Abstract:
BACKGROUND:It is unclear whether an upper gastrointestinal bleed is an isolated gastrointestinal event or an indicator of a deterioration in a patient's overall health status. Therefore, we investigated the excess causes of death in individuals after a non-variceal bleed compared with deaths in a matched sample of the general population. METHODS AND FINDINGS:Linked longitudinal data from the English Hospital Episodes Statistics (HES) data, General Practice Research Database (GPRD), and Office of National Statistics death register were used to define a cohort of non-variceal bleeds between 1997 and 2010. Controls were matched at the start of the study by age, sex, practice, and year. The excess risk of each cause of death in the 5 years subsequent to a bleed was then calculated whilst adjusting for competing risks using cumulative incidence functions. 16,355 patients with a non-variceal upper gastrointestinal bleed were matched to 81,523 controls. The total 5-year risk of death due to gastrointestinal causes (malignant or non-malignant) ranged from 3.6% (≤ 50 years, 95% CI 3.0%-4.3%) to 15.2% (≥ 80 years, 14.2%-16.3%), representing an excess over controls of between 3.6% (3.0%-4.2%) and 13.4% (12.4%-14.5%), respectively. In contrast the total 5-year risk of death due to non-gastrointestinal causes ranged from 4.1% (≤ 50 years, 3.4%-4.8%) to 46.6% (≥ 80 years, 45.2%-48.1%), representing an excess over controls of between 3.8% (3.1%-4.5%) and 19.0% (17.5%-20.6%), respectively. The main limitation of this study was potential misclassification of the exposure and outcome; however, we sought to minimise this by using information derived across multiple linked datasets. CONCLUSIONS:Deaths from all causes were increased following an upper gastrointestinal bleed compared to matched controls, and over half the excess risk of death was due to seemingly unrelated co-morbidity. A non-variceal bleed may therefore warrant a careful assessment of co-morbid illness seemingly unrelated to the bleed.
journal_name
PLoS Medjournal_title
PLoS medicineauthors
Crooks CJ,Card TR,West Jdoi
10.1371/journal.pmed.1001437subject
Has Abstractpub_date
2013-01-01 00:00:00pages
e1001437issue
4eissn
1549-1277issn
1549-1676pii
PMEDICINE-D-12-03111journal_volume
10pub_type
杂志文章相关文献
PLOS MEDICINE文献大全abstract:BACKGROUND:Hepatitis C virus (HCV)-specific T cell responses are critical for spontaneous resolution of HCV viremia. Here we examined the effect of a lymphotropic virus, HIV-1, on the ability of coinfected patients to maintain spontaneous control of HCV infection. METHODS AND FINDINGS:We measured T cell responsiveness...
journal_title:PLoS medicine
pub_type: 杂志文章,多中心研究
doi:10.1371/journal.pmed.0030492
更新日期:2006-12-01 00:00:00
abstract::This month in PLOS Medicine we launched a Special Issue on New Tools and Strategies for Tuberculosis Diagnosis, Care, and Elimination. In this issue's Editorial, the Guest Editors Claudia Denkinger, Richard Chaisson, and Mark Hatherill highlight some of the research that will publish and how these studies focusing on ...
journal_title:PLoS medicine
pub_type: 社论
doi:10.1371/journal.pmed.1002795
更新日期:2019-04-30 00:00:00
abstract:BACKGROUND:Skin atrophy is a common manifestation of aging and is frequently accompanied by ulceration and delayed wound healing. With an increasingly aging patient population, management of skin atrophy is becoming a major challenge in the clinic, particularly in light of the fact that there are no effective therapeut...
journal_title:PLoS medicine
pub_type: 杂志文章
doi:10.1371/journal.pmed.0030493
更新日期:2006-12-01 00:00:00
abstract:BACKGROUND:Unrecognized myocardial infarction (UMI) is known to constitute a substantial portion of potentially lethal coronary heart disease. However, the diagnosis of UMI is based on the appearance of incidental Q-waves on 12-lead electrocardiography. Thus, the syndrome of non-Q-wave UMI has not been investigated. De...
journal_title:PLoS medicine
pub_type: 杂志文章
doi:10.1371/journal.pmed.1000057
更新日期:2009-04-21 00:00:00
abstract:BACKGROUND:The radical cure of Plasmodium vivax and P. ovale requires treatment with primaquine or tafenoquine to clear dormant liver stages. Either drug can induce haemolysis in individuals with glucose-6-phosphate dehydrogenase (G6PD) deficiency, necessitating screening. The reference diagnostic method for G6PD activ...
journal_title:PLoS medicine
pub_type: 杂志文章,meta分析
doi:10.1371/journal.pmed.1003084
更新日期:2020-05-14 00:00:00
abstract:BACKGROUND:Introduction of pneumococcal conjugate vaccines (PCVs) of limited valency is justified in Africa by the high burden of pneumococcal disease. Long-term beneficial effects of PCVs may be countered by serotype replacement. We aimed to determine the impact of PCV-7 vaccination on pneumococcal carriage in rural G...
