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龙艺, 肖雪, 严海琳, 等. 缺血性心脏病合并消化道出血患者的住院死亡危险因素分析[J]. 四川大学学报(医学版), 2021, 52(6): 1034-1040. DOI: 10.12182/20211160108
引用本文: 龙艺, 肖雪, 严海琳, 等. 缺血性心脏病合并消化道出血患者的住院死亡危险因素分析[J]. 四川大学学报(医学版), 2021, 52(6): 1034-1040. DOI: 10.12182/20211160108
LONG Yi, XIAO Xue, YAN Hai-lin, et al. Mortality Risk Factors for Inpatients with Ischemic Heart Disease Complicated with Gastrointestinal Bleeding[J]. Journal of Sichuan University (Medical Sciences), 2021, 52(6): 1034-1040. DOI: 10.12182/20211160108
Citation: LONG Yi, XIAO Xue, YAN Hai-lin, et al. Mortality Risk Factors for Inpatients with Ischemic Heart Disease Complicated with Gastrointestinal Bleeding[J]. Journal of Sichuan University (Medical Sciences), 2021, 52(6): 1034-1040. DOI: 10.12182/20211160108

缺血性心脏病合并消化道出血患者的住院死亡危险因素分析

Mortality Risk Factors for Inpatients with Ischemic Heart Disease Complicated with Gastrointestinal Bleeding

  • 摘要:
      目的   探讨缺血性心脏病(ischemic heart disease, IHD)合并消化道出血(gastrointestinal bleeding, GIB)患者发生住院死亡的危险因素。
      方法   纳入2015年1月−2018年1月在四川大学华西医院住院治疗的IHD合并GIB的患者,收集其一般资料、基础疾病史、既往抗凝抗血小板药物史、入院时实验室检查及住院治疗措施等资料。以住院期间死亡作为研究终点事件,通过多因素二元logistic回归等统计方法分析该类患者住院期间死亡的独立危险因素,绘制受试者操作特征(receiver operating characteristic, ROC)曲线并计算曲线下面积(area under curve, AUC)。
      结果   本研究共纳入符合标准的患者395例,其中342例患者好转出院,53例患者发生住院死亡事件,死因分析中心源性死亡居首位(54.7%),其次是感染性死亡(24.5%)。logistic回归分析结果显示ST段抬高型心梗(ST-segment elevated myocardial infarction, STEMI)患者的死亡风险是非急性冠脉综合征患者的2.527倍〔比值比(odds ratio, OR)=2.527,95%置信区间(confidence interval, CI):1.152~8.277,P=0.043〕,而合并慢性肾脏疾病患者的死亡风险是无肾脏疾病患者的2.89倍(OR=2.89,95%CI:1.187~7.037,P=0.019)。入院时较高的白细胞水平(OR=1.123,95%CI:1.057~1.193,P<0.001)和较低的血红蛋白水平(OR=1.014,95%CI:1.003~1.025,P=0.013)与患者住院死亡相关,而住院期间行内镜诊治(OR=0.305,95%CI:0.103~0.881,P=0.029)可降低患者的死亡风险。联合上述指标的ROC曲线,其预测患者发生住院死亡的AUC为0.79。
      结论   IHD类型为STEMI、合并慢性肾脏疾病、入院时白细胞高和血红蛋白水平低,是IHD合并GIB的患者住院死亡结局的独立危险因素,而住院期间行内镜诊治是其保护因素。

     

    Abstract:
      Objective   To investigate the risk factors of in-hospital mortality in patients with combined ischemic heart disease (IHD) and gastrointestinal bleeding (GIB).
      Methods   Patients who were hospitalized and received treatment for IHD combined with GIB at West China Hospital, Sichuan University between Jan. 2015 and Jan. 2018 were included in the study. Information concerning their baseline data, comorbidities, history of anticoagulant and antiplatelet medication, laboratory data on admission, and in-hospital treatments was collected. In-hospital death of all causes was taken as the primary endpoint event of the study, and multivariate logistic regression analysis was conducted to identify the independent risk factors of mortality during their hospital stay for this specific type of patients. Then, receiver operating characteristic (ROC) curve was drawn and the area under curve (AUC) was calculated accordingly.
      Results   A total of 395 patients met the enrollment criteria and were included in the study. Among them, 342 patients were discharged after their condition improved, and 53 patients died during hospitalization. Analysis of the cause of death revealed that cardiogenic death was the leading cause of death (54.7%), which was followed by infection-caused death (24.5%). Logistic regression analysis revealed that patients with ST-segment elevation myocardial infarction (STEMI) had a 2.527-fold risk of mortality compared with patients with non-acute coronary syndrome (odds ratio OR=2.527, 95% confidence interval CI: 1.152-8.277, P=0.043), and patients with comorbidity of chronic renal disease (CKD) had a 2.89-fold risk of mortality (OR=2.89, 95%CI:1.187-7.037, P=0.019). It was also shown the higher level of WBC count (OR=1.123, 95%CI: 1.057-1.193, P<0.001) and lower hemoglobin (OR=1.014, 95%CI: 1.003-1.025, P=0.013) on admission were related to in-hospital mortality. On the other hand, endoscopy (OR=0.305, 95%CI: 0.103-0.881, P=0.029) was identified as a protective factor in hospital treatment that decreased the risk of in-hospital mortality. ROC curve was drawn by combining the aforementioned variables to predict in-hospital mortality, which had an AUC of 0.79.
      Conclusion   The actual type of IHD being STEMI, the patient’s condition being complicated with chronic kidney disease, and having high white blood cells and low hemoglobin levels upon admission were considered independent risk factors for in-hospital death outcome of IHD patients complicated with GIB, while undergoing endoscopy during hospitalization was considered as a protective factor.

     

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