BMC Gastroenterology最新文献

Background: Gastrointestinal bleeding is a major cause of morbidity and mortality, this study aimed to validate the performance of the new ABC score in predicting 30-day mortality in upper gastrointestinal bleeding (UGIB) and lower gastrointestinal bleeding (LGIB) in a cohort of Tanzanian patients and compare it to existing pre-endoscopy risk scores.

Methods: This retrospective single-center study at a tertiary referral hospital in Tanzania included adult patients presenting with gastrointestinal bleeding between June 2022 and December 2023. The area under receiver operating characteristic curve (AUROC) was calculated for the ABC score 30-day mortality prediction using SPSS software. In addition, the top risk prediction existing scores (the AIMS65, pre-endoscopic Rockall score, Glasgow-Blatchford score (GBS) and, the Oakland score) were evaluated and compared to the ABC score using DeLong tests.

Results: Among the 98 included patients the overall 30-day mortality was 31.6%. The ABC score had a good performance in predicting 30-day mortality (AUROC: 0.818, 95% CI: 0.732-0.903). The ABC score's performance was superior to GBS (p = 0.015) and Oakland scores (p = 0.008), while comparable to AIMS65 (p = 0.083) and Rockall scores (p = 0.032). Notably, the optimal ABC cutoff in our population was ≥ 4.5 points, differing from the international standard of ≥ 8 points.

Conclusions: Our study provides the first African validation of the ABC score, confirming a good predictive performance in Tanzanian patients while identifying the need for population-specific cutoff calibration. The ABC score represents a valuable risk stratification tool for both upper and lower gastrointestinal bleeding in resource-limited settings.

Background: Developing inflammatory bowel disease (IBD) affects platelet counts (PLT), which are involved in blood coagulation. However, the predictive or diagnostic utility of platelet characteristics in assessing IBD disease activity of inflammatory bowel disease. We conducted thisremains unknown. This meta-analysis was conducted to quantitatively evaluate changes in platelet parameters during the active phase of IBD using a large sample size.

Methods: PubMed, Embase, Wiley Online Library, Web of Science, and Google Scholar databases were searched to identify studies. Platelet parameter data were collected, pooled, examined, and assessed from studies that met the inclusion criteria and were evaluated for risk of bias using the Newcastle Ottawa Scale. The enzyme-linked immunosorbent assay was used to determine the difference in PF4 levels between normal and DSS-induced UC mice.

Results: A total of 18 articles were included in this study, with 2,160 patients, including 1,107 patients with Crohn's disease (CD) and 1,053 with ulcerative colitis (UC). There were 410 active and 697 inactive patients with CD, while 443 active and 610 inactive patients with UC. Of the 18 studies, 1 was retrospective, 2 were cross-sectional, and 15 were prospective cohort studies. Data on platelet count (PLT), the primary outcome measure of this study, were given in 15 studies, whereas mean platelet volume (MPV), fibrinogen (FIB), and PF4 were secondary outcomes. The pooling of effect size for CD patients in active and inactive phases was as follows: (PLT, MD = 55.51, 95% confidence interval [CI] (35.87, 67.16), Z = 6.45, P < 0.0001), (MPV, MD = - 0.42, 95% CI (-0.84, 0.01), Z = - 1.92, P = 0.05), (PF4, MD = 12.27, 95% CI (3.78, 20.76), Z = 2.83, P = 0.0046), (FIB, MD = 104.09, 95% CI (38.43, 169.75), Z = 3.11, P = 0.002). The pooled effect sizes of patients with UC in active and inactive phases were as follows: (PLT, MD = 58.48, 95% CI (38.71, 78.26), Z = 5.80, P < 0.0001), (MPV, MD = - 0.70, 95% CI (-0.93, - 0.47), Z = - 5.99, P < 0.0001), (PF4, MD = 3.03, 95% CI (-4.03, 10.10), Z = 0.84, P = 0.40), (FIB, MD = 109.73, 95% CI (45.64, 173.81), Z = 3.36, P = 0.001). PF4 levels were markedly elevated in DSS-induced UC mice. The heterogeneity sources analysis revealed that "Study type" was a statistically significant source of heterogeneity. Egger's test identified publication bias (t = 0.74, P = 0.47), indicating no significant asymmetry in the funnel plot.

Conclusions: Platelet parameters varied at different stages of IBD disease activity. Active patients had significantly higher PLT, PF4, and FIB levels and significantly lower MPV levels than inactive patients. Continuous monitoring of platelet parameters is an effective strategy to learn about the activity of IBD disease and an efficient means of reducing negative outcomes.

Background: Endoscopic ultrasonography (EUS) and enhanced computed tomography (CT) can offer more image features of gastric stromal tumors with higher pathological risk, which is of great significance for determining the pathological risk degree of gastric stromal tumors (GSTs) before surgery.

Aim: To investigate the correlation between EUS and enhanced CT image features and pathological risk of GSTs.

