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Journal of Nutrition and Human Health | Volume 3
May 23-24, 2019 | Vienna, Austria
Joint Event
2
nd
International Conference on
Gastroenterology and Digestive Disor
ders
17
th
International Conference on
Nutrition and Fitness
&
Risk factors and outcomes in critically ill patients presenting with Gastrointestinal
Hemorrhage complicated by Myocardial Ischemia
Mohamed Zakarya
1,2
and
James Krinsley
1,2
1
Stamford Hospital, USA
2
Columbia University Vagelos College of Physicians and Surgeons, USA
Introduction:
Gastrointestinal hemorrhage (GIB) is
frequently associated with significant cardiovascular stress
due to the resulting imbalance between myocardial oxygen
supply and demand. The aimof this study is to determine the
risk factors, clinical predictors, and prognostic significance
of myocardial ischemia in patients admitted to our intensive
care unit (ICU) with GIB.
Methods:
This is a retrospective review of our ICU database
and electronic medical record (EMR) of all patients
admitted to the ICU with GIB (including upper or lower
GIB) between 10/1/05 and 9/30/18. Data aggregated
include demographics, hemoglobin and troponin (TROP)
values, comorbidities, ICU length of stay (LOS) and outcome
parameters including in-hospital mortality. Patients
were categorized as having myocardial ischemia (“ISCH,”
including ST elevation myocardial infarction, non-ST
elevation myocardial infarction, or demand ischemia), or
no ischemia (“NON”). We compared risk factors and clinical
characteristics of patientswith andwithout ISCHand created
a multivariable logistic regression model to determine the
independent association of ISCH with mortality.
Results:
This investigation includes 403 patients with
GIB; 256 had serial TROP values. 155 of 403 (38.5%)
had enzymatic and/or electrocardiographic evidence of
ischemia. ISCH had longer ICU LOS (1.7 [1.0-3.2] vs. 1.3 [0.8-
2.0] days; p = 0.0001) and higher mortality (20.0% vs. 5.6%;
p <0.0001). Multivariable analysis demonstrated that ISCH
was independently associated with higher mortality: Odds
ratio (95% confidence interval) 3.23 (1.34-7.78; p = 0.0088).
Conclusion:
Patients admitted to the ICU with GIB are at
a high risk of developing myocardial ischemia which is
identified in this investigation as being an independent risk
factor for mortality. Recognition of associated risk factors
and comorbidities in the setting of GIB can identify patients
who are at increased risk of cardiovascular stress and could
aid in targeting more aggressive treatment, potentially
improving outcomes.
e
:
m.zakarya10@gmail.comNotes: