DOCSLIB.ORG

Prognostic Value of AIMS65 Score in Cirrhotic Patients with Upper Gastrointestinal Bleeding

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Prognostic Value of AIMS65 Score in Cirrhotic Patients with Upper Gastrointestinal Bleeding Hindawi Publishing Corporation Gastroenterology Research and Practice Volume 2014, Article ID 787256, 8 pages http://dx.doi.org/10.1155/2014/787256 Research Article Prognostic Value of AIMS65 Score in Cirrhotic Patients with Upper Gastrointestinal Bleeding Vinaya Gaduputi, Molham Abdulsamad, Hassan Tariq, Ahmed Rafeeq, Naeem Abbas, Kavitha Kumbum, and Sridhar Chilimuri Department of Medicine, Bronx Lebanon Hospital Center, 1650 Selwyn Avenue, Suite No. 10C, Bronx, NY 10457, USA Correspondence should be addressed to Hassan Tariq; [email protected] Received 5 July 2014; Revised 1 December 2014; Accepted 2 December 2014; Published 22 December 2014 Academic Editor: Spiros D. Ladas Copyright © 2014 Vinaya Gaduputi et al. 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. Introduction. Unlike Rockall scoring system, AIMS65 is based only on clinical and laboratory features. In this study we investigated the correlation between the AIMS65 score and Endoscopic Rockall score, in cirrhotic and noncirrhotic patients. Methods. This is a retrospective study of patients admitted with overt UGIB and undergoing esophagogastroduodenoscopy (EGD). AIMS65 and Rockall scores were calculated at the time of admission. We investigated the correlation between both scores along with stigmata of bleed seen on endoscopy. Results. A total of 1255 patients were studied. 152 patients were cirrhotic while 1103 patients were noncirrhotic. There was significant correlation between AIMS65 and Total Rockall scores in patients of both groups. Therewas significant correlation between AIMS65 score and Endoscopic Rockall score in noncirrhotics but not cirrhotics. AIMS65 scores in both cirrhotic and noncirrhotic groups were significantly higher in patients who died from UGIB than in patients who did not. Conclusion. We observed statistically significant correlation between AIMS65 score and length of hospitalization and mortality in noncirrhotic patients. We found that AIMS65 score paralleled the endoscopic grading of lesion causing UGIB in noncirrhotics. AIMS65 score correlated only with mortality but not the length of hospitalization or endoscopic stigmata of bleed in cirrhotics. 1. Introduction These predictors serve to help making an optimal choice towards endoscopic intervention directed towards achieving Patients with acute upper gastrointestinal bleeding (UGIB) homeostasis (dual therapy versus single therapy versus no commonly present with either hematemesis or melena. The therapy). most important step in initial evaluation of such patients The score proposed by Rockall et2 al.[ ]incorporatesboth involves risk stratification with emphasis on assessing the clinical, laboratory parameters like age, presence of shock, hemodynamicstatusanditsappropriateremediation.Itis and comorbidities and endoscopic parameters including also imperative to examine the need for endoscopic inter- diagnosis and stigmata of bleeding. This score had been vention immediately after stabilization. There have been designed to predict the risk of continued bleeding and death. multiple scores that have been put forth to prognosticate Thescorealsothereforeaidsindeterminingthetimingof the risk of rebleeding and inpatient mortality rate. These endoscopic intervention. However, some studies have shown scores could be broadly divided into two categories: scores that the score is valid in predicting the risk of rebleed alone involving weighted endoscopic findings along with clinical but not death [3]. Blatchford score [4]onthecontrarytakes and laboratory features (Rockall scores) and scores without intoaccountonlyclinicalcriteria(hemoglobin,bloodurea the endoscopic criteria (AIMS65 and Blatchford scores). nitrogen, systolic blood pressure, pulse and the presence of Katschinski et al. [1]proposedusingForrestclassification, melena, syncope, hepatic disease, or cardiac failure) but no which predicts risk of rebleeding based on endoscopic endoscopic parameters. It has been shown that reliance on stigmata, that actively spurting vessels have the highest clinical parameters alone as is the case with Blatchford score chance of rebleed whereas clean based ulcer has the lowest. does not affect its predictive value in determining the need for 2 Gastroenterology