journal_title:PLoS medicine
pub_type: 杂志文章,随机对照试验
doi:10.1371/journal.pmed.1001107
更新日期:2011-10-01 00:00:00
abstract:BACKGROUND:The anti-human epidermal growth factor receptor 2 (HER2) monoclonal antibody trastuzumab improves outcomes in patients with node-positive HER2+ early breast cancer. Given trastuzumab's high cost, we aimed to estimate its cost-effectiveness by heterogeneity in age and estrogen receptor (ER) and progesterone r...
journal_title:PLoS medicine
pub_type: 杂志文章
doi:10.1371/journal.pmed.1002067
更新日期:2016-08-09 00:00:00
abstract:BACKGROUND:There is evidence that a young child's risk of dying increases following the mother's death, but little is known about the risk when the mother becomes very ill prior to her death. We hypothesized that children would be more likely to die during the period several months before their mother's death, as well ...
journal_title:PLoS medicine
pub_type: 杂志文章
doi:10.1371/journal.pmed.1001409
更新日期:2013-01-01 00:00:00
abstract:BACKGROUND:Envenoming resulting from snakebites is an important public health problem in many tropical and subtropical countries. Few attempts have been made to quantify the burden, and recent estimates all suffer from the lack of an objective and reproducible methodology. In an attempt to provide an accurate, up-to-da...
journal_title:PLoS medicine
pub_type: 杂志文章
doi:10.1371/journal.pmed.0050218
更新日期:2008-11-04 00:00:00
abstract::Community efforts and peer support programs are needed in addition to provider-initiated and opt-out HIV testing in adolescents, Sheri Weiser and colleagues discuss. ...
journal_title:PLoS medicine
pub_type: 杂志文章
doi:10.1371/journal.pmed.1002361
更新日期:2017-07-25 00:00:00
abstract:BACKGROUND:Although the involvement of intra-tumor genetic heterogeneity in tumor progression, treatment resistance, and metastasis is established, genetic heterogeneity is seldom examined in clinical trials or practice. Many studies of heterogeneity have had prespecified markers for tumor subpopulations, limiting thei...
journal_title:PLoS medicine
pub_type: 杂志文章,多中心研究
doi:10.1371/journal.pmed.1001786
更新日期:2015-02-10 00:00:00
abstract:BACKGROUND:Malaria vaccines based on the 19-kDa region of merozoite surface protein 1 (MSP-1(19)) derived from the 3D7 strain of Plasmodium falciparum are being tested in clinical trials in Africa. Knowledge of the distribution and natural dynamics of vaccine antigen polymorphisms in populations in which malaria vaccin...
journal_title:PLoS medicine
pub_type: 杂志文章
doi:10.1371/journal.pmed.0040093
更新日期:2007-03-01 00:00:00
abstract:BACKGROUND:Insecticide-treated nets (ITNs) and indoor residual spraying (IRS) of houses provide effective malaria transmission control. There is conflicting evidence about whether it is more beneficial to provide both interventions in combination. A cluster randomised controlled trial was conducted to investigate wheth...
journal_title:PLoS medicine
pub_type: 杂志文章,随机对照试验
doi:10.1371/journal.pmed.1001630
更新日期:2014-04-15 00:00:00
abstract:BACKGROUND:Hand, foot, and mouth disease (HFMD) is a common childhood illness caused by serotypes of the Enterovirus A species in the genus Enterovirus of the Picornaviridae family. The disease has had a substantial burden throughout East and Southeast Asia over the past 15 y. China reported 9 million cases of HFMD bet...
journal_title:PLoS medicine
pub_type: 杂志文章
doi:10.1371/journal.pmed.1001958
更新日期:2016-02-16 00:00:00
abstract::David Studdert and colleagues explore how to balance public health, individual freedom, and good government when it comes to sugar-sweetened drinks. ...
journal_title:PLoS medicine
pub_type: 杂志文章
doi:10.1371/journal.pmed.1001848
更新日期:2015-07-07 00:00:00
abstract:BACKGROUND:The alpha-thalassaemias are the commonest genetic disorders of humans. It is generally believed that this high frequency reflects selection through a survival advantage against death from malaria; nevertheless, the epidemiological description of the relationships between alpha-thalassaemia, malaria, and othe...
journal_title:PLoS medicine
pub_type: 杂志文章
doi:10.1371/journal.pmed.0030158
更新日期:2006-05-01 00:00:00
abstract:BACKGROUND TO THE DEBATE:The UK Medical Research Council defines complex interventions as those comprising "a number of separate elements which seem essential to the proper functioning of the interventions although the 'active ingredient' of the intervention that is effective is difficult to specify." A typical example...
journal_title:PLoS medicine
pub_type: 杂志文章
doi:10.1371/journal.pmed.1000086
更新日期:2009-08-01 00:00:00
abstract:BACKGROUND:Most adults infected with HIV achieve viral suppression within a year of starting combination antiretroviral therapy (cART). It is important to understand the risk of AIDS events or death for patients with a suppressed viral load. METHODS AND FINDINGS:Using data from the Collaboration of Observational HIV E...
