Monteiro Sara, Gonçalves Tiago Cúrdia, Magalhães Joana, Cotter José
Sara Monteiro, Tiago Cúrdia Gonçalves, Joana Magalhães, José Cotter, Department of Gastroenterology, Hospital Senhora da Oliveira-Guimarães, Creixomil, 4835-044 Guimarães, Portugal.
World J Gastrointest Pathophysiol. 2016 Feb 15;7(1):86-96. doi: 10.4291/wjgp.v7.i1.86.
Upper gastrointestinal bleeding (UGIB) remains a significant cause of hospital admission. In order to stratify patients according to the risk of the complications, such as rebleeding or death, and to predict the need of clinical intervention, several risk scores have been proposed and their use consistently recommended by international guidelines. The use of risk scoring systems in early assessment of patients suffering from UGIB may be useful to distinguish high-risks patients, who may need clinical intervention and hospitalization, from low risk patients with a lower chance of developing complications, in which management as outpatients can be considered. Although several scores have been published and validated for predicting different outcomes, the most frequently cited ones are the Rockall score and the Glasgow Blatchford score (GBS). While Rockall score, which incorporates clinical and endoscopic variables, has been validated to predict mortality, the GBS, which is based on clinical and laboratorial parameters, has been studied to predict the need of clinical intervention. Despite the advantages previously reported, their use in clinical decisions is still limited. This review describes the different risk scores used in the UGIB setting, highlights the most important research, explains why and when their use may be helpful, reflects on the problems that remain unresolved and guides future research with practical impact.
上消化道出血（UGIB）仍是住院的一个重要原因。为了根据再出血或死亡等并发症风险对患者进行分层，并预测临床干预的必要性，已经提出了几种风险评分，国际指南也一直推荐使用这些评分。在UGIB患者的早期评估中使用风险评分系统，可能有助于区分可能需要临床干预和住院治疗的高风险患者与发生并发症几率较低的低风险患者，后者可考虑门诊治疗。尽管已经发表并验证了几种用于预测不同结果的评分，但最常被引用的是罗卡尔评分（Rockall score）和格拉斯哥布拉奇福德评分（GBS）。虽然纳入了临床和内镜变量的罗卡尔评分已被验证可预测死亡率，但基于临床和实验室参数的GBS已被用于研究预测临床干预的必要性。尽管此前已报道了它们的优点，但它们在临床决策中的应用仍然有限。本综述描述了UGIB情况下使用的不同风险评分，突出了最重要的研究，解释了使用它们为何以及何时可能有帮助，思考了仍未解决的问题，并指导具有实际影响的未来研究。