Research and Practice urgent therapeutic intervention [5]. It has also been shown Table 1: Depiction of etiologies of bleeding in cirrhotics and by Blatchford et al. that this scoring system was better than noncirrhotics, respectively. Rockall score in predicting rebleeding and mortality as well Etiology of bleeding Cirrhotics Noncirrhotics value [4]. AIMS65 score is scoring system that does not include endoscopic criteria and has been put forth as a good predictor Esophageal varices (%) 56 (36.8) NA NA of length of stay, cost of hospitalization, and mortality [6]. Out Peptic ulcer disease (%) 71 (46) 553 (50.1) 0.4375 ∗ of the two common scoring systems not including endoscopic Esophagitis (%) 20 (13.1) 426 (38.6) 0.0001 ∗ criteria AIMS65 outscored Blatchford score in predicting Mallory-Weiss tear (%) 5 (3.3) 124 (11.2) 0.0015 ∗ inpatient mortality from UGIB [7]. value < 0.05 was considered statistically significant. Clinical criteria included in computing these prediction scores often are confounded by existence of multiple coexist- ing comorbidities such as liver dysfunction and heart failure. Table 2: Distribution of etiologies of cirrhosis among study subjects. Blatchford and Rockall scores include and give weightage Etiology of liver cirrhosis Number (%) to these comorbidities unlike AIMS65 score. Multiple stud- ies have shown that AIMS65 singularly predicted few or Hepatitis-C 107 (70.4) ETOH 43 (28.3) all of the outcome measures in UGIB such as timing of ∗ endoscopy intervention, mortality, length of stay, and cost Cryptogenic (probably NAFLD ) 2 (1.3) ∗ of hospitalization [8–10]. Preliminary data from Dekonda et Nonalcoholic fatty liver disease. al., comparing AIMS65 with preendoscopic Rockall score, showed that AIMS65 score was better at predicting the risk of rebleeding and inpatient mortality. Table 3: Baseline demographic, biochemical, and liver disease severity scores among cirrhotic patients. Patients with advanced liver disease often have hyperdy- namic circulation with low blood pressure and systemic vas- Variable Mean (±SD§) cular resistance secondary to undermetabolized circulating Age 54.78 (12.95) vasodilators [11, 12]. Patients with advanced liver disease can INR 1.41 (0.49) also have impaired mentation from metabolic encephalopa- Albumin 2.76 (0.79) thy resulting from increased circulating levels of ammonia and gamma-aminobutyric acid (GABA) [13, 14]. Impaired Serum creatinine 1.83 (1.87) syntheticfunctioninadvancedliverdiseasecouldmani- Total serum bilirubin 3.11 (2.99) fest as decreased serum albumin and deranged coagulation AST 93.97 (110.03) profile (elevated prothrombin time). Therefore, theoretically ALT¥ 65.66 (105.22) AIMS65scorescouldbeelevatedinpatientswithadvanced MELD scoreC 10.09 (4.54) liver disease at baseline. AIMS65 score does not provide MELD score in variceal 9.05 (4.39) additional scoring points to the presence of chronic liver bleeders ∗ value = 0.006 disease. High mortality in patients with increased AIMS65 MELD score in 10.7 (2.9) scores could therefore be a function of underlying severe liver nonvariceal bleeders disease itself, rather than that of UGIB. §Standard deviation. International normalized ratio. In this retrospective study, we intended to see the cor- relation between the AIMS65 score and Endoscopic Rockall Aspartate aminotransferase. ¥Alanine aminotransferase. score. We looked at this correlation in cirrhotic patients and CModel for end-stage liver disease. ∗ noncirrhotic patients separately. We wanted to examine the value < 0.05 was considered statistically significant. potential confounding role that underlying advanced liver disease could play while computing and interpreting AIMS65 scores. study patients were divided into two groups: patients with cirrhosis and patients without cirrhosis. 2. Methods and Materials Baseline demographic data including age, gender, and ethnicity were collected for all patients in the study. AIMS65 2.1. Patients. This retrospective study was performed accord- scores were calculated at the time of admission. Endoscopic ing to the Declaration of Helsinki with the Institution findings of each patient were reviewed and a weighted score ReviewBoard(IRB)approvalatthestudylocation.The was given as per Rockall Criteria. A separate weighted score period of study was five years from 2008 to 2012. Electronic for endoscopic stigmata of bleeding where applicable, as per medical records of all patients admitted to the hospital with Forrest classification (for ulcer bleeding only), was given as overt UGIB who underwent esophagogastroduodenoscopy well. Etiologies of bleeding in cirrhotics and noncirrhotics (EGD) were included in the study. The data was tabulated (Table 1); etiologies of cirrhosis amongst patients included in Microsoft Excel. The patients who had minimal, self- in the study (Table 2); and their baseline demographic, limited UGIB not requiring a diagnostic or interventional biochemical, and liver disease severity scores at the time of endoscopic procedure were excluded from the study. The admission were collected (Table 3). Gastroenterology Research and Practice 3 2.2. Evaluation of