Methods: Retrospectively collect the cases of primary GSTs. The lesions were divided into four group based on the pathological risk degree. Univariate analysis was used to identify the risk factors for higher pathological risk GSTs. The relatively benign group consisted of the very low-risk group and the low-risk group, while the relatively malignant group consisted of the intermediate-risk group and the high-risk group. Independent risk factors for the relative malignancy of GSTs pathological risk degree were analyzed by multivariate logistic regression.

Results: (1) Statistically significant disparities among groups regarding the presence of ulcer on the lesion surface, length, boundary morphology, internal echo uniformity and cystic change (P < 0.05). Lesion length (P < 0.001) and irregular boundary morphology of the lesion (P = 0.003) were independent risk factors. Receiver operating characteristic (ROC) curve analysis for predicting the relative malignancy of GSTs using EUS revealed that the area under the curve (AUC) was 0.876. (2) Statistically significant differences among groups in the lesion length, shape (round or quasi-round/irregular), boundary clarity, enhancement pattern, and necrosis (P < 0.05). Lesion length (P = 0.031) and the irregular lesion shape (P = 0.019) were independent risk factors. ROC curve analysis for predicting the relative malignancy of GSTs using enhanced CT showed that the AUC was 0.795.

Conclusion: The image features of GSTs under EUS and enhanced CT is significantly correlated with the pathological risk of GSTs, which can be used to predict whether the pathological risk of GSTs is relatively malignant.

Background: Hypertriglyceridemia is an increasingly common cause of acute pancreatitis (AP). Patients with hypertriglyceridemic acute pancreatitis (HTG-AP) have higher complication and mortality rates compared to those with other etiologies. Early prediction of disease severity remains challenging due to the lack of readily available tools specifically for HTG-AP.

Method: This was a single-center retrospective cohort study. A total of 214 HTG-AP patients were classified into mild acute pancreatitis (MAP, n = 106) and moderately severe/severe acute pancreatitis (MSAP/SAP, n = 108) groups based on the revised Atlanta criteria. Clinical characteristics and laboratory parameters were compared between the two groups. Binary logistic regression analysis and ROC analysis were performed to identify risk factors and develop a combined predictive model. Bootstrap analysis was performed for internal validation, and calibration curves were utilized to evaluate model calibration.

Results: The MSAP/SAP group exhibited elevated triglyceride (TG), amylase (AMY), blood glucose (GLU), C-reactive protein (CRP), and white blood cell (WBC) levels, but lower serum calcium (Ca²⁺) and apolipoprotein A1 (ApoA1) levels. Binary logistic regression analysis identified several independent risk factors for MSAP/SAP: TG, CRP, WBC, and Ca²⁺. The combined predictive model achieved an area under the curve (AUC) of 0.837. At the optimal cut-off value of 0.48, the sensitivity and specificity of the combined predictive indicator were 77.4% and 75.0%, respectively. Bootstrap validation demonstrated that the 95% confidence intervals for the regression coefficients of TG, Ca²⁺, CRP, and WBC did not include zero. The Hosmer-Lemeshow goodness-of-fit test showed a p-value of 0.312 (>0.05).

Conclusion: Elevated TG, CRP, and WBC levels, as well as decreased Ca²⁺, are independent risk factors for severe HTG-AP. A combined model based on these readily available early parameters demonstrates robust predictive performance, stability, and calibration.

Background: Overt hepatic encephalopathy (OHE) is a common complication following transjugular intrahepatic portosystemic shunt (TIPS) procedures in patients with cirrhosis. However, the relationship between preoperative triglyceride (TG) levels and post-TIPS OHE risk remains unclear. This study aimed to investigate whether elevated preoperative TG levels are independently associated with increased risk of developing OHE following TIPS in patients with cirrhosis.

Methods: This retrospective cohort study included 172 patients with cirrhosis who underwent TIPS at Yichang Central People's Hospital from January 2021 to December 2023. The primary exposure variable was preoperative TG level, and the primary outcome was the occurrence of OHE during follow-up. Cox proportional hazards regression models were used to analyze the relationship between TG levels and OHE risk, with stratified analyses conducted according to Child-Pugh classification and blood ammonia levels.

Results: The incidence of OHE was significantly higher in the high TG group compared to the low TG group (45.2% vs 26.1%, P=0.026). After adjusting for multiple confounding factors, each 1 mmol/L increase in TG was associated with a 15.4% increase in OHE risk (HR=1.154, 95% CI: 1.042-1.426, P=0.036). Compared to the lowest quartile TG group, the highest quartile group showed a 26.5% increase in OHE risk (HR=1.265, 95% CI: 1.201-1.461, P=0.001). This association was more pronounced in patients with Child-Pugh class B/C.

Conclusions: Elevated preoperative TG levels are independently associated with increased risk of post-TIPS OHE development. Preoperative TG level assessment may help identify high-risk patients and facilitate the development of appropriate preventive strategies.