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Penaud V, Vieille T, Urbina T, Bonny V, Gabarre P, Missri L, Gasperment M, Baudel JL, Carbonell N, Beurton A, Chaibi S, Retbi A, Fartoukh M, Piton G, Guidet B, Maury E, Ait-Oufella H, Joffre J. Prediction of esophagogastroduodenoscopy therapeutic usefulness for in-ICU suspected upper gastrointestinal bleeding: the SUGIBI score study. Ann Intensive Care 2024; 14:28. [PMID: 38361004 PMCID: PMC10869326 DOI: 10.1186/s13613-024-01250-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 01/16/2024] [Indexed: 02/17/2024] Open
Abstract
BACKGROUND Suspected upper gastrointestinal bleeding (SUGIB) is a common issue during ICU stay. In the absence of specific guidelines on the indication and timing of esophagogastroduodenoscopy (EGD), there is substantial variability in EGD indication depending on accessibility and clinical presentation. This study aimed to investigate factors associated with the need for per-EGD hemostatic therapy and to create a score predicting therapeutic benefit of emergency bedside EGD in ICU patients with SUGIB. METHODS We conducted a retrospective study in our ICU to identify factors associated with the need for hemostatic procedure during EGD performed for SUGIB. From this observational cohort, we derived a score predicting the need for hemostasis during EGD, the SUGIBI score. This score was subsequently validated in a retrospective multicenter cohort. RESULTS Two hundred fifty-five patients not primarily admitted for GI bleeding who underwent a bedside EGD for SUGIB during their ICU stay were analyzed. The preeminent EGD indication were anemia (79%), melena (19%), shock (14%), and hematemesis (13%). EGD was normal in 24.7% of cases, while primary lesions reported were ulcers (23.1%), esophagitis (18.8%), and gastritis (12.5%). Only 12.9% of patients underwent hemostatic endotherapy during EGD. A SUGIBI score < 4 had a negative predictive value of 95% (91-99) for hemostatic endotherapy [AUC of 0.81; 0.75-0.91 (p < 0.0001)]. The SUGIBI score for predicting the need for an EGD-guided hemostatic procedure was next validated in a multicenter cohort with an AUC of 0.75 (0.66-0.85) (p < 0.0001), a score < 4 having a negative predictive value of 95% (92-97). CONCLUSIONS Our study shows that the therapeutic usefulness of bedside emergency EGD for SUGIB in critically ill patients is limited to a minority of patients. The SUGIBI score should help clinicians stratify the probability of a therapeutic EGD.
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Affiliation(s)
- Victor Penaud
- Medical Intensive Care Unit, Saint Antoine University Hospital, APHP, Sorbonne University, 75012, Paris, France
| | - Thibault Vieille
- Intensive Care Unit, Besançon University Hospital, 25000, Besançon, France
| | - Tomas Urbina
- Medical Intensive Care Unit, Saint Antoine University Hospital, APHP, Sorbonne University, 75012, Paris, France
| | - Vincent Bonny
- Medical Intensive Care Unit, Saint Antoine University Hospital, APHP, Sorbonne University, 75012, Paris, France
| | - Paul Gabarre
- Medical Intensive Care Unit, Saint Antoine University Hospital, APHP, Sorbonne University, 75012, Paris, France
| | - Louai Missri
- Medical Intensive Care Unit, Saint Antoine University Hospital, APHP, Sorbonne University, 75012, Paris, France
| | - Maxime Gasperment
- Medical Intensive Care Unit, Saint Antoine University Hospital, APHP, Sorbonne University, 75012, Paris, France
| | - Jean-Luc Baudel
- Medical Intensive Care Unit, Saint Antoine University Hospital, APHP, Sorbonne University, 75012, Paris, France
| | - Nicolas Carbonell
- Gastroenterology Department, AP-HP, Hôpital Saint-Antoine, Sorbonne University, 75012, Paris, France
| | - Alexandra Beurton
- Intensive Care Unit, Tenon University Hospital, APHP, Sorbonne University, 75020, Paris, France
| | - Sayma Chaibi
- Medical Intensive Care Unit, Saint Antoine University Hospital, APHP, Sorbonne University, 75012, Paris, France
| | - Aurélia Retbi
- Département d'Information Médicale, Hôpital Saint Antoine, Assistance Publique-Hôpitaux de Paris, Sorbonne University, Paris, France
| | - Muriel Fartoukh
- Intensive Care Unit, Tenon University Hospital, APHP, Sorbonne University, 75020, Paris, France
| | - Gaël Piton
- Intensive Care Unit, Besançon University Hospital, 25000, Besançon, France
| | - Bertrand Guidet
- Medical Intensive Care Unit, Saint Antoine University Hospital, APHP, Sorbonne University, 75012, Paris, France
- Pierre Louis Institute of Epidemiology and Public Health, Inserm U1136, Sorbonne University, Paris, France
| | - Eric Maury
- Medical Intensive Care Unit, Saint Antoine University Hospital, APHP, Sorbonne University, 75012, Paris, France
| | - Hafid Ait-Oufella
- Medical Intensive Care Unit, Saint Antoine University Hospital, APHP, Sorbonne University, 75012, Paris, France
- Paris Cardiovascular Research Center, Inserm U970, Paris Center University, Paris, France
| | - Jérémie Joffre
- Medical Intensive Care Unit, Saint Antoine University Hospital, APHP, Sorbonne University, 75012, Paris, France.
