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Cazacu SM, Turcu-Stiolica A, Florescu DN, Ungureanu BS, Iovanescu VF, Neagoe CD, Burtea DE, Genunche-Dumitrescu AV, Avramescu TE, Iordache S. The Reduction of After-Hours and Weekend Effects in Upper Gastro-intestinal Bleeding Mortality During the COVID-19 Pandemic Compared to the Pre-Pandemic Period. J Multidiscip Healthc 2023; 16:3151-3165. [PMID: 37908341 PMCID: PMC10615097 DOI: 10.2147/jmdh.s427449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 09/27/2023] [Indexed: 11/02/2023] Open
Abstract
Background In upper gastrointestinal bleeding (UGIB), admissions after normal working hours and during weekends may be associated with increased mortality. Aim To assess the evolution of the after-hours and weekend effects during the COVID-19 pandemic as a result of progressive improved management despite management challenges during the pandemic. Methods We performed an observational study of patients admitted for UGIB at a tertiary academic center between March 2020 and December 2021, compared to the corresponding timeframe before the pandemic. Admissions were assessed based on regular hours versus after-hours and weekdays versus weekends. We stratified patients based on demographic data, etiology, prognostic scores, the time between symptom onset and admission, as and between admission and endoscopy. The outcomes included mortality, rebleeding rate, the requirement for surgery and transfusion, and hospitalization days. Results 802 cases were recorded during the pandemic, and 1006 cases before the pandemic. The overall mortality rate was 12.33%. Patients admitted after hours and during weekends had a higher mortality rate compared to those admitted during regular hours and weekdays (15.18% versus 10.22%, and 15.25% versus 11.16%), especially in cases of non-variceal bleeding. However, the difference in mortality rates was reduced by 2/3 during the pandemic, despite the challenges posed by COVID-19 infection. This suggests that there was an equalization effect of care in UGIB, regardless of the admission time. The differences observed in mortality rates for after-hours and weekend admissions seem to be primarily related to a higher proportion of patients who did not undergo endoscopy, while the proportion of severe cases remained similar. Blood requirements, hospital days, and rebleeding rate were similar between the two groups. Conclusion Admissions during weekends and after-hours have been associated with increased mortality, particularly in cases of non-variceal bleeding. However, the impact of this association was significantly reduced during the pandemic.
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Affiliation(s)
- Sergiu Marian Cazacu
- Gastroenterology Department, University of Medicine and Pharmacy Craiova, Clinical Emergency Hospital Craiova, Dolj County, Romania
| | - Adina Turcu-Stiolica
- Biostatistics Department, University of Medicine and Pharmacy Craiova, Dolj County, Romania
| | - Dan Nicolae Florescu
- Gastroenterology Department, University of Medicine and Pharmacy Craiova, Clinical Emergency Hospital Craiova, Dolj County, Romania
| | - Bogdan Silviu Ungureanu
- Gastroenterology Department, University of Medicine and Pharmacy Craiova, Clinical Emergency Hospital Craiova, Dolj County, Romania
| | - Vlad Florin Iovanescu
- Gastroenterology Department, University of Medicine and Pharmacy Craiova, Clinical Emergency Hospital Craiova, Dolj County, Romania
| | - Carmen Daniela Neagoe
- Internal Medicine Department, University of Medicine and Pharmacy Craiova, Clinical Emergency Hospital Craiova, Dolj County, Romania
| | - Daniela Elena Burtea
- Gastroenterology Department, University of Medicine and Pharmacy Craiova, Clinical Emergency Hospital Craiova, Dolj County, Romania
| | | | - Taina Elena Avramescu
- Individual Sports, and Medical Disciplines Departments, University of Craiova, Dolj County, Romania
| | - Sevastita Iordache
- Gastroenterology Department, University of Medicine and Pharmacy Craiova, Clinical Emergency Hospital Craiova, Dolj County, Romania
