Help
Subscribe


GastroHep.com - the global online resource for all aspects of gastroenterology, hepatology and endoscopy

 25 August 2016

Advanced search
GastroHep.com - the global online resource for all aspects of gastroenterology, hepatology and endoscopy Profile of Roy Pounder

Home

News  
Journals
Review Articles
Slide Atlas
Video Clips
Online Books
Advanced Digestive Endoscopy
Classical Cases
Conference Diary
PubMed
International GH Links
USA GH Links
National GH Links
National GI Societies
Other Useful Links




Emails on Gastroenterology and Hepatology
the National AIDS Treatment Advocacy Project
Visit the gastroenterology section of the EUMS

News

Predicting risk of upper GI bleed and intracranial bleed with anticoagulants

This week's issue of the British Medical Journal predicts risk of upper gastrointestinal bleed and intracranial bleed with anticoagulants.

News image

Drs Julia Hippisley-Cox and Carol Coupland developed and validated risk algorithms (QBleed) for estimating the absolute risk of upper gastrointestinal and intracranial bleed for patients with and without anticoagulation aged 21-99 years in primary care.

The research team performed an open cohort study using routinely collected data from general practice linked to hospital episode statistics data and mortality data during the five year study period between 2008 and 2013.

The team evaluated 565 general practices in England contributing to the national QResearch database to develop the algorithm, and 188 different QResearch practices to validate the algorithm.

All 753 general practices had data linked to hospital episode statistics, and mortality data at individual patient level.

The team's endpoint was gastrointestinal bleed and intracranial bleed recorded on either the linked mortality data or the linked hospital records.

Sensitivity value for the top 10th of women at highest risk was 51%
British Medical Journal

The researchers studied 4.4 million patients in the derivation cohort with 16.4 million person years of follow-up.

During follow-up, 21 641 patients had an incident upper gastrointestinal bleed, and 9040 had an intracranial bleed.

For the validation cohort, the team identified 1.4 million patients contributing over 4.9 million person years of follow-up.

During follow-up, 6600 patients had an incident gastrointestinal bleed, and 2820 had an intracranial bleed.

The team excluded patients without a valid Townsend score for deprivation, and those prescribed anticoagulants in the 180 days before study entry.

Risk factors Candidate variables recorded on the general practice computer system before entry to the cohort, including personal variables, lifestyle variables, chronic diseases, prescribed drugs, clinical values, and laboratory test results.

The researchers also included previous bleed recorded before entry to the study.

The final QBleed algorithms incorporated 21 variables.

The team found that when applied to the validation cohort, the algorithms in women explained 40% of the variation for upper gastrointestinal bleed, and 58% for intracranial bleed.

The corresponding D statistics were 1.67 and 2.42.

The researchers noted that the receiver operating curve statistic values were 0.77 and 0.86.

The sensitivity values for the top 10th of men and women at highest risk were 38% and 51%, respectively.

The research team observed similar results for men.

Dr Hippisley-Cox and colleague conclude, "The QBleed algorithms provided valid measures of absolute risk of gastrointestinal, and intracranial bleed in patients with and without anticoagulation as shown by the performance of the algorithms in a separate validation cohort."

"Further research is needed to evaluate the clinical outcomes and the cost effectiveness of using these algorithms in primary care."

BMJ 2014;349:g4606
11 August 2014

Go to top of page Email this page Email this page to a colleague

 25 August 2016 
Short-chain fatty acids in mixed refractory constipation
 25 August 2016 
Stool DNA test for colorectal cancer screening
 25 August 2016 
Post-infectious IBS in C. diff
 24 August 2016 
Hep B after infant vaccination program
 24 August 2016 
Obeticholic acid for primary biliary cholangitis
 24 August 2016 
Genetics and therapy response in IBD
 23 August 2016 
Colorectal cancer genetics as biomarkers
 23 August 2016 
Prognostic test for mortality after liver transplant
 23 August 2016 
Postoperative mortality in elderly with IBD
 22 August 2016 
Celiac disease in the elderly
 22 August 2016 
Laparoscopic vs open colectomy databases
 22 August 2016 
Mucosal healing and ulcerative colitis outcomes
 19 August 2016 
Dietary questionnaire for GI clinics
 19 August 2016 
Botox treatment for chronic anal fissure
 19 August 2016 
Myeloid-derived suppressor cells in GI cancers
 18 August 2016 
Gallstone formation determinants
 18 August 2016 
Age disparities in IBD therapy
 18 August 2016 
Seasonal variation in diverticulitis
 17 August 2016 
IBD activity score for routine clinical use
 17 August 2016 
Attitudes to H. pylori in primary care
 17 August 2016 
Nonselective β-blockers and mortality in cirrhosis
 16 August 2016 
Upper GI lesions in adults with IBD
 16 August 2016 
C. difficile infection and mortality when managed by GI surgeons
 16 August 2016 
HCV eradication in cirrhosis
 15 August 2016 
Predicting favorable outcomes in IBD
 15 August 2016 
Scoring system predicted microscopic colitis
 15 August 2016 
Mortality in spontaneous bacterial peritonitis
 12 August 2016 
Recurrence of resected gastric cancer
 12 August 2016 
Screening for pancreatic cancer
 12 August 2016 
Index for diagnostic accuracy of Crohn's
 11 August 2016 
Colorectal neoplasm on surveillance colonoscopies
 11 August 2016 
Bowel disease in primary care patients with bowel symptoms
 11 August 2016 
Diagnosis in covert hepatic encephalopathy
 10 August 2016 
Maintenance therapy for children with eosinophilic esophagitis
 10 August 2016 
Moderate alcohol use and insulin action in HCV
 10 August 2016 
Consensus on the management of GERD
 09 August 2016 
Pancreatitis quality of life instrument
 09 August 2016 
Gallstone disease and NAFLD
 09 August 2016 
Steroid dependency and IBD
 08 August 2016 
Venous thromboembolism in celiac disease
 08 August 2016 
C. diff in IBD 
 08 August 2016 
Gut-directed hypnotherapy vs low FODMAP diet in IBS
 05 August 2016 
Therapy for H.pylori treatment
 05 August 2016 
Obesity and the development of NAFLD
 05 August 2016 
Obesity and CVD in celiac disease
 04 August 2016 
Bleeding after endoscopic resection of colorectal lesions
 04 August 2016 
Novel risk factor for post-ERCP pancreatitis
 04 August 2016 
Ondansetron for children with acute gastroenteritis
 03 August 2016 
Post-colonoscopy complications
 03 August 2016 
IVF in women with IBD
 03 August 2016 
Post-operative pancreatic fistulae after pancreatic surgery
 02 August 2016 
H. pylori in children
 02 August 2016 
Gastric cancer in patients with gastric intestinal metaplasia
 02 August 2016 
Behavioral changes and bariatric surgery
 01 August 2016 
Relapse after cessation of oral antiviral treatment in Hep B
 01 August 2016 
Antimicrobial resistance of H. pylori
 01 August 2016 
Colorectal cancers in IBD
 29 July 2016 
Susceptibility loci for gallstone disease
 29 July 2016 
H. pylori clarithromycin resistance in the USA
 29 July 2016 
Tool to diagnose Helicobacter-negative gastritis

Blackwell Publishing


GastroHep.com is a Blackwell Publishing registered trademark
© 2016 Wiley-Blackwell and GastroHep.com and contributors
Privacy Statement
Disclaimer
About Us