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J INTERN MED:住院COVID-19患者胃肠道出血

2020-12-21 MedSci原创 MedSci原创

在住院的COVID-19患者中,使用抗凝药或抗血小板药不是GI出血的危险因素。住院期间GI出血的患者死亡率有所增加。

住院的COVID-19患者有观察到胃肠道(GI)出血病例。最近的研究表明,抗凝已可降低COVID-19患者死亡率,但尚不清楚这是否会增加GI出血。近日,内科学领域权威杂志Journal of Internal Medicine上发表一篇研究文章,这项研究旨在评估:1)COVID-19患者是否存在GI出血的危险因素;2)伴有和不伴有GI出血的COVID-19住院患者之间的死亡率是否存在差异。

这是一项从3月1日至4月27日期间在纽约都会区的大型卫生系统进行的倾向得分匹配的病例对照研究。考虑到合并症、人口统计学、GI出血的危险因素和住院时间,研究人员将倾向评分的GI出血与没有GI出血的COVID-19患者以1:1进行匹配。

在11158名接受COVID-19住院治疗的患者中,有314例被确诊伴有GI出血,GI出血发生率为3%。没有可识别的GI出血危险因素。在COVID-19患者中使用抗凝药物或抗血小板药物与GI出血的风险增加无关。对于住院期间发生GI出血的患者,GI出血组的死亡风险增加(OR为1.58,p=0.02)。

由此可见,在住院的COVID-19患者中,使用抗凝药或抗血小板药不是GI出血的危险因素。住院期间GI出血的患者死亡率有所增加

原始出处:

Arvind J Trindade.et al.Gastrointestinal Bleeding in Hospitalized COVID‐19 Patients: A Propensity Score Matched Cohort Study.J INTERN MED.2020.https://onlinelibrary.wiley.com/doi/10.1111/joim.13232

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    2020-12-23 liao1619
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  5. 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objectType=article, channel=null, level=null, likeNumber=48, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo6KcicAVC1MwuOgo3iaicb1Imgk1yIfnvr6oXzibcAFB6puAyNJXbzWhNuLqaFYBVRWjh7rghkvFLPxMAfD5ib3nXwVD/0, createdBy=bed21972958, createdName=wxl882001, createdTime=Mon Dec 21 21:27:31 CST 2020, time=2020-12-21, status=1, ipAttribution=)]
    2020-12-23 Jessica

    住院期间胃肠道出血的患者死亡率有所增加。

    0

  6. 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objectType=article, channel=null, level=null, likeNumber=48, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo6KcicAVC1MwuOgo3iaicb1Imgk1yIfnvr6oXzibcAFB6puAyNJXbzWhNuLqaFYBVRWjh7rghkvFLPxMAfD5ib3nXwVD/0, createdBy=bed21972958, createdName=wxl882001, createdTime=Mon Dec 21 21:27:31 CST 2020, time=2020-12-21, status=1, ipAttribution=)]
    2020-12-22 宣之

    学习了

    0

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topicId=null, topicList=[TopicDto(id=45473, encryptionId=23e3454e353, topicName=学习)], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20200627/83a502bff6c14b759a7d0863b4068e7b/32ad40676056418ea58a94afac9c5b81.jpg, createdBy=6f475314305, createdName=水-晶, createdTime=Mon Dec 21 21:44:16 CST 2020, time=2020-12-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=909892, encodeId=4f549098926c, content=学习了,这种有个印象就行,临床中可以想起来就可以了, beContent=null, objectType=article, channel=null, level=null, likeNumber=96, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20200627/83a502bff6c14b759a7d0863b4068e7b/32ad40676056418ea58a94afac9c5b81.jpg, createdBy=6f475314305, createdName=水-晶, createdTime=Mon Dec 21 21:44:11 CST 2020, time=2020-12-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=909884, encodeId=fb719098840e, content=了解, beContent=null, objectType=article, channel=null, level=null, likeNumber=48, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo6KcicAVC1MwuOgo3iaicb1Imgk1yIfnvr6oXzibcAFB6puAyNJXbzWhNuLqaFYBVRWjh7rghkvFLPxMAfD5ib3nXwVD/0, createdBy=bed21972958, createdName=wxl882001, createdTime=Mon Dec 21 21:27:31 CST 2020, time=2020-12-21, status=1, ipAttribution=)]
    2020-12-21 寻寻到此