Load more

Recommended publications
  • Defining and Measuring Quality in Endoscopy
    Communication from the ASGE QUALITY INDICATORS FOR Quality Assurance in Endoscopy Committee GI ENDOSCOPIC PROCEDURES Defining and measuring quality in endoscopy Quality has been a key focus for gastroenterology, The expert panels that were convened in 2005 compiled a driven by a common desire to promote best practices list of quality indicators that were deemed, at the time, to be among gastroenterologists and to foster evidence-based both feasible to measure and associated with improved pa- care for our patients. The movement to define and then tient outcomes. Feasibility concerns precluded measures measure aspects of quality for endoscopy was sparked by that required data collection after the date of endoscopy ser- public demand arising from alarming reports about medi- vice. Accordingly, the majority of the initial indicators con- cal errors. Two landmark articles published in 2000 and sisted of process measures, often related to documentation 2001 led to a national imperative to address perceived of important parameters in the endoscopy note. The evi- areas of underperformance and variations in care across dence demonstrating a link between these indicators to many fields of medicine.1,2 Initial efforts to designate and improved outcomes was limited. In many instances, the require reporting a small number of basic outcome mea- 2005 task force relied on expert opinion. Setting perfor- sures were mandated by the Centers for Medicare & mance targets based on community benchmarks was intro- Medicaid Services, and the process to develop perfor- duced, yet there was significant uncertainty about standard mance measures for government reporting and “pay for levels of performance. Reports citing performance data often performance” programs was initiated.
    [Show full text]
  • Role of Aims65 Score in Determining Frequency of Mortality in Patients with Upper Gastrointestinal Bleed
    Open Access Original Article Role of AIMS65 Score in Upper Gastrointestinal Bleed Pak Armed Forces Med J 2019; 69(2): 245-49 ROLE OF AIMS65 SCORE IN DETERMINING FREQUENCY OF MORTALITY IN PATIENTS WITH UPPER GASTROINTESTINAL BLEED Raja Jibran Akbar, Muhammad Ali Yousaf, Wajjiha Waheed, Manzoor Qadir*, Sajid Ali, Hammad Javaid** Combined Military Hospital Quetta/National University of Medical Sciences (NUMS) Pakistan, *Combined Military Hospital Skardu/ National University of Medical Sciences (NUMS) Pakistan, **Combined Military Hospital Kohat/National University of Medical Sciences (NUMS) Pakistan ABSTRACT Objective: To determine the frequency of mortality in upper gastrointestinal bleed patients having AIMS65 score >3. Study Design: Descriptive case series study. Place and Duration of Study: Department of Accident and Emergency and the Department of Medicine, Combined Military Hospital Quetta, from Sep 2015 to Sep 2016. Material and Methods: All patients having AIMS65 score>3 with UGIB, defined by the presence of hematemesis, melena or hematochezia, and/or a positive N/G tube aspiration for coffee ground, black or bloody contents were enrolled. Information on clinical factors was collected by taking a history and conducting an examination. Blood pressure was recorded manually by mercury sphygmomanometer. Blood samples of patients were collected for serum Albumin and international normalized ratio (INR). Laboratory investigations were sent to hospital laboratory which was headed by classified pathologist. AIMS65 mortality score of UGIB was calculated. Each risk factor (variable) carries one point. Thirty days mortality was calculated in patients with AIMS65 score>3. If the patients had been discharged before the time then outcome was determined through telephone communication. Results: Mean age of the patients was 57.69 ± 16.68 years.
