{"title":"因非静脉曲张性上消化道出血入院的心力衰竭和慢性肾病患者的临床疗效和死亡率","authors":"Mohamad Hijazi MD, Mhd Kutaiba Albuni MD, Bassel Bitar MD, Godbless Ajenaghughrure MD, Amin Eshghabadi MD, Kamal Shemisa MD, Fayaz Khan MD, M Kenan Rahima MD","doi":"10.1016/j.jacl.2024.04.050","DOIUrl":null,"url":null,"abstract":"<div><h3>Background/Synopsis</h3><p>Chronic kidney disease (CKD) is a major risk factor for cardiovascular disease. Non-variceal upper gastrointestinal bleeding (NVUGIB) can be associated with various medical conditions, including heart failure (HF) and CKD. CKD and HF has been shown to further increase cardiovascular risks.</p></div><div><h3>Objective/Purpose</h3><p>Nevertheless, there is limited scientific evidence of clinical outcomes of NVUGIB in patients with CKD & HF. Hence, we sought to investigate this population.</p></div><div><h3>Methods</h3><p>We queried National Inpatient Sample between 2017-2020 for adult patients who were hospitalized with NVUGIB and had CKD & HF. The primary outcome was inpatient mortality. The secondary outcomes were cardiogenic shock, cardiac arrest, acute kidney injury (AKI), intubation, length of stay (LOS) and total hospital charge. Multivariable logistic regression analysis was used to estimate clinical outcomes. P-value < 0.05 was significant.</p></div><div><h3>Results</h3><p>There were 3,349,779 hospitalizations with NVUGIB and 459,980 (13.7%) had CKD & HF. HF & CKD and non-HF & CKD cohorts were with mean age of 74 vs. 66 yrs; males 46.9% vs 53.1%; Caucasians 63.5% vs 66.6%; HTN 8% vs 39%; dyslipidemia 53.3% vs 37.2%; PE 3.9% vs 4.9%; DM 56% vs 30.4%; AF 24.4% vs 23.5%; obesity 19.5% vs 13.3%; AF 50.2% vs 21.1%; history of stroke 2.0% both, COPD 33.5% vs 18.4%; alcohol use 3% vs 13.8%, respectively. HF & CKD cohort had significantly higher mortality and worse clinical outcomes (Table 1).</p></div><div><h3>Conclusions</h3><p>HF & CKD cohort demonstrated significantly higher mortality, worse clinical outcomes and resource utilization. Patients were older, obese, female, fewer Caucasians, with more frequent dyslipidemia, DM, AF and COPD. HF & CKD is associated with greater risk for cardiovascular events, renal failure, GIB, and ICU care. HF & CKD is an important predictor of adverse outcomes in NVUGIB population. Further research is necessary to describe long-term outcomes.</p></div>","PeriodicalId":15392,"journal":{"name":"Journal of clinical lipidology","volume":"18 4","pages":"Page e520"},"PeriodicalIF":3.6000,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Clinical Outcomes And Mortality in Heart Failure And Chronic Kidney Disease Patients Admitted With Non-Variceal Upper Gastrointestinal Bleeding\",\"authors\":\"Mohamad Hijazi MD, Mhd Kutaiba Albuni MD, Bassel Bitar MD, Godbless Ajenaghughrure MD, Amin Eshghabadi MD, Kamal Shemisa MD, Fayaz Khan MD, M Kenan Rahima MD\",\"doi\":\"10.1016/j.jacl.2024.04.050\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Background/Synopsis</h3><p>Chronic kidney disease (CKD) is a major risk factor for cardiovascular disease. Non-variceal upper gastrointestinal bleeding (NVUGIB) can be associated with various medical conditions, including heart failure (HF) and CKD. CKD and HF has been shown to further increase cardiovascular risks.</p></div><div><h3>Objective/Purpose</h3><p>Nevertheless, there is limited scientific evidence of clinical outcomes of NVUGIB in patients with CKD & HF. Hence, we sought to investigate this population.</p></div><div><h3>Methods</h3><p>We queried National Inpatient Sample between 2017-2020 for adult patients who were hospitalized with NVUGIB and had CKD & HF. The primary outcome was inpatient mortality. The secondary outcomes were cardiogenic shock, cardiac arrest, acute kidney injury (AKI), intubation, length of stay (LOS) and total hospital charge. Multivariable logistic regression analysis was used to estimate clinical outcomes. P-value < 0.05 was significant.</p></div><div><h3>Results</h3><p>There were 3,349,779 hospitalizations with NVUGIB and 459,980 (13.7%) had CKD & HF. HF & CKD and non-HF & CKD cohorts were with mean age of 74 vs. 66 yrs; males 46.9% vs 53.1%; Caucasians 63.5% vs 66.6%; HTN 8% vs 39%; dyslipidemia 53.3% vs 37.2%; PE 3.9% vs 4.9%; DM 56% vs 30.4%; AF 24.4% vs 23.5%; obesity 19.5% vs 13.3%; AF 50.2% vs 21.1%; history of stroke 2.0% both, COPD 33.5% vs 18.4%; alcohol use 3% vs 13.8%, respectively. HF & CKD cohort had significantly higher mortality and worse clinical outcomes (Table 1).</p></div><div><h3>Conclusions</h3><p>HF & CKD cohort demonstrated significantly higher mortality, worse clinical outcomes and resource utilization. Patients were older, obese, female, fewer Caucasians, with more frequent dyslipidemia, DM, AF and COPD. HF & CKD is associated with greater risk for cardiovascular events, renal failure, GIB, and ICU care. HF & CKD is an important predictor of adverse outcomes in NVUGIB population. Further research is necessary to describe long-term outcomes.