Hypoalbuminemia in the outcome of patients with non-variceal upper gastrointestinal bleeding

INTRODUCTION AND AIM

The role of serum albumin level in patients with non-variceal upper gastrointestinal bleeding (NVUGB) has not been extensively studied. Our aim was to evaluate the role of serum albumin on admission in terms of in-hospital mortality in patients with NVUGB.

MATERIALS AND METHODS

Patients admitted with NVUGB during a 4-year period were prospectively included. Demographic, clinical, and laboratory data were collected. ROC curve analysis was used to determine the cutoff value for serum albumin on admission that made a distinction between deceased patients and survivors with respect to serum albumin on admission, as well as its overall performance compared with the Rockall score.

RESULTS

185 patients with NVUGB were evaluated. Men predominated (56.7%) and a mean age of 59.1±19.9 years was found. Mean serum albumin on admission was 2.9±0.9g/dl with hypoalbuminemia (< 3.5g/dl) detected on admission in 71.4% of cases. The ROC curve found that the best value for predicting hospital mortality was an albumin level of 3.1g/dl (AUROC 0.738). Mortality in patients with albumin ≥ 3.2g/dl was 1.2% compared with 11.2% in patients with albumin<3.2g/dl (P=.009; OR 9.7, 95%CI 1.2-76.5). There was no difference in overall performance between the albumin level (AUORC 0.738) and the Rockall score (AUROC 0.715) for identifying mortality.

CONCLUSIONS

Patients with hypoalbuminemia presenting with NVUGB have a greater in-hospital mortality rate. The serum albumin level and the Rockall score perform equally in regard to identifying the mortality rate.

Effects of melatonin on the acute inflammatory response associated with endoscopic retrograde cholangiopancreatography: A randomized, double-blind, placebo-controlled trial

INTRODUCTION

Endoscopic retrograde cholangiopancreatography (ERCP) is associated with an acute inflammatory response and melatonin has a variety of immunomodulatory and antioxidant effects studied experimentally in pancreatobiliary pathology.

AIMS

The aim of our study was to evaluate the effects of peri-procedural administration of melatonin on the inflammatory response and lipid peroxidation associated with ERCP.

METHODS

In this proof-of-concept clinical trial, 37 patients with a high probability of choledocholithiasis were randomized to receive peri-procedure (ERCP) melatonin or placebo. We measured the serum concentration of tumor necrosis factor-alpha (TNF-alpha), interleukin-6 (IL-6), vascular endothelial growth factor (VEGF), lipid peroxidation, amylase, and liver function tests 24h before and after the procedure.

RESULTS

We found no pre-procedure or post-procedure differences between the melatonin group or the placebo group (P>.05) in the serum concentrations of TNF-alpha (melatonin: 153.8 vs. 149.4ng/m; placebo: 103.5 vs. 107.3ng/ml), IL-6 (melatonin: 131.8 vs. 133.3ng/ml; placebo: 177.8 vs. 197.8ng/ml), or VEGF (melatonin: 157.3 vs. 157.8pg/ml; placebo: 97.3 vs. 97.8pg/ml), or in relation to lipid peroxidation (melatonin: 39.2 vs. 72.3μg/ml; placebo: 66.4 vs. 90.5μg/ml). After ERCP, a significant decrease in the AST, ALT, and total bilirubin levels was found only in the melatonin group (P<.05). The administration of melatonin was safe and tolerable.

CONCLUSIONS

Melatonin is safe and tolerable in patients undergoing ERCP, but it does not appear to affect inflammatory cytokine concentrations or lipid peroxidation.

[Clinical characteristics of acute pancreatitis in Mexico]

BACKGROUND

Acute pancreatitis (AP) etiology and frequency vary in relation to geographic region.

AIMS

To determine the etiology, frequency, and mortality of AP in a Mexican population.

PATIENTS AND METHODS

We carried out a prospective study of first episode AP patients over a period of 6 years.

RESULTS

A total of 605 patients with a mean age of 40 years were included in the study. Sixty-four percent of them presented with overweight and/or obesity determined through BMI. Etiology was biliary in 66.60%, it was due to alcohol consumption in 15.90%, hypertriglyceridemia in 7.80%, it was post-endoscopic retrograde cholangiopancreatography (ERCP) in 2.10%, and was undetermined in 7.20%. Pancreatic infection was suspected in 70 patients and they underwent CT-guided fine needle aspiration. Thirty-two of those patients were diagnosed with pancreatic infection in which Staphylococcus spp was the most common microorganism. Overall mortality was 5.00% (2.60% < 30 years and 10.00% > 70 years). Necrosis, pancreatic infection, and mortality were more frequent in the cases in which etiology was due to alcohol ingestion.

CONCLUSIONS

The most frequent AP etiology was biliary, but that caused by alcohol presented with more complications. Overall mortality was 5.00% and was higher in the elderly patients.

[Pathogenesis of cirrhotic hepatic encephalopathy. Treatment implications]

BACKGROUND

Hepatic encephalopathy (HE) is a neuropsychologic syndrome associated with multifactorial metabolic disruptions. Several physiopathogenic theories have been proposed.

OBJECTIVES

To review the most important theories (ammonia, mercaptans, short chain fatty acids, false neurotransmitters, gamma-aminobutyric acid, endogenous benzodiazepines) and to analyze the different therapeutic modalities derived from these theories.

METHODS

An intensive bibliographic review was carried out using Med-Line and Current Contents data base. Randomized therapeutic trials published in the last ten years were particularly analyzed.

RESULTS

From all theories proposed, the revised ammonia theory better explains pathogenesis of HE based on the information about efficacy of anti-ammonia agents. Authors propose a theory in order to explain the effect of ammonia and serotonin in neurotransmission, particularly excitatory glutamatergic neurotransmission.

CONCLUSIONS

It seems that ammonia has a predominant role in pathogenesis of HE. Some other agents may be involved but its nature is not actually defined. Glutamatergic neurotransmission un HE has been recently studied.