Help
Subscribe


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

 30 June 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

 30 June 2016 
IBS-type symptoms in pediatric IBD
 30 June 2016 
Antibiotics in children and obesity
 30 June 2016 
Staging system for familial adenomatous polyposis
 29 June 2016 
Anti-tumor necrosis factor in mothers and newborns
 29 June 2016 
Hep C eradication in people who inject drugs
 29 June 2016 
Progression to esophageal carcinoma in Barrett's
 28 June 2016 
Cancer recurrence after immune-suppressive therapies
 28 June 2016 
Gastric cancer screening in the USA
 28 June 2016 
Acute severe ulcerative colitis
 27 June 2016 
Epidemiology of NAFLD
 27 June 2016 
Tobacco smoking and ulcerative colitis
 27 June 2016 
The Toronto Consensus for H. pylori treatment
 24 June 2016 
Dietary trends in the USA
 24 June 2016 
Statins and colorectal cancer in IBD
 24 June 2016 
Fibre for chronic idiopathic constipation
 23 June 2016 
Biomarker for eosinophilic esophagitis diagnosis
 23 June 2016 
Touch screens in the IBD outpatient clinic
 23 June 2016 
Adverse events after colonoscopy bowel preparations
 22 June 2016 
Benefits and harms of colorectal cancer screening
 22 June 2016 
IBS symptoms in IBD
 22 June 2016 
Outcomes among US veterans with Hep B
 21 June 2016 
Screening for colorectal cancer
 21 June 2016 
Tenofovir and Hep B transmission in mothers
 21 June 2016 
Access to liver subspecialty care and survival
 20 June 2016 
Genes for colorectal cancer risk
 20 June 2016 
Patients and gastroenterologists’ perceptions on IBD
 20 June 2016 
Hep C treatment in people who inject drugs
 17 June 2016 
Noninvasive markers of liver fibrosis
 17 June 2016 
Predictors of starting with long-term PPIs
 17 June 2016 
Extrahepatic manifestations of Hep C
 16 June 2016 
Assessing progression of NAFLD
 16 June 2016 
Endotracheal intubation and endoscopy unit efficiency metrics
 16 June 2016 
Bile acid diarrhea
 15 June 2016 
Consensus for acute severe ulcerative colitis
 15 June 2016 
Dental erosions in GERD
 15 June 2016 
Pharmacological treatments for obesity with weight loss
 14 June 2016 
Antibiotics and gut inflammation
 14 June 2016 
Liver-related mortality in the developed world
 14 June 2016 
Hep C patient outcomes treated with different anti-viral regimens
 13 June 2016 
Obesity in the USA
 13 June 2016 
Celiac disease drug development
 13 June 2016 
Pneumonia risk in celiac disease
 10 June 2016 

Celiac disease drug development

 10 June 2016 
Rectal cancer surgery checklist
 10 June 2016 
Breath as a marker for IBS
 09 June 2016 
Psychological morbidity in young people with IBD
 09 June 2016 
Predicting hepatic encephalopathy in cirrhosis
 09 June 2016 
Evaluation of endoscopic findings from patients with Crohn's
 08 June 2016 
Adult obesity trends in the USA
 08 June 2016 
Pediatric IBD unclassified vs other IBD
 08 June 2016 
Dark chocolate and NASH oxidation
 07 June 2016 
Flexible endoscopy for Zenker's diverticulum
 07 June 2016 
Predicting risk of hepatic encephalopathy in cirrhosis
 07 June 2016 
Electronic learning system for colon capsule endoscopy
 06 June 2016 
Disturbed sleep and symptoms in IBS
 06 June 2016 
Oral contraceptives and Crohn’s complications
 06 June 2016 
Eosinophilic esophagitis
 03 June 2016 
Antibiotic prophylaxis in cirrhosis
 03 June 2016 
Mortality in hospitalized peptic ulcer patients
 03 June 2016 
Decision aid for surgical patients with ulcerative colitis

Blackwell Publishing


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