- Centre de Recherche Saint-Antoine, Inserm UMRS-938, Sorbonne University, Paris, France.
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Vanella G, Capurso G, Burti C, Fanti L, Ricciardiello L, Souza Lino A, Boskoski I, Bronswijk M, Tyberg A, Krishna Kumar Nair G, Angeletti S, Mauro A, Zingone F, Oppong KW, de la Iglesia-Garcia D, Pouillon L, Papanikolaou IS, Fracasso P, Ciceri F, Rovere-Querini P, Tomba C, Viale E, Eusebi LH, Riccioni ME, van der Merwe S, Shahid H, Sarkar A, Yoo JWG, Dilaghi E, Speight RA, Azzolini F, Buttitta F, Porcari S, Petrone MC, Iglesias-Garcia J, Savarino EV, Di Sabatino A, Di Giulio E, Farrell JJ, Kahaleh M, Roelandt P, Costamagna G, Artifon ELDA, Bazzoli F, Testoni PA, Greco S, Arcidiacono PG. Gastrointestinal mucosal damage in patients with COVID-19 undergoing endoscopy: an international multicentre study. BMJ Open Gastroenterol 2021; 8:e000578. [PMID: 33627313 PMCID: PMC7907837 DOI: 10.1136/bmjgast-2020-000578] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 01/28/2021] [Accepted: 02/02/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Although evidence suggests frequent gastrointestinal (GI) involvement during coronavirus disease 2019 (COVID-19), endoscopic findings are scarcely reported. AIMS We aimed at registering endoscopic abnormalities and potentially associated risk factors among patients with COVID-19. METHODS All consecutive patients with COVID-19 undergoing endoscopy in 16 institutions from high-prevalence regions were enrolled. Mann-Whitney U, χ2 or Fisher's exact test were used to compare patients with major abnormalities to those with negative procedures, and multivariate logistic regression to identify independent predictors. RESULTS Between February and May 2020, during the first pandemic outbreak with severely restricted endoscopy activity, 114 endoscopies on 106 patients with COVID-19 were performed in 16 institutions (men=70.8%, median age=68 (58-74); 33% admitted in intensive care unit; 44.4% reporting GI symptoms). 66.7% endoscopies were urgent, mainly for overt GI bleeding. 52 (45.6%) patients had major abnormalities, whereas 13 bled from previous conditions. The most prevalent upper GI abnormalities were ulcers (25.3%), erosive/ulcerative gastro-duodenopathy (16.1%) and petechial/haemorrhagic gastropathy (9.2%). Among lower GI endoscopies, 33.3% showed an ischaemic-like colitis.Receiver operating curve analysis identified D-dimers >1850 ng/mL as predicting major abnormalities. Only D-dimers >1850 ng/mL (OR=12.12 (1.69-86.87)) and presence of GI symptoms (OR=6.17 (1.13-33.67)) were independently associated with major abnormalities at multivariate analysis. CONCLUSION In this highly selected cohort of hospitalised patients with COVID-19 requiring endoscopy, almost half showed acute mucosal injuries and more than one-third of lower GI endoscopies had features of ischaemic colitis. Among the hospitalisation-related and patient-related variables evaluated in this study, D-dimers above 1850 ng/mL was the most useful at predicting major mucosal abnormalities at endoscopy. TRIAL REGISTRATION NUMBER ClinicalTrial.gov (ID: NCT04318366).
