Taha Ali S, Saffouri Eliana, McCloskey Caroline, Craigen Theresa, Angerson Wilson J
Gastroenterology Unit, University Hospital Crosshouse, Kilmarnock, UK.
School of Medicine, University of Glasgow, Glasgow, UK.
Frontline Gastroenterol. 2014 Oct;5(4):243-248. doi: 10.1136/flgastro-2014-100453. Epub 2014 Apr 28.
The understanding of changes in comorbidity might improve the management of upper gastrointestinal bleeding (UGIB); such changes might not be detectable in short-term studies. We aimed to study UGIB mortality as adjusted for comorbidity and the trends in risk scores over a 14-year period.
Patients presenting with UGIB to a single institution, 1996-2010, were assessed. Those with multiple comorbidities were managed in a multi-disciplinary care unit since 2000. Trends with time were assessed using logistic regression, including those for Charlson comorbidity score, the complete Rockall score and 30-day mortality.
2669 patients were included. The Charlson comorbidity score increased significantly with time: the odds of a high (3+) score increasing at a relative rate of 4.4% a year (OR 1.044; p<0.001). The overall 30-day mortality was 4.9% and inpatient mortality was 7.1%; these showed no relationship with time. When adjusted for the increasing comorbidity, the odds of death decreased significantly at a relative rate of 4.5% per year (p=0.038). After the introduction of multi-disciplinary care, the raw mortality OR was 0.680 (p=0.08), and adjusted for comorbidity it was 0.566 (p=0.013).
30-day mortality decreased when adjusted for the rising comorbidity in UGIB; whether this is related to the introduction of multi-disciplinary care needs to be considered.
了解合并症的变化可能会改善上消化道出血（UGIB）的管理；此类变化在短期研究中可能无法检测到。我们旨在研究经合并症调整后的UGIB死亡率以及14年间风险评分的趋势。
对1996年至2010年在单一机构就诊的UGIB患者进行评估。自2000年以来，患有多种合并症的患者在多学科护理单元接受治疗。使用逻辑回归评估随时间的趋势，包括查尔森合并症评分、完整的罗卡尔评分和30天死亡率。
纳入2669例患者。查尔森合并症评分随时间显著增加：高（3+）评分的几率以每年4.4%的相对速率增加（OR 1.044；p<0.001）。总体30天死亡率为4.9%，住院死亡率为7.1%；这些与时间无关。在对合并症增加进行调整后，死亡几率以每年4.5%的相对速率显著下降（p=0.038）。引入多学科护理后，未调整的死亡率OR为0.680（p=0.08），经合并症调整后为0.566（p=0.013）。
在对UGIB中不断上升的合并症进行调整后，30天死亡率下降；这是否与引入多学科护理有关需要考虑。
