用于识别上消化道出血治疗干预需求的评分模型评估：一种针对日本患者的新预测评分模型。
Evaluation of scoring models for identifying the need for therapeutic intervention of upper gastrointestinal bleeding: A new prediction score model for Japanese patients.
作者信息
Iino Chikara, Mikami Tatsuya, Igarashi Takasato, Aihara Tomoyuki, Ishii Kentaro, Sakamoto Jyuichi, Tono Hiroshi, Fukuda Shinsaku
机构信息
Department of Internal Medicine, Hirosaki Municipal Hospital, Hirosaki, Japan.
Department of Gastroenterology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan.
出版信息
Dig Endosc. 2016 Nov;28(7):714-721. doi: 10.1111/den.12666. Epub 2016 May 3.
BACKGROUND AND AIM
Multiple scoring systems have been developed to predict outcomes in patients with upper gastrointestinal bleeding. We determined how well these and a newly established scoring model predict the need for therapeutic intervention, excluding transfusion, in Japanese patients with upper gastrointestinal bleeding.
METHODS
We reviewed data from 212 consecutive patients with upper gastrointestinal bleeding. Patients requiring endoscopic intervention, operation, or interventional radiology were allocated to the therapeutic intervention group. Firstly, we compared areas under the curve for the Glasgow-Blatchford, Clinical Rockall, and AIMS65 scores. Secondly, the scores and factors likely associated with upper gastrointestinal bleeding were analyzed with a logistic regression analysis to form a new scoring model. Thirdly, the new model and the existing model were investigated to evaluate their usefulness.
RESULTS
Therapeutic intervention was required in 109 patients (51.4%). The Glasgow-Blatchford score was superior to both the Clinical Rockall and AIMS65 scores for predicting therapeutic intervention need (area under the curve, 0.75 [95% confidence interval, 0.69-0.81] vs 0.53 [0.46-0.61] and 0.52 [0.44-0.60], respectively). Multivariate logistic regression analysis retained seven significant predictors in the model: systolic blood pressure <100 mmHg, syncope, hematemesis, hemoglobin <10 g/dL, blood urea nitrogen ≥22.4 mg/dL, estimated glomerular filtration rate ≤ 60 mL/min per 1.73 m , and antiplatelet medication. Based on these variables, we established a new scoring model with superior discrimination to those of existing scoring systems (area under the curve, 0.85 [0.80-0.90]).
CONCLUSION
We developed a superior scoring model for identifying therapeutic intervention need in Japanese patients with upper gastrointestinal bleeding.
背景与目的
已开发出多种评分系统来预测上消化道出血患者的预后。我们确定了这些评分系统以及一种新建立的评分模型对日本上消化道出血患者除输血外的治疗干预需求的预测效果。
方法
我们回顾了212例连续性上消化道出血患者的数据。需要内镜干预、手术或介入放射学治疗的患者被分配到治疗干预组。首先，我们比较了格拉斯哥-布拉奇福德（Glasgow-Blatchford）评分、临床洛卡尔（Clinical Rockall）评分和AIMS65评分的曲线下面积。其次，使用逻辑回归分析对评分及可能与上消化道出血相关的因素进行分析，以形成一个新的评分模型。第三，对新模型和现有模型进行研究以评估它们的实用性。
结果
109例患者（51.4%）需要治疗干预。在预测治疗干预需求方面，格拉斯哥-布拉奇福德评分优于临床洛卡尔评分和AIMS65评分（曲线下面积分别为0.75 [95%置信区间，0.69 - 0.81] 对比0.53 [0.46 - 0.61] 和0.52 [0.44 - 0.60]）。多因素逻辑回归分析在模型中保留了7个显著预测因素：收缩压<100 mmHg、晕厥、呕血、血红蛋白<10 g/dL、血尿素氮≥22.4 mg/dL、估计肾小球滤过率≤60 mL/min/1.73 m²以及抗血小板药物治疗。基于这些变量，我们建立了一个新的评分模型，其辨别能力优于现有评分系统（曲线下面积为0.85 [0.80 - 0.90]）。
结论
我们开发了一种更优的评分模型，用于识别日本上消化道出血患者是否需要治疗干预。
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