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Analysis of risk factors for hypoglycemia in patients with gastrointestinal bleeding induced by somatostatin for injection and establishment of the prediction model. International journal of clinical pharmacology and therapeutics OBJECTIVES:This study aimed to explore the risk factors of hypoglycemia in patients with gastrointestinal bleeding caused by somatostatin for injection and to establish a prediction model based on logistic regression combined with receiver operating characteristic (ROC) curve. MATERIALS AND METHODS:This retrospective study analyzed patients diagnosed with gastrointestinal bleeding and treated with somatostatin from January 2022 to May 2023 and collected hypoglycemic events. Univariate and multivariate logistic regression analysis were used to determine the independent influencing factors of somatostatin-induced hypoglycemia, and a prediction model was established. ROC analysis was used to evaluate the prediction model. RESULTS:A total of 331 patients were enrolled in this study, and 42 patients developed hypoglycemic events. Age and co-infection were found to be significant risk factors for hypoglycemia in patients with gastrointestinal bleeding induced by somatostatin. Binary logistic regression fitting established the hypoglycemia prediction model Logit (P) = -4.125+0.053Y+1.366Y (co-infection: X = 1, non-co-infection: X = 0), Hosmer-Lemeshow test results showed that the model had a good fit (χ = 10.552, df = 8, p = 0.228), and the AUC of the prediction model to predict the risk of hypoglycemia caused by somatostatin in patients with gastrointestinal bleeding was 0.744 (95% CI: 0.653 - 0.835, p < 0.001), the sensitivity was 57.14%, and the specificity was 93.77%. CONCLUSION:Among adult patients with gastrointestinal bleeding treated with somatostatin for injection, our study found that age and co-infection were significant risk factors for somatostatin-induced hypoglycemia in this patient population, and the fitted models had high predictive value in predicting the occurrence of hypoglycemia. 10.5414/CP204487
Risk Factors for Inadequate Bowel Preparation in Colonoscopy: A Comprehensive Systematic Review and Meta-Analysis. The American journal of gastroenterology INTRODUCTION:Inadequate bowel preparation (IBP) before colonoscopy remains a common problem. This meta-analysis aimed to assess the risk factors associated with IBP. METHODS:We searched multiple databases for studies that assessed risk factors for IBP after adjustment and reported the data as adjusted odds ratios with 95% confidence intervals. Meta-analyses were conducted using a random-effects model, and pooled adjusted odds ratios for risk factors reported in ≥ 3 studies were constructed. RESULTS:One hundred fifty-four studies with 358,257 participants were included. We analyzed 48 unique risk factors. Sociodemographic predictors of IBP were Medicaid insurance, obesity, current tobacco use, age ≥ 65 years, Black race, low education level, male sex, and unmarried status. Comorbidity-related predictors of IBP were any psychiatric disease, cirrhosis, American Society of Anesthesiologists (ASA) class ≥ 3, poor functional status, constipation, diabetes, previous abdominopelvic surgery, and hematochezia. Medication-related predictors of IBP were tricyclic antidepressants, antidepressants, opioids, nontricyclic antidepressants, and calcium channel blockers. Preparation/procedure-related predictors of IBP were brown liquid rectal effluent, any incomplete bowel preparation (BP) intake, lack of split-dose BP, increased BP-to-defecation interval, any nonadherence to dietary instructions, increased BP-to-colonoscopy interval, any BP intolerance, previous IBP, and inpatient status. Although afternoon colonoscopy was a predictor of IBP, subgroup analysis of prospective studies revealed no significant association. DISCUSSION:Our meta-analysis focused on adjusted risk factors to provide precise estimates of the most important risk factors for IBP. Our findings could help develop a validated prediction model to identify high-risk patients for IBP, improve colonoscopy outcomes, reduce the need for repeat colonoscopies, and reduce associated healthcare costs. 10.14309/ajg.0000000000003073
Prediction of Hypoglycemia in Diabetic Patients During Colonoscopy Preparation. Experimental and clinical endocrinology & diabetes : official journal, German Society of Endocrinology [and] German Diabetes Association OBJECTIVE:To explore the clinical outcomes and establish a predictive model of hypoglycemia during colonoscopy preparation for diabetic patients. METHODS:Three-hundred ninety-four patients with diabetes who received colonoscopy were retrospectively enrolled in this study and assigned to hypoglycemia or non-hypoglycemia groups. Information about clinical characteristics and outcomes during colonoscopy preparation was collected and compared between the two groups. Logistic regression analysis was applied to identify the risk factors of hypoglycemia. These risk factors were used to construct a hypoglycemia predictive model verified by the receiver operating characteristic (ROC) curve and Hosmer-Lemeshow goodness fit test. RESULTS:Among 394 participants, 66 (16.8%) underwent a total of 88 hypoglycemia attacks during the bowel preparation. Grade 1 hypoglycemia (≤3.9 mmol/L) comprised 90.9% (80/88) of all hypoglycemia attacks and grade 2 hypoglycemia accounted for 9.1% (8/88), signifying that grade 1 hypoglycemia is the most common type. No severe hypoglycemia was identified. The incidence of nocturnal hypoglycemia was 15.9%. Logistic regression analyses revealed that the main risk factors of hypoglycemia during colonoscopy preparation were postprandial C-peptide, serum triglyceride, gender, type of diabetes mellitus, and insulin injection frequencies. The area under the ROC curve of the hypoglycemia prediction model was 0.777 (95% CI: 0.720-0.833). CONCLUSION:Diabetic patients are prone to develop mild to moderate hypoglycemia during colonoscopy preparation. This study proposes a predictive model that could provide a reference for identifying patients with a high risk of hypoglycemia during colonoscopy preparation. 10.1055/a-2044-0685