Analysis Of Risk Factors For Upper Gastrointestinal Hemorrhage Complicated With Acute Coronary Syndrome

ObjectiveTo investigate the risk factors of acute coronary syndrome(ACS)in patients with upper gastrointestinal hemorrhage(UGIH)by analyze the demographic characteristics,related medical history,vital signs and laboratory inspections of patients.MethodsA retrospective analysis of 40 patients with UGIH complicated with ACS admitted to The Second Hospital of Dalian Medical University was set as an observation group.At the same time,120 patients with UGIH but without ACS at the same time wererandomly selected as the control group.Collect demographic characteristics(gender,age),bad habits(smoking,drinking),basic vital signs(systolic blood pressure,diastolic blood pressure,pulse),underlying diseases(coronary heart disease,hypertension,diabetes),laboratory inspections(hemoglobin,hematocrit,platelets,plasma D-dimer,cholesterol,triglycerides,fasting blood glucose,serum creatinine,blood ureanitrogen),and Blatchford score.Using retrospective analysis,statistical methods include chi-square test,t-test,logistic multivariate regression analysis,and ROC curve.Results1.There was no significant difference in gender composition between the two groups(?~2=0.093,P=0.761).2.Average age of the observation group[(69.75±13.27)years]is significantly higher than the control group[(55.57±16.01)years],(t=5.050,P=0.000).3.There was no significant difference in the mean systolic blood pressurebetween the observation group and the control group(t=1.859,P=0.065).The average diastolic blood pressure in the observation group[(65.95±15.92)mmHg]wassignificantly lower than control group[(74.63±11.26)mmHg],(t=-3.784,P=0.002);The average pulse of the observation group[(94.88±21.69)beats/min]wassignificantly higher than that of the control group[(94.88±21.69)beats/min],(t=2.898,P=0.004).4.The proportion of smokers in the observation group was significantly higher than that in the control group(?2=4.672 P=0.031);The proportion of drinking patients in the observation group was significantly higher than that in the control group(?2=5.209 P=0.022).5.The proportion of patients with hypertension in the observation group was significantly higher than that in the control group(?2=13.889,P=0.000);The proportion of diabetic patients in the observation group was significantly higher than that in the control group(?2=9.367,P=0.002);The proportion of patients with coronary heart disease in the observation group was significantly higher than that in the control group(?2=13.320,P=0.001).6.The average hemoglobin of the observation group[(75.00±20.15)g/L]was significantly lower than that of the control group[(93.86±22.61)g/L],(t=-4.689,P=0.000).The average hematocrit of the observation group[(23.92±7.12)%]was significantly lower than that of the control group[(29.21±6.75)%],(t=-4.235,P=0.000);The average plasma D-dimer level in the observation group[(1.58±1.63)mg/L]was significantly higher than that in the control group[(0.77±0.98)mg/L],(t=4.389,P=0.000).There was no significant difference in mean platelet difference between the two groups(t=-0.670,P=0.504).7.There was no significant difference in cholesterol between the two groups(t=-0.886,P=0.385).There was no significant difference in triglyceride between the two groups(t=-0.486,P=0.633).There was no significant difference in fasting blood glucose levels between the two groups(t=-1.473,P=0.149).8.The average urea nitrogen level in the observation group[(12.03±7.02)mmol/L]was significantly higher than the control group[(7.86±4.37)mmol/L],(t=3.410,P=0.001).The average serum creatinine in the observation group[(103.18±41.98)umol/L]was significantly higher than the control group[(74.65±29.50)umol/L],(t=3.801,P=0.001).9.The observation group's Blatchford score[(11.35±2.84)point]wassignificantly higher than the control group[(7.76±3.19)point],(t=6.308,P=0.000).10.Logistics multivariate regression analysis of these 14 factors,including diastolic blood pressure,pulse,hemoglobin,hematocrit,plasma D-dimer,serumcreatinine,blood urea nitrogen,Blatchford score,smoking history,drinking history,history of hypertension,history of coronary heart disease,history of diabetes.Result prompt:age(OR=1.091,95%CI 1.036-1.149,P=0.001).Diastolic blood pressure(OR=0.952,95%CI 0.910-0.996,P=0.033).Pulse(OR=1.031,95%CI 1.003-1.059,P=0.032).Hemoglobin(OR=0.964,95%CI 0.935-0.993,P=0.017).Hematocrit(OR=0.853,95%CI 0.793-0.918,P=0.000).Plasma D-dimer(OR=1.710,95%CI 1.195-2.446,P=0.003).Blatchford score(OR=1.516,95%CI 1.227-1.799,P=0.000).These seven factors are risk factors for UGIH complicated with ACS.11.Optimal cut-off analysis of age,pulse,diastolic blood pressure,hemoglobin,hematocrit,plasma D-dimer,and Blatchford score,draw ROC curve,reach conclusion:The ROC curve of age values showed that the area under the ROC curvewas0.748,the optimal cut-off value was 62.5 year old,and the relative sensitivity and specificity were0.725 and 0.667;The ROC curve of pulse values showed that the area under the ROC curvewas 0.636,the optimal cut-off value was 117 times/min,and the relativesensitivity and specificity were 0.225 and 0.967;The ROC curve of diastolic blood pressurevalues showed that the area under the ROC curve was 0.682,the optimal cut-off value was 65.5mmHg,and the relative sensitivity and specificity were 0.5 and0.833;The ROC curve of hemoglobin values showed that the area under the ROCcurve was 0.746,the optimal cut-off value was 79.49g/L,and the relative sensitivity and specificity were 0.850 and 0.533;The ROC curve of hematocrit values showed that the area under the ROC curve was 0.737,the optimal cut-off value was 23.45%,and the relative sensitivity and specificity were 0.575 and 0.850;The ROC curve of plasmaD-dimer values showed that the area under the ROC curve was 0.730,the optimalcut-off value was 0.57mg/L,and the relative sensitivity and specificity were 0.825 and0.417;The ROC curve of Blatchford score values showed that the area under the ROC curve was 0.796,the optimal cut-off value was 10.60,and the relative sensitivity and specificity were 0.650 and 0.208.ConclusionAge,diastolic blood pressure,pulse,hemoglobin,hematocrit,plasma D-dimer,and Blatchford score are the risk factors for UGIH combined with ACS.Especially when age(29)62.5 years,pulse(29)117beats/min,diastolic blood pressure(27)65.5mmHg,hemoglobin(27)79.49g/L,hematocrit(27)23.45%,plasma D-dimer(29)0.57mg/L,Blatchford score(29)10.60 points,UGIH concurrent ACS The higher the risk.