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Affiliation(s)
- Giuseppe Vanella
- Pancreatobiliary Endoscopy and Endosonography Division, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Gabriele Capurso
- Pancreatobiliary Endoscopy and Endosonography Division, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Cesare Burti
- Digestive Endoscopy Unit, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Lorella Fanti
- Gastroenterology and Gastrointestinal Endoscopy Division, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Luigi Ricciardiello
- Department of Medical and Surgical Sciences, University of Bologna and Sant'Orsola Malpighi Hospital, Bologna, Italy
| | - Andre Souza Lino
- GI Endoscopy Service, Hospital Casa de Saude de Santos, Santos, Brazil
| | - Ivo Boskoski
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Center for Endoscopic Research Therapeutics and Training (CERTT), Università Cattolica del Sacro Cuore, Rome, Italy
| | - Michiel Bronswijk
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium
| | - Amy Tyberg
- Robert Wood Johnson Medical School Rutgers University, New Brunswick, New Jersey, USA
| | - Govind Krishna Kumar Nair
- Section of Digestive Diseases, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Stefano Angeletti
- Digestive Endoscopy Unit, Sant'Andrea Hospital, Sapienza University, Rome, Italy
| | - Aurelio Mauro
- Department of Internal Medicine, San Matteo Hospital Foundation, University of Pavia, Pavia, Italy
| | - Fabiana Zingone
- Gastroenterology Unit, Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy
| | - Kofi W Oppong
- Department of Gastroenterology, Newcastle upon Tyne hospitals NHS Trust, Newcastle upon Tyne, UK
| | - Daniel de la Iglesia-Garcia
- Department of Gastroenterology and Hepatology, University Hospital of Santiago de Compostela. Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
| | - Lieven Pouillon
- Imelda GI Clinical Research Center, Imeldaziekenhuis, Bonheiden, Belgium
| | - Ioannis S Papanikolaou
- National and Kapodistrian University of Athens, "Attikon" University General Hospital, Athens, Greece
| | | | - Fabio Ciceri
- Department of Hematology and Stem Cell Transplantation, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Patrizia Rovere-Querini
- Division of Immunology, Transplantation and Infectious Diseases, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Carolina Tomba
- Digestive Endoscopy Unit, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Edi Viale
- Gastroenterology and Gastrointestinal Endoscopy Division, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Leonardo Henry Eusebi
- Department of Medical and Surgical Sciences, University of Bologna and Sant'Orsola Malpighi Hospital, Bologna, Italy
| | - Maria Elena Riccioni
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Center for Endoscopic Research Therapeutics and Training (CERTT), Università Cattolica del Sacro Cuore, Rome, Italy
| | - Schalk van der Merwe
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium
- Department of Chronic Disease, Metabolism and Ageing (CHROMETA), KU Leuven, Leuven, Belgium
| | - Haroon Shahid
- Robert Wood Johnson Medical School Rutgers University, New Brunswick, New Jersey, USA
| | - Avik Sarkar
- Robert Wood Johnson Medical School Rutgers University, New Brunswick, New Jersey, USA
| | - Jin Woo Gene Yoo
- Section of Digestive Diseases, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Emanuele Dilaghi
- Digestive Endoscopy Unit, Sant'Andrea Hospital, Sapienza University, Rome, Italy
| | - R Alexander Speight
- Department of Gastroenterology, Newcastle upon Tyne hospitals NHS Trust, Newcastle upon Tyne, UK
| | - Francesco Azzolini
- Gastroenterology and Gastrointestinal Endoscopy Division, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Francesco Buttitta
- Department of Medical and Surgical Sciences, University of Bologna and Sant'Orsola Malpighi Hospital, Bologna, Italy
| | - Serena Porcari
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Center for Endoscopic Research Therapeutics and Training (CERTT), Università Cattolica del Sacro Cuore, Rome, Italy
| | - Maria Chiara Petrone
- Pancreatobiliary Endoscopy and Endosonography Division, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Julio Iglesias-Garcia
- Department of Gastroenterology and Hepatology, University Hospital of Santiago de Compostela. Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
| | - Edoardo V Savarino
- Gastroenterology Unit, Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy
| | - Antonio Di Sabatino
- Department of Internal Medicine, San Matteo Hospital Foundation, University of Pavia, Pavia, Italy
| | - Emilio Di Giulio
- Digestive Endoscopy Unit, Sant'Andrea Hospital, Sapienza University, Rome, Italy
| | - James J Farrell
- Section of Digestive Diseases, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Michel Kahaleh
- Robert Wood Johnson Medical School Rutgers University, New Brunswick, New Jersey, USA
| | - Philip Roelandt
