急性上消化道出血的风险分层：AIMS65 评分与格拉斯哥-布拉奇福德和罗克洛评分系统的比较。
Risk stratification in acute upper GI bleeding: comparison of the AIMS65 score with the Glasgow-Blatchford and Rockall scoring systems.
机构信息
Department of Gastroenterology and Liver Transplant Unit, Austin Hospital, Heidelberg, Victoria, Australia.
Department of Gastroenterology and Liver Transplant Unit, Austin Hospital, Heidelberg, Victoria, Australia; Department of Medicine, The University of Melbourne, Austin Health, Heidelberg, Victoria, Australia.
出版信息
Gastrointest Endosc. 2016 Jun;83(6):1151-60. doi: 10.1016/j.gie.2015.10.021. Epub 2015 Oct 26.
BACKGROUND AND AIMS
The American College of Gastroenterology recommends early risk stratification in patients presenting with upper GI bleeding (UGIB). The AIMS65 score is a risk stratification score previously validated to predict inpatient mortality. The aim of this study was to validate the AIMS65 score as a predictor of inpatient mortality in patients with acute UGIB and to compare it with established pre- and postendoscopy risk scores.
METHODS
ICD-10 (International Classification of Diseases, Tenth Revision) codes identified patients presenting with UGIB requiring endoscopy. All patients were risk stratified by using the AIMS65, Glasgow-Blatchford score (GBS), pre-endoscopy Rockall, and full Rockall scores. The primary outcome was inpatient mortality. Secondary outcomes were a composite endpoint of inpatient mortality, rebleeding, and endoscopic, radiologic, or surgical intervention; blood transfusion requirement; intensive care unit (ICU) admission; rebleeding; and hospital length of stay. The area under the receiver-operating characteristic curve (AUROC) was calculated for each score.
RESULTS
Of the 424 study patients, 18 (4.2%) died and 69 (16%) achieved the composite endpoint. The AIMS65 score was superior to both the GBS (AUROC, 0.80 vs 0.76, P < .027) and the pre-endoscopy Rockall score (0.74, P = .001) and equivalent to the full Rockall score (0.78, P = .18) in predicting inpatient mortality. The AIMS65 score was superior to all other scores in predicting the need for ICU admission and length of hospital stay. AIMS65, GBS, and full Rockall scores were equivalent (AUROCs, 0.63 vs 0.62 vs 0.63, respectively) and superior to pre-endoscopy Rockall (AUROC, 0.55) in predicting the composite endpoint. GBS was superior to all other scores for predicting blood transfusion.
CONCLUSION
The AIMS65 score is a simple risk stratification score for UGIB with accuracy superior to that of GBS and pre-endoscopy Rockall scores in predicting in-hospital mortality and the need for ICU admission.
背景与目的
美国胃肠病学会建议对出现上消化道出血（UGIB）的患者进行早期风险分层。AIMS65 评分是一种先前经过验证可预测住院死亡率的风险分层评分。本研究的目的是验证 AIMS65 评分作为急性 UGIB 住院患者死亡率预测指标的有效性，并将其与已建立的内镜前和内镜后风险评分进行比较。
方法
国际疾病分类第 10 版（ICD-10）代码确定了需要内镜检查的 UGIB 患者。所有患者均使用 AIMS65、格拉斯哥-布拉奇福德评分（GBS）、内镜前罗克厄尔评分和完整罗克厄尔评分进行风险分层。主要结局是住院死亡率。次要结局包括住院死亡率、再出血和内镜、放射学或手术干预、输血需求、重症监护病房（ICU）入院、再出血和住院时间的复合终点。计算每个评分的受试者工作特征曲线（ROC）下面积（AUROC）。
结果
在 424 例研究患者中，18 例（4.2%）死亡，69 例（16%）达到复合终点。AIMS65 评分优于 GBS（AUROC，0.80 与 0.76，P<0.027）和内镜前罗克厄尔评分（0.74，P=0.001），与完整罗克厄尔评分（0.78，P=0.18）相当，预测住院死亡率。AIMS65 评分优于其他所有评分，可预测 ICU 入院和住院时间的需求。AIMS65、GBS 和完整罗克厄尔评分（AUROCs，0.63 与 0.62 与 0.63，分别）与内镜前罗克厄尔评分（AUROC，0.55）相当，预测复合终点。GBS 优于其他所有评分，可预测输血需求。
结论
AIMS65 评分是一种用于 UGIB 的简单风险分层评分，其预测住院死亡率和 ICU 入院需求的准确性优于 GBS 和内镜前罗克厄尔评分。
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