    [Show full text]
  • Accuracy of Rockall Score for in Hospital Re- Bleeding Among Cirrhotic Patients with Vari- Ceal Bleed
    Original Article ACCURACY OF ROCKALL SCORE FOR IN HOSPITAL RE- BLEEDING AMONG CIRRHOTIC PATIENTS WITH VARI- CEAL BLEED Samina Ali Asgher,1 Muhammad Khurram Saleem,2 Amina Hussain 3 Abstract assessed by calculating sensitivity, specificity, positive and negative predictive values using 2 × 2 tables. Objective: To assess the diagnostic accuracy of Roc- Results: In the study, 175 patients were included. kall scoring system for predicting in-hospital re-ble- Mean age was 51.5 ± 1.22 years. Male to female ratio eding in cirrhotic patients presenting with variceal was 1.5 to 1.Out of 175 patients, 157 patients (89.7%) bleed. were of low risk group (score ≤ 2) while 18 patients Material and Methods: This descriptive case series (10.3%) were in high risk group (score ≥ 8). In low study was conducted at Department of Medicine Com- risk group, re-bleeding occurred only in 2 patients bined Military Hospital Lahore from December 2013 (1.2%) while in high risk group, re-bleeding occurred to May 2014. We included patients with liver cirrhosis in 14 patients (78%). Rockall score was found to have who presented with upper GI bleeding and showed good diagnostic accuracy with sensitivity of 87.5%, varices as the cause of bleeding on endoscopy. Clini- specificity of 97.48%, positive predictive value of cal and endoscopic features were noted to calculate 77.8% and negative predictive value of 98.7%. Rockall score. Patients with score of ≤ 2 and ≥ 8 were Conclusion: In cases of variceal bleed, frequency of included. After treating with appropriate pharmacolo- re-bleed is less in patients who are in low risk category gical and endoscopic therapy, patients were followed with lower Rockall score and high in high risk patients for re-bleeding for 10 days.
    [Show full text]
  • Clinical Scoring Systems in Predicting the Outcomes of Small Bowel Bleeding
    32 6 Clinical Scoring Systems Predicting Small Bowel Bleeding ORIGINAL ARTICLE GASTROINTESTINAL TRACT Su et al. Clinical Scoring Systems in Predicting the Outcomes of Small Bowel Bleeding Su Shuai1, Zhang Zhifang2, Wang Yuming1, Jin Hong1, Sun Chao1, Jiang Kui1, Wang Bangmao1 1Department of gastroenterology and hepatology, Tianjin Medical University General Hospital, Tianjin, People’s Republic of China 2Department of Neurology, Tianjin Xiqing Hospital, Tianjin, People’s Republic of China Cite this article as: Su S, Zhang Z, Wang Y, et al. Clinical scoring systems in predicting the outcomes of small bowel bleeding. Turk J Gastroenterol. 2021; 32(6): 493-499. ABSTRACT Background: The aim was to assess the clinical Glasgow–Blatchford score (GBS), Rockall score (CRS), and AIMS65 score in predicting outcomes (rebleeding, need for intervention, and length of stay) among patients with small bowel hemorrhage. Methods: We conducted a retrospective study of patients with small bowel bleeding (SBB). Rebleeding, need for intervention, and length of stay was investigated by 3 scoring systems. The area under the receiver operator characteristic curve was used to analyze the perfor- mance of 3 scoring systems. Results: Among 162 included patients, the scores of rebleeding, intervention, and length of stay ≥10 days groups were higher than no rebleeding, non-intervention, and length of stay <10 days groups, respectively (P < .05). The CRS, GBS, and AIMS65 scoring systems dem- onstrated statistically significant difference in predicting rebleeding (AUROC 0.693 vs. 0.790 vs. 0.740; all P < .01), intervention (AUROC: 0.726 vs. 0.825 vs. 0.773; all P < .01) and length of stay (AUROC 0.651 vs.
