and miR-331-3p were then observed. Compared with the patients in Group A, those in Group B had lower post-treatment inflammatory cytokine levels (P < 0.05), better post-treatment liver function indices (P < 0.05), lower incidences of adverse reactions (P < 0.05), and a higher total effective rate (P < 0.05). The OA + SS treatment group had upregulated miR-1291 and downregulated miR-331-3p (P < 0.05).

CONCLUSION

OA + SS therapy is safe and effective for the treatment of patients with cirrhosis and UGIB.

Patients with Liver Cirrhosis as Frequent Attenders of Emergency Departments

Objectives

Frequent attendance for nonemergency problems to emergency departments (EDs) contributes to ED overcrowding, resulting in medical care delays, increased medical errors, and social and economic burdens. Most studies regarding frequent attenders of EDs examine general patients without classifying certain subgroups. This study aimed to investigate patients with liver cirrhosis who present repeatedly to the ED.

Methods

This was a retrospective, observational cohort study of adult patients with a history of liver cirrhosis presenting to the ED from January 2011 to December 2015. We included patients with cirrhosis whose first ED visit occurred during the study period. We went far back for 20 years and excluded patients with any ED visits (including both cirrhosis and noncirrhosis-related ones) before the study period. We categorized frequent attenders as patients with more than 4 ED visits within 12 months after the first ED visit; infrequent attenders were those who did not meet this criterion.

Results

A total of 3513 patients with cirrhosis were included in this retrospective cohort study. Compared with the infrequent attenders, frequent attenders had a higher rate of presentations due to hepatic encephalopathy (15.2% vs 13.7%, P < 0.001) and ascites (10% vs 4%, P < 0.001) and ascites (10% vs 4%, P < 0.001) and ascites (10% vs 4%.

Conclusions

Hepatic encephalopathy and ascites account for more ED visits in frequent than in infrequent attenders. Our findings provide information for those planning outpatient support for patients with cirrhosis. Further research is warranted.