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Cazacu SM, Parscoveanu M, Cartu D, Moraru E, Rogoveanu I, Ungureanu BS, Iordache S, Florescu DN, Iovanescu VF, Dragomir MI. NLR48 is Better Than CRP, and mCTSI, and Similar to BISAP and SOFA Scores for Mortality Prediction in Acute Pancreatitis: A Comparison of 6 Scores. J Inflamm Res 2023; 16:4793-4804. [PMID: 37881651 PMCID: PMC10596122 DOI: 10.2147/jir.s432408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 10/10/2023] [Indexed: 10/27/2023] Open
Abstract
Introduction The neutrophil-lymphocyte ratio (NLR) has been suggested as a reliable marker for predicting inflammation progression and severity of acute pancreatitis, although the role of the NLR stratified by etiology is still insufficiently studied. However, the NLR's role in mortality prediction was poorly evaluated in the literature. Patients and Methods We performed a retrospective, cross-sectional study to analyze the role of NLR0 (at admission) and NLR48 (at 48 hours) in acute pancreatitis as compared with CRP, BISAP, SOFA, and modified CTSI (mCTSI) for the prediction of mortality and severe acute pancreatitis (SAP) in patients admitted into the Emergency Clinical County Hospital of Craiova during 48 months. The primary assessed outcomes were the rate of in-hospital mortality, the rate of persistent organ failure, and ICU admissions. We analyzed mortality prediction for all acute pancreatitis, for biliary, alcoholic, and hypertriglyceridemic acute pancreatitis, for severe forms, and for patients admitted to the ICU. Results A total of 725 patients were selected; 42.4% had biliary acute pancreatitis, 27.7% had alcoholic acute pancreatitis, and 8.7% had hypertriglyceridemia-induced acute pancreatitis. A total of 13.6% had POF during admission. The AUC for NLR48 in predicting mortality risk and SAP was 0.81 and 0.785, superior to NLR0, CRP48, and mCTSI but inferior to BISAP and SOFA scores. The NLR48/NLR0 ratio did not add significantly to the accuracy. NLR0 and NLR48 performed poorly for mortality prediction in severe forms and in patients admitted to the ICU. NLR48 has good accuracy in our study for predicting death risk in biliary and alcoholic acute pancreatitis but not in hypertriglyceridemic acute pancreatitis. Conclusion NLR48 was a good indicator in predicting mortality risk and severe forms in all patients with acute pancreatitis, but not of death in SAP and in patients admitted to ICU, with good accuracy for predicting death risk in biliary and alcoholic acute pancreatitis but not in hypertriglyceridemic acute pancreatitis.
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Affiliation(s)
- Sergiu Marian Cazacu
- Gastroenterology Department, University of Medicine and Pharmacy Craiova, Clinical Emergency Hospital Craiova, Craiova, Romania
| | - Mircea Parscoveanu
- Surgery Department, University of Medicine and Pharmacy Craiova, Clinical Emergency Hospital Craiova, Craiova, Romania
| | - Dan Cartu
- Surgery Department, University of Medicine and Pharmacy Craiova, Clinical Emergency Hospital Craiova, Craiova, Romania
| | - Emil Moraru
- Surgery Department, University of Medicine and Pharmacy Craiova, Clinical Emergency Hospital Craiova, Craiova, Romania
| | - Ion Rogoveanu
- Gastroenterology Department, University of Medicine and Pharmacy Craiova, Clinical Emergency Hospital Craiova, Craiova, Romania
| | - Bogdan Silviu Ungureanu
- Gastroenterology Department, University of Medicine and Pharmacy Craiova, Clinical Emergency Hospital Craiova, Craiova, Romania
| | - Sevastita Iordache
- Gastroenterology Department, University of Medicine and Pharmacy Craiova, Clinical Emergency Hospital Craiova, Craiova, Romania
| | - Dan Nicolae Florescu
- Gastroenterology Department, University of Medicine and Pharmacy Craiova, Clinical Emergency Hospital Craiova, Craiova, Romania
| | - Vlad Florin Iovanescu
- Gastroenterology Department, University of Medicine and Pharmacy Craiova, Clinical Emergency Hospital Craiova, Craiova, Romania
| | - Manuela Iuliana Dragomir
- Public Health Management Department, University of Medicine and Pharmacy Craiova, Craiova, Romania