    [Show full text]
  • Endoscopic Hemostasis Followed by Preventive Transarterial
    Kaminskis et al. World Journal of Emergency Surgery (2019) 14:45 https://doi.org/10.1186/s13017-019-0264-z RESEARCH ARTICLE Open Access Endoscopic hemostasis followed by preventive transarterial embolization in high-risk patients with bleeding peptic ulcer: 5-year experience Aleksejs Kaminskis1* , Patricija Ivanova1, Aina Kratovska1, Sanita Ponomarjova1, Margarita Ptašņuka2, Jevgenijs Demičevs3, Renate Demičeva3, Viesturs Boka3 and Guntars Pupelis1,2 Abstract Background: Upper gastrointestinal bleeding (UGIB) due to peptic ulcer disease is one of the leading causes of death in patients with non-variceal bleeding, resulting in up to 10% mortality rate, and the patient group at high risk of rebleeding (Forrest IA, IB, and IIA) often requires additional therapy after endoscopic hemostasis. Preventive transarterial embolization (P-TAE) after endoscopic hemostasis was introduced in our institution in 2014. The aim of the study is an assessment of the intermediate results of P-TAE following primary endoscopic hemostasis in patients with serious comorbid conditions and high risk of rebleeding. Methods: During the period from 2014 to 2018, a total of 399 patients referred to our institution with a bleeding peptic ulcer, classified as type Forrest IA, IB, or IIA with the Rockall score ≥ 5, after endoscopic hemostasis was prospectively included in two groups—P-TAE group and control group, where endoscopy alone (EA) was performed. The P-TAE patients underwent flow-reducing left gastric artery or gastroduodenal artery embolization according to the ulcer type. The rebleeding rate, complications, frequency of surgical interventions, transfused packed red blood cells (PRBC), amount of fresh frozen plasma (FFP), and mortality rate were analyzed.
    [Show full text]
  • Validity of Rockall Scoring System in Determining In
    Original Article Validity Of Rockall Scoring System In Determining In- Hospital Rebleeding Among Cirrhotic Patients With Acute Esophageal/Gastric Variceal Hemorrhage Using Endoscopy As Gold Standard Maqsood Ahmad, Naeem Afzal, Saeed Akhter, Muhammad Irfan, Zahid Yaseen Hashmie Abstract The rate of rebleeding of esophageal varices remains observation for re-bleed in 10 days. Results: The high after cessation of acute esophageal variceal mean age of patients was 50.99±12.47 years. Out of hemorrhage. Rockall scoring system primarily 87 positive cases on Rockall score, 82 cases were developed for patients with non variceal source of true positive. Out of 89 cases, that were negative, 81 bleeding. Objective: To determine the validity of were true negative. Sensitivity, Specificity and Rockall scoring system in determining in-hospital diagnostic accuracy of Rockall score was found to re-bleeding among cirrhotic patients with acute be 91.1%, 94.1% and 92.6%, respectively. Positive esophageal/gastric variceal haemorrhage using predictive value (PPV) of Rockall score was 94.2% endoscopy as gold standard. The study was and negative predictive values (NPV) was 90.0%. conducted in Allied hospital and Liver Centre Conclusion: The risk scoring system developed by Allied/DHQ Hospitals, Faisalabad. Study Period: Rockall and coworkers is a clinically useful scoring Study was carried out from 28-06-2010 to 27-12- system among cirrhotic patients with acute 2010. Patients and Methods: Total 176 cases were esophageal/gastric variceal haemorrhage. Key include in this study. The subjects were scored using Words: Esophageal varices, Cirrhosis, Rockall Rockall scoring system and placed under scoring system, Bleeding.
