Objective To investigate the impact of acute-phase aspirin management strategies on the prognosis of elderly patients with non-major upper gastrointestinal bleeding(UGIB),and to evaluate the role of stratification for patients with a history of percutaneous coronary intervention(PCI).Methods A total of 526 elderly patients with upper UGIB were retrospectively enrolled from the Geriatric Disease Database of Chinese PLA General Hospital between January 2010 and December 2019,and another 380 UGIB patients from the MIMIC-Ⅳ database were included for external validation.All patients had received long-term low-dose aspirin treatment.Based on aspirin usage,patients were divided into a discontinuation group(no aspirin use within 10 d before admission or during hospitalization,n=476)and a continuation group(aspirin use maintained during hospitalization,n=50).Then according to whether there is a history of PCI,the cases are divided into 428 cases without a history of PCI and 98 cases with a history of PCI.The primary outcome was the 30-day composite adverse events(CAE).Multivariate logistic regression and propensity score matching analyses were employed.Results Compared with the discontinuation group,the continuation group had significantly higher proportions of PCI history,renal disease,myocardial infarction,and proton pump inhibitor use,but significantly lower rates of malignancy,platelet count,and estimated glomerular filtration rate(P＜0.05,P＜0.01).A history of PCI was a protective factor for in-hospital CAE.Aspirin use significantly increased the risk of CAE in patients without a PCI history(OR=5.34,95％CI:1.69～15.52,P＜0.01),whereas in patients with a PCI history,aspirin continuation did not increase the risk of adverse outcomes(OR=0.48,95％CI:0.00～11.88,P＞0.05).Consistent results were observed in the MIMIC-Ⅳ validation cohort.Conclusion In elderly patients with non-major UGIB,continuation or discontinuation of aspirin during the acute phase shows no significant difference in overall short-term prognosis.PCI history is a key stratifying factor:continued aspirin use may maintain cardiovascular protective benefits in high-risk post-PCI patients,whereas it may increase adverse risks in those without PCI history.

Objective To investigate the impact of acute-phase aspirin management strategies on the prognosis of elderly patients with non-major upper gastrointestinal bleeding(UGIB),and to evaluate the role of stratification for patients with a history of percutaneous coronary intervention(PCI).Methods A total of 526 elderly patients with upper UGIB were retrospectively enrolled from the Geriatric Disease Database of Chinese PLA General Hospital between January 2010 and December 2019,and another 380 UGIB patients from the MIMIC-Ⅳ database were included for external validation.All patients had received long-term low-dose aspirin treatment.Based on aspirin usage,patients were divided into a discontinuation group(no aspirin use within 10 d before admission or during hospitalization,n=476)and a continuation group(aspirin use maintained during hospitalization,n=50).Then according to whether there is a history of PCI,the cases are divided into 428 cases without a history of PCI and 98 cases with a history of PCI.The primary outcome was the 30-day composite adverse events(CAE).Multivariate logistic regression and propensity score matching analyses were employed.Results Compared with the discontinuation group,the continuation group had significantly higher proportions of PCI history,renal disease,myocardial infarction,and proton pump inhibitor use,but significantly lower rates of malignancy,platelet count,and estimated glomerular filtration rate(P＜0.05,P＜0.01).A history of PCI was a protective factor for in-hospital CAE.Aspirin use significantly increased the risk of CAE in patients without a PCI history(OR=5.34,95％CI:1.69～15.52,P＜0.01),whereas in patients with a PCI history,aspirin continuation did not increase the risk of adverse outcomes(OR=0.48,95％CI:0.00～11.88,P＞0.05).Consistent results were observed in the MIMIC-Ⅳ validation cohort.Conclusion In elderly patients with non-major UGIB,continuation or discontinuation of aspirin during the acute phase shows no significant difference in overall short-term prognosis.PCI history is a key stratifying factor:continued aspirin use may maintain cardiovascular protective benefits in high-risk post-PCI patients,whereas it may increase adverse risks in those without PCI history.

Objective::Older patients with comorbidity, such as coronary heart disease (CHD) and malignant gastrointestinal tumors, are at a high risk of bleeding events. However, risk prediction models based on risk factor assessment remain unclear. This study aimed to establish an individualized bleeding risk assessment system based on the analysis of 10-year inpatient clinical big data.Methods::Total clinical data of 56,819 patients with CHD and 25,988 patients with malignant digestive tract tumors (admitted from January 2008 to December 2017) were retrospectively collected at the First and Second Medical Centers of Chinese People’s Liberation Army General Hospital. Among them, 1307 patients with CHD and malignant digestive tract tumors were screened as the derivation cohort. The dependent variable was the occurrence of major clinical bleeding events. Baseline statistics and hypothesis tests of differences were performed for independent variables according to the occurrence of bleeding. Decision Tree, eXtreme Gradient Boosting (XGBoost), logistic regression, and random forest models were used for comparison. The accuracy, sensitivity, specificity, and area under the receiver operating characteristic curve (AUC-ROC) were applied as the criteria for evaluating and verifying model performance. To evaluate this developed model, another cohort comprising 454 patients (admitted from January 2018 to December 2019) was prospectively enrolled as the validation cohort based on the same inclusion and exclusion criteria.Results::Among the 64 variables with <50% missing values, the recursive feature elimination method with a random forest model was used to screen the selected variables. The highest accuracy was obtained following the selection of 10 scalars, and the final model was constructed accordingly. XGBoost demonstrated the best performance comprehensively. The AUC-ROC of this model was 0.981, with an accuracy, sensitivity, and specificity of 0.939, 0.950, and 0.927, respectively. In the validation cohort, the AUC-ROC, accuracy, sensitivity, and specificity of the XGBoost model were 0.702, 0.718, 0.636, and 0.725, respectively. The rate of major bleeding events has a positive correlation with the bleeding risk score quintiles. To allow for convenient clinical application, a smartphone application was developed for easy access and calculation (http://fir.master-wx.com/sghr).Conclusion::We successfully established a risk model and score for predicting bleeding events in older patients with comorbidity, such as CHD and gastrointestinal cancer.