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Ungureanu BS, Gheonea DI, Florescu DN, Iordache S, Cazacu SM, Iovanescu VF, Rogoveanu I, Turcu-Stiolica A. Predicting mortality in patients with nonvariceal upper gastrointestinal bleeding using machine-learning. Front Med (Lausanne) 2023; 10:1134835. [PMID: 36873879 PMCID: PMC9982090 DOI: 10.3389/fmed.2023.1134835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 02/06/2023] [Indexed: 02/19/2023] Open
Abstract
Background Non-endoscopic risk scores, Glasgow Blatchford (GBS) and admission Rockall (Rock), are limited by poor specificity. The aim of this study was to develop an Artificial Neural Network (ANN) for the non-endoscopic triage of nonvariceal upper gastrointestinal bleeding (NVUGIB), with mortality as a primary outcome. Methods Four machine learning algorithms, namely, Linear Discriminant Analysis (LDA), Quadratic Discriminant Analysis (QDA), logistic regression (LR), K-Nearest Neighbor (K-NN), were performed with GBS, Rock, Beylor Bleeding score (BBS), AIM65, and T-score. Results A total of 1,096 NVUGIB hospitalized in the Gastroenterology Department of the County Clinical Emergency Hospital of Craiova, Romania, randomly divided into training and testing groups, were included retrospectively in our study. The machine learning models were more accurate at identifying patients who met the endpoint of mortality than any of the existing risk scores. AIM65 was the most important score in the detection of whether a NVUGIB would die or not, whereas BBS had no influence on this. Also, the greater AIM65 and GBS, and the lower Rock and T-score, the higher mortality will be. Conclusion The best accuracy was obtained by the hyperparameter-tuned K-NN classifier (98%), giving the highest precision and recall on the training and testing datasets among all developed models, showing that machine learning can accurately predict mortality in patients with NVUGIB.
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Affiliation(s)
- Bogdan Silviu Ungureanu
- Department of Gastroenterology, University of Medicine and Pharmacy of Craiova, Craiova, Romania
| | - Dan Ionut Gheonea
- Department of Gastroenterology, University of Medicine and Pharmacy of Craiova, Craiova, Romania
| | - Dan Nicolae Florescu
- Department of Gastroenterology, University of Medicine and Pharmacy of Craiova, Craiova, Romania
| | - Sevastita Iordache
- Department of Gastroenterology, University of Medicine and Pharmacy of Craiova, Craiova, Romania
| | - Sergiu Marian Cazacu
- Department of Gastroenterology, University of Medicine and Pharmacy of Craiova, Craiova, Romania
| | - Vlad Florin Iovanescu
- Department of Gastroenterology, University of Medicine and Pharmacy of Craiova, Craiova, Romania
| | - Ion Rogoveanu
- Department of Gastroenterology, University of Medicine and Pharmacy of Craiova, Craiova, Romania
| | - Adina Turcu-Stiolica
- Department of Pharmacoeconomics, University of Medicine and Pharmacy of Craiova, Craiova, Romania
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Popa P, Iordache S, Florescu DN, Iovanescu VF, Vieru A, Barbu V, Bezna MC, Alexandru DO, Ungureanu BS, Cazacu SM. Mortality Rate in Upper Gastrointestinal Bleeding Associated with Anti-Thrombotic Therapy Before and During Covid-19 Pandemic. J Multidiscip Healthc 2022; 15:2679-2692. [PMID: 36425876 PMCID: PMC9680964 DOI: 10.2147/jmdh.s380500] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 11/09/2022] [Indexed: 08/27/2023] Open
Abstract
INTRODUCTION During the last few years, a progressive higher proportion of patients have had upper gastrointestinal bleeding (UGIB) related to antithrombotic therapy. The introduction of direct oral anticoagulant (DOAC) and COVID-19 pandemic may change the incidence, mortality, and follow-up, especially in patients at high risk of bleeding. PATIENTS AND METHODS We studied the use of anti-thrombotic therapy (AT) in patients with upper gastrointestinal bleeding for 5 years (January 2017-December 2021) including Covid-19 pandemic period (March 2020-December 2021). We analyzed mortality rate, rebleeding rate and need for transfusion in patients with AT therapy