Rassameehiran Supannee, Teerakanok Jirapat, Suchartlikitwong Sakolwan, Nugent Kenneth
From the Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock.
South Med J. 2017 Nov;110(11):738-743. doi: 10.14423/SMJ.0000000000000729.
Patients with upper gastrointestinal bleeding (UGIB) frequently require hospitalization, and a small but significant percentage of these patients have adverse outcomes. Risk-scoring tools can help clinicians organize care and make predictions about outcomes. The shock index (heart rate divided by systolic blood pressure) has been used in multiple acute disorders and has the potential to identify patients with UGIB who are at risk for adverse outcomes.
We retrospectively reviewed the electronic medical records of patients admitted with UGIB between January 1, 2012 and December 31, 2015. We collected information about patient demographics, presenting symptoms, underlying clinical disorders, endoscopic results, and outcomes. We calculated risk scores using the Glasgow-Blatchford score, the pre-endoscopy Rockall score, the full Rockall score, the AIMS65 (albumin, international normalized ratio, mental status, systolic blood pressure, age older than 65 years) score, and the shock index.
This study included 214 admissions for acute UGIB. The mean age was 59.0 ± 15.9 years, 64.5% were men, the mean hemoglobin was 9.2 ± 3.1 g/dL, and the mean shock index was 0.78 ± 0.21 bpm/mm Hg. The mean shock index was significantly increased in patients requiring endoscopic therapy, admission to the intensive care unit, blood component transfusion, and red blood cell transfusion. Classification of patients by a shock index >0.7 preferentially selected patients with these adverse short-term outcomes. Among the scoring tools evaluated in this study, the shock index was the best predictor of the need for endoscopic therapy.
The shock index is a good tool to identify patients with the potential for short-term adverse outcomes when they present with UGIB. It performs as well as other risk-scoring tools for GI bleeding and has the potential for serial use during hospitalization to identify changes in the clinical course.
上消化道出血（UGIB）患者常需住院治疗，其中一小部分但比例可观的患者会出现不良结局。风险评分工具可帮助临床医生安排治疗并预测结局。休克指数（心率除以收缩压）已应用于多种急性疾病，有可能识别出有不良结局风险的UGIB患者。
我们回顾性分析了2012年1月1日至2015年12月31日期间因UGIB入院患者的电子病历。我们收集了患者人口统计学信息、症状表现、基础临床疾病、内镜检查结果及结局。我们使用格拉斯哥 - 布拉奇福德评分、内镜检查前罗卡尔评分、完整罗卡尔评分、AIMS65（白蛋白、国际标准化比值、精神状态、收缩压、年龄大于65岁）评分及休克指数计算风险评分。
本研究纳入了214例急性UGIB患者。平均年龄为59.0±15.9岁，64.5%为男性，平均血红蛋白为9.2±3.1 g/dL，平均休克指数为0.78±0.21次/分/毫米汞柱。在内镜治疗、入住重症监护病房、血液成分输血及红细胞输血的患者中，平均休克指数显著升高。休克指数>0.7对患者进行分类时，优先选择了有这些不良短期结局的患者。在本研究评估的评分工具中，休克指数是内镜治疗需求的最佳预测指标。
休克指数是识别UGIB患者出现短期不良结局可能性的良好工具。它在预测胃肠道出血方面与其他风险评分工具表现相当，并且在住院期间有连续使用以识别临床病程变化的潜力。