    [Show full text]
  • The Treatment of Haematemesis and Upper Gastrointestinal Bleeding in United Kingdom Armed Forces and Other Deployed Units
    J Royal Naval Medical Service 2014, Vol 100.3 308 The treatment of haematemesis and upper gastrointestinal bleeding in United Kingdom Armed Forces and other deployed units Surg Lt R Arr Woodward, Surg Cdr M Khan Abstract Introduction Upper Gastro-intestinal (UGI) bleeding is a significant cause of morbidity worldwide. United Kingdom Armed Forces (UKAFs) are not immune to this condition. There is a substantial body of conflicting evidence regarding initial management and risk stratification. Aim To provide the background knowledge and treatment pathways required to assess and manage a patient adequately during the first 24 hours of an episode of UGI bleeding. Assessment Clinical grading of hypovolaemic shock is inaccurate, but is a broad indicator of severity; the Rockall Score must not be used to assess requirement for intervention. Where laboratory assets are available, the Blatchford score is adequate to assess requirements for intervention. Management The principles of hypotensive resuscitation (target systolic blood pressure 90 mmHg for the first hour) hold true for UGI bleeds. In areas where endoscopy is available within four hours, a restrictive pattern of packed Red Blood Cell (pRBC) transfusion may be beneficial. Despite limited evidence of benefit, Proton Pump Inhibitors (PPIs) should be given routinely in UKAFs. Where available, in cases of variceal and non-variceal UGI Haemorrhage without locally available endoscopy, administration of tranexamic acid and somatostatin or octreotide should be considered. Introduction however, Role One units, in particular Royal Naval or Upper Gastro-intestinal (UGI) bleeding is one of the most light infantry units, often operate outside of effective common causes of admission to hospital in the United local medical care.
    [Show full text]
  • (BSG)- Led Multisociety Consensus Care Bundle for the Early Clinical
    GUIDELINES British Society of Gastroenterology (BSG)- led multisociety consensus care bundle for the early clinical management of acute upper gastrointestinal bleeding Keith Siau ,1,2,3 Sarah Hearnshaw,4 Adrian J Stanley,5 Lise Estcourt,6 Ashraf Rasheed,7,8 Andrew Walden,9,10 Mo Thoufeeq,11 Mhairi Donnelly,5 Russell Drummond,5 Andrew M Veitch,12 Sauid Ishaq,3,13 Allan John Morris5,14 For numbered affiliations see end ABSTRACT evidence- based interventions and drive quality of article. Medical care bundles improve standards of improvement and patient outcomes in AUGIB. Correspondence to care and patient outcomes. Acute upper Dr Allan John Morris, Glasgow gastrointestinal bleeding (AUGIB) is a common Royal Infirmary, Glasgow G4 0SF, medical emergency which has been consistently INTRODUCTION UK; john. morris@ ggc. scot. nhs. uk Acute upper gastrointestinal bleeding associated with suboptimal care. We aimed to (AUGIB) is a common medical emer- British Society of develop a multisociety care bundle centred on gency in the UK with an estimated inci- Gastroenterology Conference the early management of AUGIB. 2019 dence of 134 per 100 000 population,1 Commissioned by the British Society of roughly equating to one presentation Gastroenterology (BSG), a UK multisociety task every 6 min. Mortality following AUGIB force was assembled to produce an evidence- over the last two decades has remained based and consensus- based care bundle detailing high at approximately 10%,2 with several key interventions to be performed within UK- wide audits revealing poor stand- 24 hours of presentation with AUGIB. A modified ards of care.2 3 Multiple guidelines have Delphi process was conducted with stakeholder been developed in an attempt to define representation from BSG, Association of Upper quality standards in AUGIB and improve Gastrointestinal Surgeons, Society for Acute patient outcomes.4–6 These unanimously Medicine and the National Blood Transfusion acknowledge the importance of timely Service of the UK.