compared with those without AT therapy and risk factors for mortality, and also the incidence of gastrointestinal bleeding in patients admitted for COVID-19 infection. RESULTS A total of 824 patients were admitted during Covid-19 pandemic period and 1631 before pandemic period; a total of 426 cases of bleeding were recorded in patients taking antithrombotic therapy and the frequency of antithrombotic therapy in patients with UGIB was higher in pandemic period (24.39% versus 13.8%). Unadjusted mortality was 12.21%, similar with patients with no antithrombotic treatment but age-adjusted mortality was 9.62% (28% lower). The rate of endoscopy was similar but fewer therapeutic procedures were required. Mean Hb level was 10% lower, and more than 60% of patients required blood transfusion. CONCLUSION Mortality was similar compared with patients with no antithrombotic therapy, fewer therapeutic endoscopies were performed and similar rebleeding rate and emergency surgery were noted. Hb level was 10% lower and a higher proportion of patients required blood transfusions. Mortality was higher in DOAC treatment group compared with VKA patients but with no statistical significance. The rate of upper gastrointestinal bleeding in Covid-19 positive hospitalized cases was 0.58%. The mortality risk in multivariate analysis was associated with GB score, with no endoscopy performed, with obscure and variceal bleeding and with LMWH versus VKA therapy.
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Affiliation(s)
- Petrica Popa
- Gastroenterology Department, University of Medicine and Pharmacy Craiova, Craiova, Dolj County, Romania
| | - Sevastita Iordache
- Gastroenterology Department, University of Medicine and Pharmacy Craiova, Craiova, Dolj County, Romania
| | - Dan Nicolae Florescu
- Gastroenterology Department, University of Medicine and Pharmacy Craiova, Craiova, Dolj County, Romania
| | - Vlad Florin Iovanescu
- Gastroenterology Department, University of Medicine and Pharmacy Craiova, Craiova, Dolj County, Romania
| | - Alexandru Vieru
- Gastroenterology Department, Clinical Emergency County Hospital Craiova, Craiova, Dolj County, Romania
| | - Valentin Barbu
- Gastroenterology Department, Clinical Emergency County Hospital Craiova, Craiova, Dolj County, Romania
| | - Maria-Cristina Bezna
- Cardiology Department, Clinical Emergency County Hospital Craiova, Craiova, Romania
| | - Dragos Ovidiu Alexandru
- Department of Medical Informatics and Statistics, University of Medicine and Pharmacy Craiova, Craiova, Dolj County, Romania
| | - Bogdan Silviu Ungureanu
- Gastroenterology Department, University of Medicine and Pharmacy Craiova, Craiova, Dolj County, Romania
| | - Sergiu Marian Cazacu
- Gastroenterology Department, University of Medicine and Pharmacy Craiova, Craiova, Dolj County, Romania
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Iovanescu VF, Streba CT, Ionescu M, Constantinescu AF, Vere CC, Rogoveanu I, Moța E. Diabetes mellitus and renal involvement in chronic viral liver disease. J Med Life 2015; 8:483-7. [PMID: 26664475 PMCID: PMC4656957 DOI: pmid/26664475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
HYPOTHESIS Chronic viral liver disease is often associated with other conditions. Diabetes mellitus (DM) is frequently reported in this context and may play a role in the progression of the liver disease to hepatocellular carcinoma (HCC). Renal disease is also an important extrahepatic manifestation of hepatitis viral infection and its presence is associated with poor prognosis and management issues. OBJECTIVES Our study had multiple purposes: to determine the frequency of the association between chronic viral liver disease and diabetes mellitus, evaluate the potential of diabetes mellitus as a risk factor for HCC and assess an eventual renal involvement. METHODS AND RESULTS We included in our study a number of 246 patients with chronic liver disease, from whom 136 were diagnosed with chronic viral hepatitis and 110 with viral liver cirrhosis. These patients were assessed by using a clinical examination and a series of tests, including serum transaminase