    0

  8. [GetPortalCommentsPageByObjectIdResponse(id=1297500, encodeId=7305129e5007f, content=<a href='/topic/show?id=c0385134ab' target=_blank style='color:#2F92EE;'>#COVID-19患者#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=60, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=5134, encryptionId=c0385134ab, topicName=COVID-19患者)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=6976269, createdName=zhangph, createdTime=Wed Dec 23 11:32:28 CST 2020, time=2020-12-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1346335, encodeId=1392134633558, content=<a href='/topic/show?id=339e8332035' target=_blank style='color:#2F92EE;'>#胃肠道#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=83320, encryptionId=339e8332035, topicName=胃肠道)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=e03212, 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attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=325e5422748, createdName=宣之, createdTime=Tue Dec 22 14:32:18 CST 2020, time=2020-12-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=909901, encodeId=aed990990154, content=赞, beContent=null, objectType=article, channel=null, level=null, likeNumber=117, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTLHoRmy6NiboIAB60qN4aSx7DBKUhrErP15HhOiazIsQx8cmoWhZNMK2VuESGje1Ylt6qAhA5xcxg7A/132, createdBy=91622093406, createdName=寻寻到此, createdTime=Mon Dec 21 22:25:01 CST 2020, time=2020-12-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=909893, encodeId=ac3f90989313, content=<a href='/topic/show?id=23e3454e353' target=_blank style='color:#2F92EE;'>#学习#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=88, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=45473, encryptionId=23e3454e353, topicName=学习)], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20200627/83a502bff6c14b759a7d0863b4068e7b/32ad40676056418ea58a94afac9c5b81.jpg, createdBy=6f475314305, createdName=水-晶, createdTime=Mon Dec 21 21:44:16 CST 2020, time=2020-12-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=909892, encodeId=4f549098926c, content=学习了,这种有个印象就行,临床中可以想起来就可以了, beContent=null, objectType=article, channel=null, level=null, likeNumber=96, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20200627/83a502bff6c14b759a7d0863b4068e7b/32ad40676056418ea58a94afac9c5b81.jpg, createdBy=6f475314305, createdName=水-晶, createdTime=Mon Dec 21 21:44:11 CST 2020, time=2020-12-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=909884, encodeId=fb719098840e, content=了解, beContent=null, objectType=article, channel=null, level=null, likeNumber=48, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo6KcicAVC1MwuOgo3iaicb1Imgk1yIfnvr6oXzibcAFB6puAyNJXbzWhNuLqaFYBVRWjh7rghkvFLPxMAfD5ib3nXwVD/0, createdBy=bed21972958, createdName=wxl882001, createdTime=Mon Dec 21 21:27:31 CST 2020, time=2020-12-21, status=1, ipAttribution=)]
    2020-12-21 水-晶
  9. [GetPortalCommentsPageByObjectIdResponse(id=1297500, encodeId=7305129e5007f, content=<a href='/topic/show?id=c0385134ab' target=_blank style='color:#2F92EE;'>#COVID-19患者#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=60, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=5134, encryptionId=c0385134ab, topicName=COVID-19患者)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=6976269, createdName=zhangph, createdTime=Wed Dec 23 11:32:28 CST 2020, time=2020-12-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1346335, encodeId=1392134633558, content=<a href='/topic/show?id=339e8332035' target=_blank style='color:#2F92EE;'>#胃肠道#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=83320, encryptionId=339e8332035, topicName=胃肠道)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=e03212, 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attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=325e5422748, createdName=宣之, createdTime=Tue Dec 22 14:32:18 CST 2020, time=2020-12-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=909901, encodeId=aed990990154, content=赞, beContent=null, objectType=article, channel=null, level=null, likeNumber=117, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTLHoRmy6NiboIAB60qN4aSx7DBKUhrErP15HhOiazIsQx8cmoWhZNMK2VuESGje1Ylt6qAhA5xcxg7A/132, createdBy=91622093406, createdName=寻寻到此, createdTime=Mon Dec 21 22:25:01 CST 2020, time=2020-12-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=909893, encodeId=ac3f90989313, content=<a href='/topic/show?id=23e3454e353' target=_blank style='color:#2F92EE;'>#学习#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=88, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=45473, encryptionId=23e3454e353, topicName=学习)], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20200627/83a502bff6c14b759a7d0863b4068e7b/32ad40676056418ea58a94afac9c5b81.jpg, createdBy=6f475314305, createdName=水-晶, createdTime=Mon Dec 21 21:44:16 CST 2020, time=2020-12-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=909892, encodeId=4f549098926c, content=学习了,这种有个印象就行,临床中可以想起来就可以了, beContent=null, objectType=article, channel=null, level=null, likeNumber=96, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20200627/83a502bff6c14b759a7d0863b4068e7b/32ad40676056418ea58a94afac9c5b81.jpg, createdBy=6f475314305, createdName=水-晶, createdTime=Mon Dec 21 21:44:11 CST 2020, time=2020-12-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=909884, encodeId=fb719098840e, content=了解, beContent=null, objectType=article, channel=null, level=null, likeNumber=48, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo6KcicAVC1MwuOgo3iaicb1Imgk1yIfnvr6oXzibcAFB6puAyNJXbzWhNuLqaFYBVRWjh7rghkvFLPxMAfD5ib3nXwVD/0, createdBy=bed21972958, createdName=wxl882001, createdTime=Mon Dec 21 21:27:31 CST 2020, time=2020-12-21, status=1, ipAttribution=)]
    2020-12-21 水-晶