    [Show full text]
  • 7Th International Advanced Endoscopy Workshop Annual
    Annual Scientific Meeting of the Malaysian Society of Gastroenterology and Hepatology Incorporating the 7th International Advanced Endoscopy Workshop 29 August – 1 September 2007 Kota Kinabalu, Sabah, Malaysia Malaysian Society of Gastroenterology and Hepatology CONTENTS LECTURES L1 Milestones In Therapeutic Endoscopy – A Personal Journey 1 N Soehendra L3 The 4th Panir Chelvam Memorial Lecture 2 Evidence Based Medicine In The Real World R H Hunt L5 Screening And Surveillance For Colorectal Cancer: Rationale And 3 Recommendations F A Macrae SYMPOSIA S1 CHRONIC VIRAL HEPATITIS Does Treatment Alter The Natural History Of Disease? – A Critical Look • Does Treatment Alter The Natural History Of Chronic Viral 4 B Hepatitis? – A Critical Perspective M Silva • Does Treatment Alter The Natural History Of Chronic 5 Hepatitis C Disease? C E Millson S2 GASTRIC CANCER • Identifying High-Risk Groups For Gastric Cancer 6 R H Hunt • Improving Outcomes And Treatment For Gastric Cancer 7 K G Yeoh YOUNG INVESTIGATOR’S FREE PAPER SESSION YIA 01 The Correlation Between Non-Invasive Markers And Fibrotic Index 8 On Liver Histology M Z Faizal1, M N Razul1, M Radzi1, N Raihan2, B P Ooi1 1Department of Medicine, 2Department of Pathology, Hospital Alor Setar, Alor Setar, Kedah, Malaysia YIA 02 Randomized Comparison Between Adrenaline Injection Alone 9 And Adrenaline Injection Combined With Monopolar Electrocoagulation In The Treatment Of Acute Bleeding Peptic Ulcer J Rokayah, J Shukri, A R Hashimah Sarawak General Hospital, Kuching, Sarawak, Malaysia GUT 2007 i
    [Show full text]
  • Acute Upper Gastrointestinal Bleeding
    NATIONAL INSTITUTE FOR HEALTH AND CLINICAL EXCELLENCE QUALITY STANDARDS PROGRAMME Quality standard topic: Acute upper gastrointestinal bleeding Output: Briefing paper Introduction This briefing paper presents a structured evidence review to help determine the suitability of recommendations from the key development sources listed below, to be developed into a NICE quality standard. The draft quality statements and measures presented in this paper are based on published recommendations from these key development sources: Gastrointestinal bleeding: the management of acute upper gastrointestinal bleeding. NICE clinical guideline 141 (2012; NICE accredited). Available from www.nice.org.uk/guidance/CG141 Structure of the briefing paper The body of the paper presents supporting evidence for the draft quality standard reviewed against the three dimensions of quality: clinical effectiveness, patient experience and safety. Information is also provided on available cost-effectiveness evidence and current clinical practice for the proposed standard. Where possible, evidence from the clinical guideline is presented. When this is not available, other evidence sources have been used. Quality standard topic: Acute upper gastrointestinal bleeding 1 of 43 NICE QS Topic Expert Group Briefing Paper 1 Risk assessment 1.1 NICE CG141 Recommendations 1.1.1 [KPI] and 1.1.2 1.1.1 Relevant NICE clinical guideline recommendations and proposed quality statement Guideline 1.1.1 Use the following formal risk assessment scores for all recommendations patients with acute
    [Show full text]
  • Clinical Utility of Risk Scores in Variceal Bleeding