levels, serum bilirubin, serum albumin, markers of cholestasis, fasting plasma glucose levels, serum creatinine, urea, albuminuria, Addis-Hamburger test, electrophoresis of urinary proteins, abdominal ultrasound and, in some cases, CT examination. We obtained the following results: diabetes mellitus is often associated with chronic liver disease of viral etiology, having been identified in 18.29% of the patients in our study. Age above 60 in patients with chronic hepatitis (p=0.013<0.05) and presence of hepatitis C virus were particularly correlated with the presence of diabetes mellitus. Renal disease was present in 13.4% of the patients with chronic liver disease and it was especially associated with liver cirrhosis and hepatitis C virus. The most common form of renal injury was glomerulonephritis. Acute kidney injury was diagnosed only in cirrhotic patients as hepatorenal syndrome, occurring in 7.27% of the subjects, while chronic kidney disease was identified only in two cases of chronic viral hepatitis. Four patients in our study were diagnosed with HCC and none of them presented diabetes mellitus. DISCUSSION Our study revealed that there is a significant association between diabetes mellitus and chronic viral liver disease induced by hepatitis C virus. Glomerulonephritis was the most common type of renal disease in both hepatitis patients and in those with cirrhosis. Glomerular injury was strongly correlated with the presence of hepatitis C virus than with hepatitis B virus. A connection between diabetes mellitus and hepatocellular carcinoma could not be established.
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Affiliation(s)
- V F Iovanescu
- University of Medicine and Pharmacy of Craiova, Craiova, Romania
| | - C T Streba
- Gastroenterology Department, University of Medicine and Pharmacy of Craiova, Craiova, Romania
| | - M Ionescu
- Department of Medical Informatics and Biostatistics, University of Medicine and Pharmacy of Craiova, Craiova, Romania
| | | | - C C Vere
- Gastroenterology Department, University of Medicine and Pharmacy of Craiova, Craiova, Romania
| | - I Rogoveanu
- Gastroenterology Department, University of Medicine and Pharmacy of Craiova, Craiova, Romania
| | - E Moța
- Department of Nephrology, University of Medicine and Pharmacy of Craiova, Craiova, Romania
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Constantinescu AF, Ionescu M, Rogoveanu I, Ciurea ME, Streba CT, Iovanescu VF, Vere CC. Wireless Capsule Endoscopy in Correlation with Software Application in Gastrointestinal Diseases. Curr Health Sci J 2015; 41:89-94. [PMID: 30364860 PMCID: PMC6201197 DOI: 10.12865/chsj.41.02.01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/10/2015] [Accepted: 03/01/2015] [Indexed: 11/25/2022]
Abstract
Wireless capsule endoscopy is one of the most recent investigation techniques of gastrointestinal pathology. Unlike conventional upper and lower endoscopy, it has the advantages of being a noninvasive and painless procedure. One of the capsule endoscopy disadvantages is represented by the necessary time to analyze the video frames obtained. Software applications proposed in this purpose could offer support in the images evaluation. Different algorithms have been described in the literature, but further research is needed to establish the practical value of computer vision tools in gastroenterology.
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Affiliation(s)
| | - M Ionescu
- Medical Informatics Department, University of Medicine and Pharmacy of Craiova, Romania
| | - I Rogoveanu
- Gastroenterology Department, University of Medicine and Pharmacy of Craiova, Romania
| | - M E Ciurea
- Plastic Surgery Department, University of Medicine and Pharmacy of Craiova, Romania
| | - C T Streba
- Gastroenterology Department, University of Medicine and Pharmacy of Craiova, Romania
| | - V F Iovanescu
- Gastroenterology Department, University of Medicine and Pharmacy of Craiova, Romania
| | - C C Vere
- Gastroenterology Department, University of Medicine and Pharmacy of Craiova, Romania
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