Gastroenterology Hospital Maresca, Torre del Greco, Italy.
Gastroenterology Hospital Maresca, Torre del Greco, Italy.
Dig Liver Dis. 2014 Mar;46(3):231-6. doi: 10.1016/j.dld.2013.10.017. Epub 2013 Dec 19.
There is a lack of validated predictors on which to decide the timing of discharge in patients already hospitalized for upper nonvariceal bleeding.
Identify factors that appear to protect nonvariceal bleeders from the development of negative outcome (rebleeding, surgery, death).
Secondary analysis of two prospective multicenter studies. Multivariate analyses for each investigated outcome were performed; a single model was developed including all factors that were statistically significant in each sub-model. A final score was developed to predict favourable outcomes. Prognostic accuracy was tested with ROC curve analysis.
Out of 2398 patients, 211 (8.8%) developed one or more adverse outcomes: 87 (3.63%) had rebleeding, 46 (1.92%) needed surgery and 107 (4.46%) died. Predictors of favourable prognosis were: ASA score 1 or 2, absence of neoplasia, outpatient bleeding, use of low-dose aspirin, no need for transfusions, clean-based ulcer, age <70 years, no haemodynamic instability successful endoscopic diagnosis/therapy, no Dieulafoy's lesion at endoscopy, no hematemesis on presentation and no need for endoscopic treatment. Overall prognostic accuracy of the model was 83%. The final score accurately identified 20-30% of patients that eventually do not develop any negative outcome.
The "good luck score" may be a useful tool in deciding when to discharge a patient already hospitalized for acute non-variceal bleeding.
目前缺乏可用于判断已住院治疗的上消化道非静脉曲张性出血患者出院时机的有效预测因子。
确定似乎可预防非静脉曲张性出血患者发生不良结局（再出血、手术、死亡）的因素。
对两项前瞻性多中心研究进行二次分析。对每个研究结局进行多变量分析；建立一个单一模型，纳入各亚模型中具有统计学意义的所有因素。开发最终评分以预测有利结局。采用 ROC 曲线分析评估预后准确性。
在 2398 例患者中，211 例（8.8%）发生了 1 种或多种不良结局：87 例（3.63%）再出血，46 例（1.92%）需要手术，107 例（4.46%）死亡。有利预后的预测因素为：ASA 评分为 1 或 2 分、无肿瘤、门诊出血、使用低剂量阿司匹林、无需输血、基底清洁的溃疡、年龄<70 岁、无血流动力学不稳定、内镜诊断/治疗成功、内镜下无杜氏病损、就诊时无呕血和无需内镜治疗。该模型的整体预后准确性为 83%。最终评分可准确识别 20%-30%的患者最终不会发生任何不良结局。
“好运评分”可能是用于判断急性非静脉曲张性出血患者何时出院的有用工具。