    AG-2019-53 AHEADORIGINAL OF ARTICLEPRINT dx.doi.org/10.1590/S0004-2803.201900000-54 Clinical utility of risk scores in variceal bleeding Sanjay CHANDNANI, Pravin RATHI, Suhas Sudhakarrao UDGIRKAR, Nikhil SONTHALIA, Qais CONTRACTOR and Samit JAIN Received 22/3/2019 Accepted 17/6/2019 ABSTRACT – Background – Variceal bleeding remains important cause of upper gastrointestinal bleed. Various risk scores are used in risk stratification for non-variceal bleed. Their utility in variceal bleeding patients is not clear. Objective – This study aims to compare probability of these scores in predicting various outcomes in same population. To study characteristics and validate AIMS65, Rockall, Glasgow Blatchford score(GBS), Progetto Nazionale Emorragia Digestiva (PNED) score in variceal Upper Gastrointestinal Bleed (UGIB) patients for predicting various outcomes in our pop- ulation. Methods – Three hundred subjects with UGIB were screened prospectively. Of these 141 patients with variceal bleeding were assessed with clinical, blood investigations and endoscopy and risk scores were calculated and compared to non-variceal cases. All cases were followed up for 30 days for mortality, rebleeding, requirement of blood transfusion and need of radiological or surgical intervention. Results – Variceal bleeding (141) was more common than non variceal (134) and 25 had negative endoscopy. In variceal group, cirrhosis (85%) was most common etiology. Distribu- tion of age and sex were similar in both groups. Presence of coffee coloured vomitus (P=0.002), painless bleed (P=0.001), edema (P=0.001), ascites (P=0.001), hemoglobin <7.5 gms (P<0.001), pH<7.35 (P<0.001), serum bicarbonate level <17.6 mmol/L (P<0.001), serum albumin<2.75 gms% (P<0.001), platelet count <1.2 lacs/µL (P<0.001), high INR 1.35 (P<0.001), BUN >25mmol/L (P<0.001), and ASA status (P<0.001), high lactate >2.85 mmol/L (P=0.001) were significant.
    [Show full text]
  • The Development and Validation of a Novel Canine Mucosal Endoscopic Scoring System Applied to Dogs with Inflammatory Bowel Disea
    Iowa State University Capstones, Theses and Graduate Theses and Dissertations Dissertations 2014 The development and validation of a novel canine mucosal endoscopic scoring system applied to dogs with inflammatory bowel disease Jennifer Ellen Slovak Iowa State University Follow this and additional works at: https://lib.dr.iastate.edu/etd Part of the Veterinary Medicine Commons Recommended Citation Slovak, Jennifer Ellen, "The development and validation of a novel canine mucosal endoscopic scoring system applied to dogs with inflammatory bowel disease" (2014). Graduate Theses and Dissertations. 13758. https://lib.dr.iastate.edu/etd/13758 This Thesis is brought to you for free and open access by the Iowa State University Capstones, Theses and Dissertations at Iowa State University Digital Repository. It has been accepted for inclusion in Graduate Theses and Dissertations by an authorized administrator of Iowa State University Digital Repository. For more information, please contact [email protected]. The development and validation of a novel canine mucosal endoscopic scoring system applied to dogs with inflammatory bowel disease by Jennifer E. Slovak A thesis submitted to the graduate faculty in partial fulfillment of the requirements for the degree of MASTER OF SCIENCE Major: Veterinary Clinical Science Program of Study Committee: Albert E. Jergens, Major Professor Krysta Deitz Heather Flaherty JoAnn Morrison Iowa State University Ames, Iowa 2014 Copyright © Jennifer E. Slovak, 2014. All rights reserved. ii DEDICATION I dedicate this thesis to my husband, Dr. Robert G. Dyke, a fellow veterinarian and clinician scientist. He is an exceptionally patient, understanding and supportive spouse, for whom I can never thank enough. iii TABLE OF CONTENTS Page LIST OF FIGURES ..................................................................................................
    [Show full text]