journal_title:PLoS medicine
pub_type: 杂志文章
doi:10.1371/journal.pmed.1001194
更新日期:2012-01-01 00:00:00
abstract:BACKGROUND:Rare diseases affect as many as 60 million people in the United States and Europe. However, most rare diseases lack effective therapies and are in critical need of clinical research. Our objective was to determine the frequency of noncompletion and nonpublication of trials studying rare diseases. METHODS AN...
journal_title:PLoS medicine
pub_type: 杂志文章
doi:10.1371/journal.pmed.1002966
更新日期:2019-11-21 00:00:00
abstract:BACKGROUND:Many mathematical models have investigated the impact of expanding access to antiretroviral therapy (ART) on new HIV infections. Comparing results and conclusions across models is challenging because models have addressed slightly different questions and have reported different outcome metrics. This study co...
journal_title:PLoS medicine
pub_type: 杂志文章
doi:10.1371/journal.pmed.1001245
更新日期:2012-01-01 00:00:00
abstract:BACKGROUND:Exposure to a nutritionally deficient environment during fetal life and early infancy may adversely alter the ontogeny of the immune system and affect an infant's ability to mount an optimal immune response to vaccination. We examined the effects of maternal nutritional supplementation during pregnancy on in...
journal_title:PLoS medicine
pub_type: 杂志文章,随机对照试验
doi:10.1371/journal.pmed.1002854
更新日期:2019-08-06 00:00:00
abstract:BACKGROUND:Toll-like receptors (TLRs) are essential in host defense against pathogens by virtue of their capacity to detect microbes and initiate the immune response. TLR2 is seen as the most important receptor for gram-positive bacteria, while TLR4 is regarded as the gram-negative TLR. Melioidosis is a severe infectio...
journal_title:PLoS medicine
pub_type: 杂志文章
doi:10.1371/journal.pmed.0040248
更新日期:2007-07-31 00:00:00
abstract:BACKGROUND:Perinatal mortality and morbidity continue to be major global health challenges strongly associated with prematurity and reduced fetal growth, an issue of further interest given the mounting evidence that fetal growth in general is linked to degrees of risk of common noncommunicable diseases in adulthood. Ag...
journal_title:PLoS medicine
pub_type: 杂志文章
doi:10.1371/journal.pmed.1002220
更新日期:2017-01-24 00:00:00
abstract:BACKGROUND:Prescription opioid misuse has become a leading cause of unintentional injury and death among adolescents and young adults in the United States. However, there is limited information on how adolescents and young adults obtain prescription opioids. There are also inadequate recent data on the prevalence of ad...
journal_title:PLoS medicine
pub_type: 杂志文章
doi:10.1371/journal.pmed.1002922
更新日期:2019-11-05 00:00:00
abstract:BACKGROUND:Effective implementation strategies are needed to increase engagement in HIV services in hyperendemic settings. We conducted a pragmatic cluster-randomized trial in a high-risk, highly mobile fishing community (HIV prevalence: approximately 38%) in Rakai, Uganda, to assess the impact of a community health wo...
journal_title:PLoS medicine
pub_type: 杂志文章
doi:10.1371/journal.pmed.1003475
更新日期:2021-01-06 00:00:00
abstract::Kwonjune Seung and colleagues describe the Eugene Bell Foundation's experience of treating MDR-TB in North Korea. ...
journal_title:PLoS medicine
pub_type: 杂志文章
doi:10.1371/journal.pmed.1002062
更新日期:2016-08-02 00:00:00
abstract:BACKGROUND:Randomized clinical trials of oral antiretroviral pre-exposure prophylaxis (PrEP) for HIV prevention have widely divergent efficacy estimates, ranging from 0% to 75%. These discrepancies are likely due to differences in adherence. To our knowledge, no studies to date have examined the impact of improving adh...
journal_title:PLoS medicine
pub_type: 杂志文章,随机对照试验
doi:10.1371/journal.pmed.1001511
更新日期:2013-01-01 00:00:00
abstract:BACKGROUND:Although the success of HIV treatment programs depends on retention and viral suppression, routine program monitoring of these outcomes may be incomplete. We used data from the national electronic medical record (EMR) system in Zambia to enumerate a large and regionally representative cohort of patients on t...
journal_title:PLoS medicine
pub_type: 杂志文章,多中心研究
doi:10.1371/journal.pmed.1002811
更新日期:2019-05-31 00:00:00
abstract:BACKGROUND:The identification and characterization of tumor suppressor genes has enhanced our understanding of the biology of cancer and enabled the development of new diagnostic and therapeutic modalities. Whereas in past decades, a handful of tumor suppressors have been slowly identified using techniques such as link...
journal_title:PLoS medicine
pub_type: 杂志文章
doi:10.1371/journal.pmed.0050114
更新日期:2008-05-27 00:00:00
abstract::Martin Gerdin and colleagues argue that disaster health interventions and decision-making can benefit from an evidence-based approach Please see later in the article for the Editors' Summary. ...
journal_title:PLoS medicine
pub_type: 杂志文章
doi:10.1371/journal.pmed.1001632
更新日期:2014-04-22 00:00:00