    学习了,这种有个印象就行,临床中可以想起来就可以了

    0

  10. 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attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=325e5422748, createdName=宣之, createdTime=Tue Dec 22 14:32:18 CST 2020, time=2020-12-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=909901, encodeId=aed990990154, content=赞, beContent=null, objectType=article, channel=null, level=null, likeNumber=117, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTLHoRmy6NiboIAB60qN4aSx7DBKUhrErP15HhOiazIsQx8cmoWhZNMK2VuESGje1Ylt6qAhA5xcxg7A/132, createdBy=91622093406, createdName=寻寻到此, createdTime=Mon Dec 21 22:25:01 CST 2020, time=2020-12-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=909893, encodeId=ac3f90989313, content=<a href='/topic/show?id=23e3454e353' target=_blank style='color:#2F92EE;'>#学习#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=88, replyNumber=0, topicName=null, 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objectType=article, channel=null, level=null, likeNumber=48, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo6KcicAVC1MwuOgo3iaicb1Imgk1yIfnvr6oXzibcAFB6puAyNJXbzWhNuLqaFYBVRWjh7rghkvFLPxMAfD5ib3nXwVD/0, createdBy=bed21972958, createdName=wxl882001, createdTime=Mon Dec 21 21:27:31 CST 2020, time=2020-12-21, status=1, ipAttribution=)]
    2020-12-21 wxl882001

    了解

    0

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由此可见,该研究可观察到成年重症患者临床上胃肠道大出血的总体发生率较低。皮质类固醇治疗可能会稍微增加临床上胃肠道大出血的发生率,但不会增加任何严重程度的出血。事件较罕见、很少的试验报告和偏倚的高风险降低了证据的质量。

丹麦研究:房颤患者胃肠道出血,需警惕肠癌!

房颤患者常规服用华法林、达比加群、利伐沙班和阿哌沙班等抗凝药物,以防止血栓形成而导致中风。然而,存在胃肠道出血的风险,估计每年约有1%-2%的患者会出血。近日,欧洲心脏杂志上发表的一项丹麦研究称,应用抗凝治疗的房颤患者如果出现胃肠道出血,建议进行肠癌的筛查,不能单纯认为是抗凝药物的原因。该研究发现,与没有胃肠道出血的患者相比,那些发生出血的患者被诊断为肠癌的可能性高出11-24倍。该研究中,发生消

BMJ:质子泵抑制剂和组胺受体拮抗剂对胃肠道出血的预防效果

研究认为,质子泵抑制剂和组胺-2受体拮抗剂可降低高风险人群胃肠道出血风险,但导致患者肺炎风险增加,预防干预对患者死亡率无影响

Clinica Chimica Acta:粪便免疫化学测试和愈创木脂隐血测试在住院患者胃肠道出血评估中的应用?

愈创木脂大便潜血测试(gFOBT)通常用于胃肠道(GI)出血的尚未被临床试验认可的检测方法。 粪便免疫化学测试(FIT)在大肠癌筛查中正逐渐取代gFOBT,并可能在评估严重肠病中发挥作用。 我们检查了住院患者以及第1天和第3天之间的gFOBT结果与FIT与gFOBT(Hemoccult Sensa II)的一致性。。 研究人员在所有送至温尼伯卫生科学中心实验室提取神秘血液的住院病人粪便中,在

Eur Heart J:抗凝治疗房颤患者胃肠道出血与结直肠癌风险

由此可见,在接受抗凝治疗的AF患者中,胃肠道出血导致发生结直肠癌的绝对风险升高。GI出血不应作为OAC治疗的良性结局而排除,而应始终评估潜在的恶性病因。

Intens Care Med:ICU成年患者胃肠道出血的预测因素

由此可见,该研究确定了成年ICU患者CIB和明显胃肠道出血的预测因素。这些发现可用于确定最有可能从应激性溃疡预防中获益的胃肠道出血风险较高的ICU患者。

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