Kyungpook National University Hospital, Daegu, South Korea.
Department of Internal Medicine, School of Medicine, Kyungpook National University, 807 Hoguk-ro, Buk-gu, Daegu, 702-210, South Korea.
Dig Dis Sci. 2018 Dec;63(12):3253-3261. doi: 10.1007/s10620-018-5255-5. Epub 2018 Aug 21.
Compared with ulcer bleeding (UB) in non-variceal upper gastrointestinal bleeding (NVUGIB), non-ulcer bleeding (NUB) is often considered to have a low risk of poor outcomes and is treated less intensively without any risk stratification. We conducted this study to assess the predictability of scoring systems for NUB and compare the outcomes of NUB and UB.
A total of 1831 UGIB patients were registered in the database during the period from February 2011 to December 2013. Among them, 1424 patients with NVUGIB were divided into two groups: Group UB (1101 patients with peptic ulcer bleeding) and Group NUB (323 patients with non-peptic ulcer-related bleeding).
The most common cause of bleeding in Group NUB was Mallory-Weiss tears (51.1%), followed by Dieulafoy lesions (18.9%). A receiver operating characteristic (ROC) analysis revealed that the pre-Rockall score [area under the ROC (AUROC) = 0.798; 95% CI 0.707-0.890] and full Rockall score (AUROC = 0.794; 95% CI 0.693-0.895) were relatively good at predicting overall mortality in NUB. Glasgow-Blatchford score (AUROC = 0.783; 95% CI 0.730-0.836) was the most closely correlated with the need for clinical intervention in NUB. Those who had Glasgow-Blatchford score of 0 did not require any interventions, including blood transfusions. There were no statistical differences in overall mortality (p = 0.387), bleeding-related mortality (p = 0.447), or the incidence of re-bleeding (p = 0.117) between the two groups.
Scoring systems are useful to predict mortality and the need for clinical intervention in patients with NUB.
相较于非静脉曲张性上消化道出血（NVUGIB）中的溃疡出血（UB），非溃疡出血（NUB）通常被认为发生不良结局的风险较低，治疗强度也较低，而无需进行任何风险分层。我们进行这项研究旨在评估用于 NUB 的评分系统的预测能力，并比较 NUB 和 UB 的结局。
在 2011 年 2 月至 2013 年 12 月期间，数据库中登记了 1831 例 UGIB 患者。其中，1424 例 NVUGIB 患者分为两组：UB 组（1101 例消化性溃疡出血）和 NUB 组（323 例非消化性溃疡相关出血）。
NUB 组最常见的出血原因是 Mallory-Weiss 撕裂（51.1%），其次是杜氏病损（18.9%）。受试者工作特征（ROC）分析显示，前 Rockall 评分[ROC 曲线下面积（AUROC）=0.798；95%置信区间（CI）0.707-0.890]和完整 Rockall 评分（AUROC=0.794；95%CI 0.693-0.895）在预测 NUB 总体死亡率方面表现相对较好。Glasgow-Blatchford 评分（AUROC=0.783；95%CI 0.730-0.836）与 NUB 中临床干预的需求相关性最强。Glasgow-Blatchford 评分为 0 的患者无需任何干预，包括输血。两组之间的总体死亡率（p=0.387）、出血相关死亡率（p=0.447）或再出血发生率（p=0.117）均无统计学差异。
评分系统可用于预测 NUB 患者的死亡率和临床干预需求。
