Risk Factors for Acute Coronary Syndrome in Upper Gastrointestinal Bleeding Patients
Tianyu Chi, Quchuan Zhao, Peili Wang
Abstract
Background. Upper gastrointestinal bleeding (UGIB) is a common critical disease with a certain fatality rate. Acute coronary syndrome (ACS), another critical ill condition, is a regular occurrence in the UGIB. We identified risk factors for ACS in UGIB. Methods. 676 patients diagnosed with UGIB were enrolled retrospectively. We assessed the occurrence of ACS in UGIB patients and identified the risk factors for ACS by logistic regression analysis and random forest analysis. Results. After propensity score matching (PSM), the ACS group ( <a:math xmlns:a="http://www.w3.org/1998/Math/MathML" id="M1"><a:mi>n</a:mi><a:mo>=</a:mo><a:mn>69</a:mn></a:math> ) and non-ACS group ( <c:math xmlns:c="http://www.w3.org/1998/Math/MathML" id="M2"><c:mi>n</c:mi><c:mo>=</c:mo><c:mn>276</c:mn></c:math> ) were analyzed. Logistic regression analysis showed that syncope ( <e:math xmlns:e="http://www.w3.org/1998/Math/MathML" id="M3"><e:mi>P</e:mi><e:mo>=</e:mo><e:mn>0.001</e:mn></e:math> ), coronary heart disease history ( <g:math xmlns:g="http://www.w3.org/1998/Math/MathML" id="M4"><g:mi>P</g:mi><g:mo>=</g:mo><g:mn>0.001</g:mn></g:math> ), Glasgow Blatchford score ( <i:math xmlns:i="http://www.w3.org/1998/Math/MathML" id="M5"><i:mi>P</i:mi><i:mo>≤</i:mo><i:mn>0.001</i:mn></i:math> ), Rockall risk score ( <k:math xmlns:k="http://www.w3.org/1998/Math/MathML" id="M6"><k:mi>P</k:mi><k:mo>=</k:mo><k:mn>0.004</k:mn></k:math> ), red blood cell distribution width (RDW) ( <m:math xmlns:m="http://www.w3.org/1998/Math/MathML" id="M7"><m:mi>P</m:mi><m:mo>≤</m:mo><m:mn>0.001</m:mn></m:math> ), total bilirubin (TBil) ( <o:math xmlns:o="http://www.w3.org/1998/Math/MathML" id="M8"><o:mi>P</o:mi><o:mo>=</o:mo><o:mn>0.046</o:mn></o:math> ), fibrinogen ( <q:math xmlns:q="http://www.w3.org/1998/Math/MathML" id="M9"><q:mi>P</q:mi><q:mo>≤</q:mo><q:mn>0.001</q:mn></q:math> ), and hemoglobin ( <s:math xmlns:s="http://www.w3.org/1998/Math/MathML" id="M10"><s:mi>P</s:mi><s:mo>=</s:mo><s:mn>0.001</s:mn></s:math> ) had important roles in ACS patients. With Mean Decrease Gini (MDG) sequencing, fibrinogen, RDW, and hemoglobin were ranked the top three risk factors associated with ACS. In ROC analysis, fibrinogen ( <u:math xmlns:u="http://www.w3.org/1998/Math/MathML" id="M11"><u:mtext>AUC</u:mtext><u:mo>=</u:mo><u:mn>0.841</u:mn></u:math> , 95% CI: 0.779-0.903) and RDW ( <w:math xmlns:w="http://www.w3.org/1998/Math/MathML" id="M12"><w:mtext>AUC</w:mtext><w:mo>=</w:mo><w:mn>0.826</w:mn></w:math> , 95% CI: 0.769-0.883) obtained good discrimination performance. According to <y:math xmlns:y="http://www.w3.org/1998/Math/MathML" id="M13"><y:mtext>sensitivity</y:mtext><y:mo>></y:mo><y:mn>80</y:mn></y:math> %, the pAUC of fibrinogen and RDW were 0.077 and 0.101, respectively, and there was no significant difference ( <ab:math xmlns:ab="http://www.w3.org/1998/Math/MathML" id="M14"><ab:mi>P</ab:mi><ab:mo>=</ab:mo><ab:mn>0.326</ab:mn></ab:math> ). However, according to <cb:math xmlns:cb="http://www.w3.org/1998/Math/MathML" id="M15"><cb:mtext>specificity</cb:mtext><cb:mo>></cb:mo><cb:mn>80</cb:mn></cb:math> %, the pAUC of fibrinogen was higher than that of RDW (0.126 vs. 0.088, <eb:math xmlns:eb="http://www.w3.org/1998/Math/MathML" id="M16"><eb:mi>P</eb:mi><eb:mo>=</eb:mo><eb:mn>0.018</eb:mn></eb:math> ). Conclusion. Fibrinogen and RDW were important risk factors for ACS in UGIB. Additionally, combination with coronary heart disease, syncope, hemoglobin, and TBil played important roles in the occurrence of ACS. Meanwhile, it was also noted that Rockall score and Glasgow Blatchford score should be performed to predict the risk.