</p></div>\",\"PeriodicalId\":15392,\"journal\":{\"name\":\"Journal of clinical lipidology\",\"volume\":\"18 4\",\"pages\":\"Page e520\"},\"PeriodicalIF\":3.6000,\"publicationDate\":\"2024-07-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of clinical lipidology\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S1933287424000977\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"PHARMACOLOGY & PHARMACY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of clinical lipidology","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S1933287424000977","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"PHARMACOLOGY & PHARMACY","Score":null,"Total":0}
引用次数: 0
摘要
背景/简介慢性肾脏病（CKD）是心血管疾病的主要风险因素。非静脉曲张性上消化道出血（NVUGIB）可能与多种疾病相关，包括心力衰竭（HF）和慢性肾脏病。尽管如此，有关慢性肾功能衰竭（CKD）和心力衰竭（HF）患者非静脉性上消化道出血（NVUGIB）临床结果的科学证据却很有限。因此，我们试图对这一人群进行调查。方法我们查询了 2017-2020 年间全国住院患者样本，以了解因 NVUGIB 住院且患有 CKD & HF 的成年患者的情况。主要结果是住院死亡率。次要结果为心源性休克、心脏骤停、急性肾损伤（AKI）、插管、住院时间（LOS）和住院总费用。多变量逻辑回归分析用于估计临床结果。结果NVUGIB住院人数为3,349,779人，其中459,980人（13.7%）患有CKD & HF。HF & CKD 和非 HF & CKD 组群的平均年龄为 74 岁 vs. 66 岁；男性 46.9% vs. 53.1%；白种人 63.5% vs. 66.6%；高血压 8% vs. 39%；血脂异常 53.3% vs. 37.2%；PE 3.9% vs 4.9%；DM 56% vs 30.4%；房颤 24.4% vs 23.5%；肥胖 19.5% vs 13.3%；房颤 50.2% vs 21.1%；中风史 2.0%，COPD 33.5% vs 18.4%；饮酒 3% vs 13.8%。HF&CKD队列的死亡率明显更高，临床预后更差（表1）。患者年龄较大、肥胖、女性、白种人较少，血脂异常、糖尿病、房颤和慢性阻塞性肺病患者较多。心房颤动及合并症、慢性肾脏病与心血管事件、肾功能衰竭、GIB 和重症监护室护理的更高风险相关。心房颤动和慢性肾功能衰竭是预测 NVUGIB 患者不良预后的重要因素。有必要开展进一步研究，以描述长期结果。
Clinical Outcomes And Mortality in Heart Failure And Chronic Kidney Disease Patients Admitted With Non-Variceal Upper Gastrointestinal Bleeding
Background/Synopsis
Chronic kidney disease (CKD) is a major risk factor for cardiovascular disease. Non-variceal upper gastrointestinal bleeding (NVUGIB) can be associated with various medical conditions, including heart failure (HF) and CKD. CKD and HF has been shown to further increase cardiovascular risks.
Objective/Purpose
Nevertheless, there is limited scientific evidence of clinical outcomes of NVUGIB in patients with CKD & HF. Hence, we sought to investigate this population.
Methods
We queried National Inpatient Sample between 2017-2020 for adult patients who were hospitalized with NVUGIB and had CKD & HF. The primary outcome was inpatient mortality. The secondary outcomes were cardiogenic shock, cardiac arrest, acute kidney injury (AKI), intubation, length of stay (LOS) and total hospital charge. Multivariable logistic regression analysis was used to estimate clinical outcomes. P-value < 0.05 was significant.
Results
There were 3,349,779 hospitalizations with NVUGIB and 459,980 (13.7%) had CKD & HF. HF & CKD and non-HF & CKD cohorts were with mean age of 74 vs. 66 yrs; males 46.9% vs 53.1%; Caucasians 63.5% vs 66.6%; HTN 8% vs 39%; dyslipidemia 53.3% vs 37.2%; PE 3.9% vs 4.9%; DM 56% vs 30.4%; AF 24.4% vs 23.5%; obesity 19.5% vs 13.3%; AF 50.2% vs 21.1%; history of stroke 2.0% both, COPD 33.5% vs 18.4%; alcohol use 3% vs 13.8%, respectively. HF & CKD cohort had significantly higher mortality and worse clinical outcomes (Table 1).
Conclusions
HF & CKD cohort demonstrated significantly higher mortality, worse clinical outcomes and resource utilization. Patients were older, obese, female, fewer Caucasians, with more frequent dyslipidemia, DM, AF and COPD. HF & CKD is associated with greater risk for cardiovascular events, renal failure, GIB, and ICU care. HF & CKD is an important predictor of adverse outcomes in NVUGIB population. Further research is necessary to describe long-term outcomes.
期刊介绍：
Because the scope of clinical lipidology is broad, the topics addressed by the Journal are equally diverse. Typical articles explore lipidology as it is practiced in the treatment setting, recent developments in pharmacological research, reports of treatment and trials, case studies, the impact of lifestyle modification, and similar academic material of interest to the practitioner. While preference is given to material of immediate practical concern, the science that underpins lipidology is forwarded by expert contributors so that evidence-based approaches to reducing cardiovascular and coronary heart disease can be made immediately available to our readers. Sections of the Journal will address pioneering studies and the clinicians who conduct them, case studies, ethical standards and conduct, professional guidance such as ATP and NCEP, editorial commentary, letters from readers, National Lipid Association (NLA) news and upcoming event information, as well as abstracts from the NLA annual scientific sessions and the scientific forums held by its chapters, when appropriate.
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