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Occurrence and Impact of Gastrointestinal Bleeding and Major Adverse Cardiovascular Events during Sepsis: A 15-Year Observational Study

OBJECTIVE: Sepsis patients are at risk of gastrointestinal bleeding (GIB) and major adverse cardiovascular events (MACEs), but few data are available on the occurrence of GIB and MACEs and their impact on sepsis outcomes. METHODS: The medical claims records of 220,082 patients admitted for sepsis be...

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Autores principales: Hsieh, Ming-Shun, Liao, Shu-Hui, Chia-Rong Hsieh, Vivian, How, Chorng-Kuang
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Hindawi 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7537703/
https://www.ncbi.nlm.nih.gov/pubmed/33062335
http://dx.doi.org/10.1155/2020/9685604
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author Hsieh, Ming-Shun
Liao, Shu-Hui
Chia-Rong Hsieh, Vivian
How, Chorng-Kuang
author_facet Hsieh, Ming-Shun
Liao, Shu-Hui
Chia-Rong Hsieh, Vivian
How, Chorng-Kuang
author_sort Hsieh, Ming-Shun
collection PubMed
description OBJECTIVE: Sepsis patients are at risk of gastrointestinal bleeding (GIB) and major adverse cardiovascular events (MACEs), but few data are available on the occurrence of GIB and MACEs and their impact on sepsis outcomes. METHODS: The medical claims records of 220,082 patients admitted for sepsis between 1999 and 2013 were retrieved from the nationwide database. The adjusted odds ratios (aORs) of composite outcomes including the hospital mortality, intensive care unit (ICU) admission, and mechanical ventilation (MV) in patients with a MACE or GIB were estimated by multivariate logistic regression and joint effect analyses. RESULTS: The enrollees were 70.15 ± 15.17 years of age with a hospital mortality rate of 38.91%. GIB developed in 3.80% of the patients; MACEs included ischemic stroke in 1.54%, intracranial hemorrhage (ICH) in 0.92%, and acute myocardial infarction (AMI) in 1.59%. Both ICH and AMI significantly increased the risk of (1) ICU admission (aOR = 8.02, 95% confidence interval (CI): 6.84–9.42 for ICH and aOR = 4.78, 95% CI: 4.21–5.42 for AMI, respectively), (2) receiving MV (aOR = 3.92, 95% CI: 3.52–4.40 and aOR = 1.99, 95% CI: 1.84–2.16, respectively), and (3) the hospital mortality (aOR = 1.08, 95% CI: 0.98–1.19 and aOR = 1.11, 95% CI: 1.03–1.19, respectively). However, sepsis with GIB or ischemic stroke increased only the risk of ICU admission and MV but not the hospital mortality (aOR = 0.98, 95% CI: 0.93–1.03 for GIB and aOR = 0.84, 95% CI: 0.78–0.91 for ischemic stroke, respectively). CONCLUSIONS: GIB and MACEs significantly increased the risk of ICU admission and receiving MV but not the hospital mortality, which was independently associated with both AMI and ICH. Early prevention can at least reduce the complexity of clinical course and even the hospital mortality.
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spelling pubmed-75377032020-10-13 Occurrence and Impact of Gastrointestinal Bleeding and Major Adverse Cardiovascular Events during Sepsis: A 15-Year Observational Study Hsieh, Ming-Shun Liao, Shu-Hui Chia-Rong Hsieh, Vivian How, Chorng-Kuang Emerg Med Int Research Article OBJECTIVE: Sepsis patients are at risk of gastrointestinal bleeding (GIB) and major adverse cardiovascular events (MACEs), but few data are available on the occurrence of GIB and MACEs and their impact on sepsis outcomes. METHODS: The medical claims records of 220,082 patients admitted for sepsis between 1999 and 2013 were retrieved from the nationwide database. The adjusted odds ratios (aORs) of composite outcomes including the hospital mortality, intensive care unit (ICU) admission, and mechanical ventilation (MV) in patients with a MACE or GIB were estimated by multivariate logistic regression and joint effect analyses. RESULTS: The enrollees were 70.15 ± 15.17 years of age with a hospital mortality rate of 38.91%. GIB developed in 3.80% of the patients; MACEs included ischemic stroke in 1.54%, intracranial hemorrhage (ICH) in 0.92%, and acute myocardial infarction (AMI) in 1.59%. Both ICH and AMI significantly increased the risk of (1) ICU admission (aOR = 8.02, 95% confidence interval (CI): 6.84–9.42 for ICH and aOR = 4.78, 95% CI: 4.21–5.42 for AMI, respectively), (2) receiving MV (aOR = 3.92, 95% CI: 3.52–4.40 and aOR = 1.99, 95% CI: 1.84–2.16, respectively), and (3) the hospital mortality (aOR = 1.08, 95% CI: 0.98–1.19 and aOR = 1.11, 95% CI: 1.03–1.19, respectively). However, sepsis with GIB or ischemic stroke increased only the risk of ICU admission and MV but not the hospital mortality (aOR = 0.98, 95% CI: 0.93–1.03 for GIB and aOR = 0.84, 95% CI: 0.78–0.91 for ischemic stroke, respectively). CONCLUSIONS: GIB and MACEs significantly increased the risk of ICU admission and receiving MV but not the hospital mortality, which was independently associated with both AMI and ICH. Early prevention can at least reduce the complexity of clinical course and even the hospital mortality. Hindawi 2020-09-27 /pmc/articles/PMC7537703/ /pubmed/33062335 http://dx.doi.org/10.1155/2020/9685604 Text en Copyright © 2020 Ming-Shun Hsieh et al. https://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Research Article
Hsieh, Ming-Shun
Liao, Shu-Hui
Chia-Rong Hsieh, Vivian
How, Chorng-Kuang
Occurrence and Impact of Gastrointestinal Bleeding and Major Adverse Cardiovascular Events during Sepsis: A 15-Year Observational Study
title Occurrence and Impact of Gastrointestinal Bleeding and Major Adverse Cardiovascular Events during Sepsis: A 15-Year Observational Study
title_full Occurrence and Impact of Gastrointestinal Bleeding and Major Adverse Cardiovascular Events during Sepsis: A 15-Year Observational Study
title_fullStr Occurrence and Impact of Gastrointestinal Bleeding and Major Adverse Cardiovascular Events during Sepsis: A 15-Year Observational Study
title_full_unstemmed Occurrence and Impact of Gastrointestinal Bleeding and Major Adverse Cardiovascular Events during Sepsis: A 15-Year Observational Study
title_short Occurrence and Impact of Gastrointestinal Bleeding and Major Adverse Cardiovascular Events during Sepsis: A 15-Year Observational Study
title_sort occurrence and impact of gastrointestinal bleeding and major adverse cardiovascular events during sepsis: a 15-year observational study
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7537703/
https://www.ncbi.nlm.nih.gov/pubmed/33062335
http://dx.doi.org/10.1155/2020/9685604
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