AUTHOR=Qiu Weizhi , Liu Chubin , Ye Jinfu , Wang Gang , Yang Fuxing , Pan Zhigang , Hu Weipeng , Gao Hongzhi 

TITLE=Age-to-Glasgow Coma Scale score ratio predicts gastrointestinal bleeding in patients with primary intracerebral hemorrhage

JOURNAL=Frontiers in Neurology

VOLUME=Volume 14 - 2023

YEAR=2023

URL=https://www.frontiersin.org/journals/neurology/articles/10.3389/fneur.2023.1034865

DOI=10.3389/fneur.2023.1034865

ISSN=1664-2295

ABSTRACT=Objective: Recent clinical studies have demonstrated that advanced age and low initial Glasgow Coma Scale (GCS) score were independent predictors of gastrointestinal bleeding (GIB) in patients with primary intracerebral hemorrhage (ICH). However, used singly, age and GCS score have their respective shortcomings in predicting the occurrence of GIB. This study aimed to investigate the association between age to initial GCS score ratio (AGR) and the risk of GIB following ICH. 
Methods: We conducted a single-center, retrospective observational study of consecutive patients presenting with spontaneous primary ICH at our hospital from January 2017 through January 2021. Patients who fulfilled the inclusion and exclusion criteria were categorized into the GIB and non-GIB groups. Univariate and multivariate logistic regression analyses were implemented to identify the independent risk factors for the occurrence of GIB, and a multicollinearity test was performed. Furthermore, One-to-one matching was conducted to balance important patient characteristics by the groups’ propensity score matching (PSM) analysis.
Results: A total of 786 consecutive patients fulfilled the inclusion/exclusion criteria for the study, and 64 (8.14%) patients experienced GIB after primary ICH. Univariate analysis revealed that patients with GIB were significantly older, had a higher AGR and a lower initial GCS score [9.0(7.0-11.0) vs.11.0(8.0-13.0), p<0.001]. The multicollinearity test revealed that no multicollinearity was observed in the multivariable models. Multivariate analysis showed that AGR was a significant independent predictor of GIB [odds ratio (OR) 1.155, 95% confidence interval (CI) 1.041-1.281, p=0.007], as well as prior anticoagulation or antiplatelet therapy (OR 0.388, 95% CI 0.160-0.940, p=0.036) and MV used >24h (OR 0.462, 95% CI 0.252–0.848, p=0.013). Receiver operating curve (ROC) analysis illustrated that the optimal cutoff value for AGR as a predictor for GIB in primary ICH patients was 6.759[the area under the curve (AUC) was 0.713 with a corresponding sensitivity of 60.94% and specificity of 70.5%, 95%CI 0.680-0.745, p<0.001]. After 1:1 PSM, the matched GIB group had significantly higher AGR levels compared with the matched non-GIB group. AGR levels were statistically correlated with unfunctional 90-day outcomes.
Conclusions: Higher AGR was associated with an increased risk of GIB and unfunctional 90-day outcomes in patients with primary ICH.