Banister Thomas, Spiking Josesph, Ayaru Lakshmana
Department of Gastroenterology, Imperial College Healthcare and Imperial College London, London, UK.
BMJ Open Gastroenterol. 2018 Aug 30;5(1):e000225. doi: 10.1136/bmjgast-2018-000225. eCollection 2018.
To use an extended Glasgow-Blatchford Score (GBS) cut-off of ≤1 to aid discharge of patients presenting with acute upper gastrointestinal bleeding (AUGIB) from emergency departments.
The GBS accurately predicts the need for intervention and death in AUGIB, and a cut-off of 0 is recommended to identify patients for discharge without endoscopy. However, this cut-off is limited by identifying a low percentage of low-risk patients. Extension of the cut-off to ≤1 or ≤2 has been proposed to increase this proportion, but there is controversy as to the optimal cut-off and little data on performance in routine clinical practice.
Dual-centre study in which patients with AUGIB and GBS ≤1 were discharged from the emergency department without endoscopy unless there was another reason for admission. Retrospective analysis of associated adverse outcome defined as a 30-day combined endpoint of blood transfusion, intervention or death.
569 patients presented with AUGIB from 2015 to 2018. 146 (25.7%) had a GBS ≤1 (70, GBS=0; 76, GBS=1). Of these, 103 (70.5%) were managed as outpatients, and none had an adverse outcome. GBS ≤1 had a negative predictive value=100% and the GBS had an area under receiver operator characteristic (AUROC)=0.89 (95% CI 0.86 to 0.91) in predicting adverse outcomes. In 2008-2009, prior to risk scoring (n=432), 6.5% of patients presenting with AUGIB were discharged safely from the emergency department in comparison with 18.1% (p<0.001) in this cohort. A GBS cut-off ≤2 was associated with an adverse outcome in 8% of cases.
GBS of ≤1 is the optimal cut-off for the discharge of patients with an AUGIB from the emergency department.
采用扩展格拉斯哥-布拉奇福德评分（GBS）≤1的截断值，以帮助急诊科对急性上消化道出血（AUGIB）患者进行出院评估。
GBS能准确预测AUGIB患者的干预需求和死亡情况，建议采用截断值0来识别无需内镜检查即可出院的患者。然而，该截断值识别出的低风险患者比例较低，存在局限性。有人提议将截断值扩展至≤1或≤2以提高这一比例，但对于最佳截断值存在争议，且关于其在常规临床实践中的表现数据较少。
一项双中心研究，AUGIB且GBS≤1的患者除非有其他入院原因，否则可在急诊科不经内镜检查即出院。对相关不良结局进行回顾性分析，不良结局定义为输血、干预或死亡的30天综合终点。
2015年至2018年期间，569例患者出现AUGIB。146例（25.7%）GBS≤1（70例GBS = 0；76例GBS = 1）。其中，103例（70.5%）作为门诊患者处理，无一例出现不良结局。GBS≤1的阴性预测值为100%，GBS在预测不良结局方面的受试者工作特征曲线下面积（AUROC）= 0.89（95%可信区间0.86至0.91）。在2008 - 2009年风险评分之前（n = 432），AUGIB患者中有6.5%从急诊科安全出院，而本队列中这一比例为18.1%（p < 0.001）。GBS截断值≤2与8%的病例出现不良结局相关。
GBS≤1是急诊科AUGIB患者出院的最佳截断值。
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