Risk of Gastrointestinal Bleeding in Patients with End-Stage Renal Disease: The Link between Gut, Heart, and Kidneys.

IF 2 4区 医学 Q3 GASTROENTEROLOGY & HEPATOLOGY
Avleen Kaur, Syed M Baqir, Kundan Jana, Kalyana C Janga
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引用次数: 0

Abstract

Patients with end-stage renal disease (ESRD) have a five times higher risk of gastrointestinal bleed (GIB) and mortality than the general population. Aortic stenosis (AS) has been associated with GIB from intestinal angiodysplasia. In this retrospective analysis, we obtained data from the 2012 and 2019 National Inpatient Sample. The primary outcome of interest was all-cause in-hospital mortality and risk factors of mortality in patients with ESRD with GIB with aortic valve disorders especially AS. We identified all patients (≥18 years of age) with ESRD (n = 1,707,452) and analyzed based on discharge diagnosis of valvular heart disease (n = 6521) in patients with GIB compared with those without GIB (n = 116,560). Survey statistical methods accounting for strata and weighted data were used for analysis using survey packages in R (version 4.0). Baseline categorical data were compared using Rao-Scott chi square test, and continuous data were compared using Student's t-test. Covariates were assessed using univariate regression analysis, and factors with p value less than 0.1 in the univariate analysis were entered in the final model. The univariate and multivariable associations of presumed risk factors of mortality in ESRD with GIB patients were performed by Cox proportional hazards model censored at length of stay. Propensity score matching was done using MatchIt package in R (version 4.3.0). 1 : 1 nearest neighbour matching was done with propensity scores estimated through logistic regression, in which occurrence of GIB, valvular lesions, and AS was regressed according to other patient characteristics. Among patients with ESRD with valvular heart diseases, AS was found to be associated with increased risk of GIB (adj.OR = 1.005; 95% CI 1.003-1.008; p < 0.01). ESRD patients with AS showed increased risk of lower GIB (OR = 1.04; 95% CI 1.01-1.06; p = 0.02), colonic angiodysplasia (OR = 1.03; 95% CI 1.01-1.05; p < 0.01), stomach and duodenal angiodysplasia (OR = 1.03; 95% CI 1.02-1.06; p < 0.01), need for blood transfusion add pressors as compared to those without AS. However, there was no increased risk of mortality (OR = 0.97; 95% CI 0.95-0.99; p < 0.01).

Abstract Image

Abstract Image

终末期肾病患者消化道出血的风险:肠道、心脏和肾脏之间的联系
终末期肾病(ESRD)患者发生胃肠道出血(GIB)和死亡率的风险是一般人群的5倍。主动脉瓣狭窄(AS)与肠血管发育不良引起的GIB有关。在这项回顾性分析中,我们获得了2012年和2019年全国住院患者样本的数据。研究的主要结局是ESRD合并GIB合并主动脉瓣病变(尤其是AS)患者的全因住院死亡率和死亡率危险因素。我们确定了所有ESRD患者(≥18岁)(n = 1,707,452),并根据GIB患者的瓣膜病出院诊断(n = 6521)与非GIB患者(n = 116,560)进行分析。使用R(4.0版)中的调查软件包,采用考虑地层和加权数据的调查统计方法进行分析。基线分类资料比较采用Rao-Scott卡方检验,连续资料比较采用Student’st检验。采用单因素回归分析评估协变量,将单因素分析中p值小于0.1的因子输入最终模型。采用Cox比例风险模型对ESRD与GIB患者推定的死亡率风险因素进行单因素和多变量关联,并对住院时间进行审查。倾向评分匹配使用R(4.3.0版本)中的MatchIt包完成。1:1最近邻匹配,通过逻辑回归估计倾向得分,其中GIB、瓣膜病变和AS的发生根据患者的其他特征进行回归。在ESRD合并瓣膜性心脏病的患者中,AS与GIB风险增加相关(or = 1.005;95% ci 1.003-1.008;P < 0.01)。ESRD合并AS患者低GIB风险增加(OR = 1.04;95% ci 1.01-1.06;p = 0.02),结肠血管发育不良(OR = 1.03;95% ci 1.01-1.05;p < 0.01),胃和十二指肠血管发育不良(OR = 1.03;95% ci 1.02-1.06;p < 0.01),与无as组相比,输血需药量增加。然而,死亡风险没有增加(OR = 0.97;95% ci 0.95-0.99;P < 0.01)。
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来源期刊
Gastroenterology Research and Practice
Gastroenterology Research and Practice GASTROENTEROLOGY & HEPATOLOGY-
CiteScore
4.40
自引率
0.00%
发文量
91
审稿时长
1 months
期刊介绍: Gastroenterology Research and Practice is a peer-reviewed, Open Access journal which publishes original research articles, review articles and clinical studies based on all areas of gastroenterology, hepatology, pancreas and biliary, and related cancers. The journal welcomes submissions on the physiology, pathophysiology, etiology, diagnosis and therapy of gastrointestinal diseases. The aim of the journal is to provide cutting edge research related to the field of gastroenterology, as well as digestive diseases and disorders. Topics of interest include: Management of pancreatic diseases Third space endoscopy Endoscopic resection Therapeutic endoscopy Therapeutic endosonography.
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