Predictors of myocardial injury in patients with acute upper gastrointestinal bleeding

Abstract

UPPER gastrointestinal bleeding (UGIB) is a common, potentially life-threatening condition. Myocardial injury may complicate UGIB. Previous studies were conducted to evaluate causes and consequences of UGIB after acute myocardial infarction (AMI). Acute MI adds additional risk to already critically ill patients of UGIB and markedly worsens their prognosis. However, little data are known about the prediction of MI in patients with acute UGIB. The aim of the work was to study the predictive risk factors for acute myocardial infarction in patients with acute upper gastrointestinal bleeding. One hundred and five patients with UGIB (67 males and 38 females) with mean age of 52.9 ± 9.3 years were enrolled in the study. Patients were excluded from the study if there was one or more of the following: age younger than 35 years, initial systolic blood pressure > 100 mmHg, initial hemoglobin ⩾ 12 gm/dl, history of previous ischemic heart disease, or contraindication for upper GIT endoscopy. All patients were submitted to full history taken and clinical examination, emergency upper gastrointestinal endoscopy, 12-leads electrocardiography (ECG), CK, CK-MB, Troponin I, complete blood picture, liver and kidney function tests, bleeding profile, arterial blood gases and electrolytes, lipid profile, fasting and postprandial blood glucose level, abdominal ultrasonography, and echocardiographic assessment. According to the presence of myocardial injury, patients were divided into two groups: Group I; included 66 patients without myocardial injur. Group II: included 39 patients with myocardial injury. Population characteristics were comparable in all groups. In patients with myocardial injury, there were significantly more hypertensive patients, more smokers, more patients with liver cirrhosis, and more patients with rebleeding than among those without myocardial injury. In patients with myocardial injury, mean body mass index, mean C-reactive protein, and mean hospital were significantly higher than in patients without myocardial injury. Logistic regression analysis showed that the most significant predictors for myocardial injury in descending order were: hypertension (score = 14.48, odd ratio = 7.057, p < 0.00001), cigarette smoking (score = 10.425, odd ratio = 5.425, p < 0.0001), liver cirrhosis (score = 7.845, odd ratio = 4.972, p = 0.0017), body mass index > 25 kg/m 2 (score = 7.132, odd ratio = 4.214, p = 0.0073), and C-reactive protein level > 5 mg/dl (score = 6.321, odd ratio = 3.986, p = 0.0159). Among patients with UGIB, patients with myocardial injury had significantly more incidence of hypertension, smoking, liver cirrhosis, and rebleeding than those without myocardial injury. Mean body mass index, mean C-reactive protein level, and mean hospital stay were significantly higher in patients with myocardial injury. The most significant predictors for myocardial injury in patients with UGIB in descending order were hypertension, cigarette smoking, liver cirrhosis, body mass index > 25 kg/m 2 , and C-reactive protein level > 5 mg/dl.