Objective::Older patients with comorbidity, such as coronary heart disease (CHD) and malignant gastrointestinal tumors, are at a high risk of bleeding events. However, risk prediction models based on risk factor assessment remain unclear. This study aimed to establish an individualized bleeding risk assessment system based on the analysis of 10-year inpatient clinical big data.Methods::Total clinical data of 56,819 patients with CHD and 25,988 patients with malignant digestive tract tumors (admitted from January 2008 to December 2017) were retrospectively collected at the First and Second Medical Centers of Chinese People’s Liberation Army General Hospital. Among them, 1307 patients with CHD and malignant digestive tract tumors were screened as the derivation cohort. The dependent variable was the occurrence of major clinical bleeding events. Baseline statistics and hypothesis tests of differences were performed for independent variables according to the occurrence of bleeding. Decision Tree, eXtreme Gradient Boosting (XGBoost), logistic regression, and random forest models were used for comparison. The accuracy, sensitivity, specificity, and area under the receiver operating characteristic curve (AUC-ROC) were applied as the criteria for evaluating and verifying model performance. To evaluate this developed model, another cohort comprising 454 patients (admitted from January 2018 to December 2019) was prospectively enrolled as the validation cohort based on the same inclusion and exclusion criteria.Results::Among the 64 variables with <50% missing values, the recursive feature elimination method with a random forest model was used to screen the selected variables. The highest accuracy was obtained following the selection of 10 scalars, and the final model was constructed accordingly. XGBoost demonstrated the best performance comprehensively. The AUC-ROC of this model was 0.981, with an accuracy, sensitivity, and specificity of 0.939, 0.950, and 0.927, respectively. In the validation cohort, the AUC-ROC, accuracy, sensitivity, and specificity of the XGBoost model were 0.702, 0.718, 0.636, and 0.725, respectively. The rate of major bleeding events has a positive correlation with the bleeding risk score quintiles. To allow for convenient clinical application, a smartphone application was developed for easy access and calculation (http://fir.master-wx.com/sghr).Conclusion::We successfully established a risk model and score for predicting bleeding events in older patients with comorbidity, such as CHD and gastrointestinal cancer.

OBJECTIVE: To investigate the correlation between the severity of obstructive sleep apnea syndrome (OSAS) and red cell distribution width (RDW) in elderly patients. METHODS: A cross-sectional study was conducted among 311 elderly patients diagnosed with OSAS in the snoring clinic between January, 2015 and October, 2016 and 120 healthy controls without OSAS from physical examination populations in the General Hospital of PLA. The subjects were divided into control group with apnea-hypopnea index (AHI) <5 (=120), mild OSAS group (AHI of 5.0-14.9; =90), moderate OSAS group (AHI of 15.0-29.9; =113) and severe OSAS group (AHI ≥ 30; =108). The clinical characteristics and the results of polysomnography, routine blood tests and biochemical tests of the subjects were collected. Multiple linear regression analysis was used to examine the correlation between OSAS severity and RDW. RESULTS: The levels of RDW and triglyceride were significantly higher in severe OSAS group than in the other groups ( < 0.01). The levels of fasting blood glucose and body mass index were significantly higher in severe and moderate OSAS groups than in mild OSAS group and control group ( < 0.05 or < 0.01). Multiple linear regression analysis showed that AHI was positively correlated with body mass index (β=0.111, =0.032) and RDW (β=0.106, =0.029). The area under ROC curve of RDW for predicting the severity of OSAS was 0.687 (=0.0001). CONCLUSIONS The RDW increases as OSAS worsens and may serve as a potential marker for evaluating the severity of OSAS.
Aged ; Cross-Sectional Studies ; Erythrocyte Indices ; Humans ; Polysomnography ; Severity of Illness Index ; Sleep Apnea, Obstructive

OBJECTIVE: To evaluate the changes of cardiac structure and function and their risk factors in elderly patients with obstructive sleep apnea syndrome (OSA) without cardiovascular complications. METHODS: Eighty-two elderly OSA patients without cardiovascular disease admitted between January, 2015 and October, 2016 were enrolled in this study. According to their apnea-hypopnea index (AHI, calculated as the average number of episodes of apnoea and hypopnoea per hour of sleep), the patients were divided into mild OSA group (AHI < 15) and moderate to severe OSA group (AHI ≥ 15). The demographic data and the general clinical data were recorded and fasting blood samples were collected from the patients on the next morning following polysomnographic monitoring for blood cell analysis and biochemical examination. Echocardiography was performed within one week after overnight polysomnography, and the cardiac structure, cardiac function and biochemical indexes were compared between the two groups. RESULTS: Compared with those with mild OSA group, the patients with moderate to severe OSA had significantly higher hematocrit (0.22±0.08 CONCLUSIONS Cardiac diastolic function impairment may occur in elderly patients with moderate or severe OSA who do not have hypertension or other cardiovascular diseases, and the severity of the impairment is positively correlated with AHI.
Aged ; Cardiovascular Diseases/etiology* ; Humans ; Risk Factors ; Severity of Illness Index ; Sleep Apnea, Obstructive/complications* ; Stroke Volume ; Ventricular Dysfunction, Left ; Ventricular Function, Left