Introduction
Gastrointestinal bleeding (GIB) and Ischemic heart disease (IHD) both remain the important causes of morbidity and mortality. Patients with IHD are more likely to suffer from GIB due to the characteristics of the population, heart disease, stress state and long-term use of antithrombotic drugs[1-3]. Previous studies have found that patients with simultaneous GIB and IHD have higher mortality than that of each individual disease[4-5]. Treatment for those patients is a challenge for both the cardiologists and gastroenterologists. In order to assess the frequency of in-hospital mortality in patients with GIB and IHD, and determine the potential risk factors for this condition, we designed and conducted this single center study.
Aims & Methods
Our study assessed the hospitalized outcomes of patients with simultaneous GIB and IHD. Moreover, we explored the risk factors of in-hospital mortality in those patients.We performed a retrospective study in West China hospital between January 2014 and December 2018. Patients diagnosed with GIB and IHD were included. The primary outcome was in-hospital mortality for all causes. Clinical and laboratory data were collected and analyzed for clinical characteristics and potential risk factors of in-hospital mortality.
Results
574 GIB patients with IHD were enrolled in the current study, and among them 107 in-hospital deaths were observed (in-hospital mortality rate of 18.64%). The causes of death included cardiovascular death (46, 42.99%), hemorrhagic shock (10, 9.35%), severe infection (33, 30.84%), and other causes (18, 16.82%). Patients who died were older than survivors [78（68, 82） vs. 74（65, 80），P = 0.008], with a higher incidence of COPD (27.10% vs. 13.70%, P=0.001) and chronic renal failure (47.66% vs. 27.19%, P<0.001). Patients with a higher heart rate at admission (90 vs. 81, P=0.006), or with a course of CHD less than 3 months (53.27% vs. 32.76%, P<0.001) were more likely to die. More patients in death group received plasma infusion (24.30% vs. 7.92%, P<0.001), and present with acute coronary syndrome (53.27% vs. 38.97%, P=0.007). Compared with survivors, patients who died showed increased peak white blood cell (WBC) count [18.75(14.35, 24.9) vs. 9.79 (7.19, 13.82) ×109/L,P < 0.001], increased peak INR [1.51 (1.21, 2.58) vs. 1.13 (1.05, 1.31),P < 0.001)], and lower minimum platelet counts [94 (52, 147) vs. 128 (83, 180)×109/L, p<0.001]. In multivariable logistic analysis, age [OR (95% CI) =1.032 (1.006-1.058), P=0.014], peak WBC count [OR (95% CI) =1.123 (1.085-1.163), P<0.001], peak INR levels [OR (95%CI) =1.220(1.061-1.402), P=0.005], and heart rate at admission [OR (95%CI) =1.015(1.002-1.028), P=0.026] were independent predictors of in-hospital mortality.
Conclusion
Patients with simultaneous GIB and IHD had a high in-hospital mortality. Age, peak WBC count, peak INR levels, and heart rate at admission were independent risk factors for in-hospital death.
References
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