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium
- Department of Chronic Disease, Metabolism and Ageing (CHROMETA), KU Leuven, Leuven, Belgium
| | - Guido Costamagna
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Center for Endoscopic Research Therapeutics and Training (CERTT), Università Cattolica del Sacro Cuore, Rome, Italy
| | | | - Franco Bazzoli
- Department of Medical and Surgical Sciences, University of Bologna and Sant'Orsola Malpighi Hospital, Bologna, Italy
| | - Per Alberto Testoni
- Gastroenterology and Gastrointestinal Endoscopy Division, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Salvatore Greco
- Digestive Endoscopy Unit, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Paolo Giorgio Arcidiacono
- Pancreatobiliary Endoscopy and Endosonography Division, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
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Jean-Baptiste S, Messika J, Hajage D, Gaudry S, Barbieri J, Duboc H, Dreyfuss D, Coffin B, Ricard JD. Clinical impact of upper gastrointestinal endoscopy in critically ill patients with suspected bleeding. Ann Intensive Care 2018; 8:75. [PMID: 29974284 PMCID: PMC6031555 DOI: 10.1186/s13613-018-0423-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Accepted: 06/28/2018] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND AND AIMS Upper gastrointestinal endoscopies' (UGE) profitability is undisputable in patients admitted for an overt upper digestive tract bleeding. In critically ill subjects admitted for other causes, its performances have scarcely been investigated despite its broad use. We sought to question the performance of bedside UGE in intensive care unit (ICU) patients, admitted for another reason than overt bleeding. METHODS This was a six-year (January 2007-December 2012) retrospective observational study of all UGE performed in a medico-surgical ICU. Exclusion of those performed: in patients admitted for a patent upper digestive bleeding; for a second-look gastroscopy of a known lesion; as a planned interventional procedure. Main demographic and clinical data were recorded; UGE indication and profitability were rated according to its findings and therapeutic impact. Operative values of the indications of UGE were calculated. This study received approval from the Ethics Committee of the French Society of Intensive Care (n° 12-363). RESULTS Eighty-four patients (74% male, mean age 61 ± 14 years) underwent a diagnostic UGE, all for a suspected upper digestive tract bleeding. The main symptoms justifying the procedure were anemia (52%), digestive bleeding (27%), vomiting (15%), hemodynamic instability (3%) and hyperuremia (3%). The profitability of UGE was rated as major (n = 5; 5.8%); minor (n = 34; 40.5%); or null (n = 45; 53.6%). CONCLUSIONS When ICU admission is not warranted by a digestive bleeding, UGE has limited diagnostic and therapeutic interest, despite being often performed.
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Affiliation(s)
- Sylvain Jean-Baptiste
- Medico-Surgical Intensive Care Unit, AP-HP, Hôpital Louis Mourier, 178 rue des Renouillers, 92700 Colombes, France
| | - Jonathan Messika
- Medico-Surgical Intensive Care Unit, AP-HP, Hôpital Louis Mourier, 178 rue des Renouillers, 92700 Colombes, France
- IAME, UMR 1137, INSERM, 75018 Paris, France
- IAME, UMR 1137, Univ Paris Diderot, Sorbonne Paris Cité, 75018 Paris, France
| | - David Hajage
- Département de Biostatistiques, Santé Publique et Information Médicale, AP-HP, Hôpital Pitié-Salpêtrière, 75013 Paris, France
- Univ Pierre et Marie Curie, Sorbonne Universités, 75013 Paris, France
- ECEVE, U1123, CIC-EC 1425, INSERM, 75010 Paris, France
- ECEVE, UMRS 1123, Univ Paris Diderot, Sorbonne Paris Cité, 75010 Paris, France
| | - Stéphane Gaudry
- Medico-Surgical Intensive Care Unit, AP-HP, Hôpital Louis Mourier, 178 rue des Renouillers, 92700 Colombes, France
- ECEVE, U1123, CIC-EC 1425, INSERM, 75010 Paris, France
- ECEVE, UMRS 1123, Univ Paris Diderot, Sorbonne Paris Cité, 75010 Paris, France
| | - Julie Barbieri
- Gastroenterology Unit, AP-HP, Hôpital Louis Mourier, 178 rue des Renouillers, 92700 Colombes, France
| | - Henri Duboc
- Univ Paris Diderot, Sorbonne Paris Cité, 75018 Paris, France
| | - Didier Dreyfuss
- Medico-Surgical Intensive Care Unit, AP-HP, Hôpital Louis Mourier, 178 rue des Renouillers, 92700 Colombes, France
- IAME, UMR 1137, INSERM, 75018 Paris, France
- IAME, UMR 1137, Univ Paris Diderot, Sorbonne Paris Cité, 75018 Paris, France
| | - Benoit Coffin
- Gastroenterology Unit, AP-HP, Hôpital Louis Mourier, 178 rue des Renouillers, 92700 Colombes, France
- Univ Paris Diderot, Sorbonne Paris Cité, 75018 Paris, France
| | - Jean-Damien Ricard
- Medico-Surgical Intensive Care Unit, AP-HP, Hôpital Louis Mourier, 178 rue des Renouillers, 92700 Colombes, France
- IAME, UMR 1137, INSERM, 75018 Paris, France
- IAME, UMR 1137, Univ Paris Diderot, Sorbonne Paris Cité, 75018 Paris, France
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