Cheetham T Craig, Levy Gerald, Spence Michele
Pharmacy Strategy and Operations, Kaiser Permanente, 9521 Dalen Street, Downey, CA 90242, USA.
J Rheumatol. 2003 Oct;30(10):2241-4.
To validate that, using patient demographics and other risk factors readily obtained from computerized databases, one can predict a priori the risk for developing a nonsteroidal antiinflammatory drug (NSAID) associated gastrointestinal (GI) bleed prior to exposing patients to therapy.
We conducted a retrospective cohort analysis using computer-stored information from a large group-model health maintenance organization. All patients who received one or more prescriptions for a single NSAID over a 9 month period were eligible. Historical and risk factor data was obtained for age, sex, prior GI bleeds, use of GI medications, prednisone use, and use of disease modifying antirheumatic drugs (DMARD). We tested a model (eSCORE) that is based on a previous risk stratification method. The primary outcome was a hospital admission for a GI bleed (GI event).
A total of 303,211 NSAID patient-users met eligibility requirements. Serious GI events occurred in 302 patients, for a rate of 0.68% (0.68 events per 100 patient-years' exposure). All the risk factors except DMARD use were associated with a significant increase in the GI event rate. Higher eSCORE points were associated with increased GI event rates.
The study supports the concept that the rate of GI events can be predicted by a defined set of easily assessed patient criteria using the eSCORE. Stratification of patients by risk score can guide the physician to appropriate therapeutic options, with the potential of protecting patients at greatest risk for a GI event.
验证利用从计算机数据库中轻松获取的患者人口统计学信息和其他风险因素，能否在患者接受治疗前先验预测发生非甾体抗炎药（NSAID）相关胃肠道（GI）出血的风险。
我们使用来自一个大型团体模式健康维护组织的计算机存储信息进行了一项回顾性队列分析。所有在9个月期间接受一种或多种单一NSAID处方的患者均符合条件。获取了年龄、性别、既往GI出血史、GI药物使用情况、泼尼松使用情况以及疾病修饰抗风湿药物（DMARD）使用情况的历史和风险因素数据。我们测试了一个基于先前风险分层方法的模型（eSCORE）。主要结局是因GI出血住院（GI事件）。
共有303,211名NSAID使用者符合资格要求。302名患者发生了严重GI事件，发生率为0.68%（每100患者年暴露0.68次事件）。除DMARD使用外，所有风险因素均与GI事件发生率显著增加相关。较高的eSCORE分数与较高的GI事件发生率相关。
该研究支持这样一种概念，即使用eSCORE通过一组明确的易于评估的患者标准可以预测GI事件的发生率。根据风险评分对患者进行分层可以指导医生选择合适的治疗方案，有可能保护发生GI事件风险最高的患者。
