Hreinsson Johann P, Sigurdardottir Ragna, Lund Sigrun H, Bjornsson Einar S
a Department of Internal Medicine, Section of Gastroenterology and Hepatology , Landspitali - The National University Hospital , Reykjavik , Iceland.
b Faculty of Medicine , University of Iceland , Reykjavik , Iceland.
Scand J Gastroenterol. 2018 Dec;53(12):1484-1489. doi: 10.1080/00365521.2018.1532019. Epub 2018 Nov 20.
Lower gastrointestinal bleeding (LGIB) risk scores have mainly focused on identifying high-risk patients. A risk score aimed at predicting which patients will not require hospital-based intervention may reduce unnecessary hospital admissions. The aim of the current study was to develop such a risk score.
A retrospective, population-based study that included patients presenting to the emergency room (ER) with LGIB from 2010 to 2013. Hospital-based intervention was defined as blood transfusion, endoscopic hemostasis, arterial embolization or surgery. The study cohort was split into train (70%) and test (30%) data. Train data were used to produce a multiple logistic regression model and a risk score that was validated on the test data.
Overall, 581 patients presented 625 times to the ER, mean age 61 (±22), males 49%. Of train data patients, 72% did not require hospital-based intervention. Independent predictors of low-risk patients (did not require hospital-based intervention) were systolic pressure ≥100mmHg (Odds ratio [OR] 4.9), hemoglobin >12g/dL (OR 103), hemoglobin 10.5-12.0g/dL (OR 19), no antiplatelets (OR 3.7), no anticoagulants (OR 2.2), pulse ≤100 (OR 2.9), and visible bleeding in the ER (OR 3.8). When validating the score on the test data, only 2% were wrongly predicted to be low-risk, the negative predictive value was 96% and the area under curve was 0.83.
A new risk score has been developed for LGIB that may help identify low-risk patients in the ER that can be managed in an outpatient setting, thereby lowering unnecessary hospital admissions.
下消化道出血（LGIB）风险评分主要集中于识别高危患者。旨在预测哪些患者无需基于医院的干预措施的风险评分可能会减少不必要的住院治疗。本研究的目的是开发这样一种风险评分。
一项基于人群的回顾性研究，纳入了2010年至2013年因LGIB就诊于急诊室（ER）的患者。基于医院的干预措施定义为输血、内镜止血、动脉栓塞或手术。研究队列被分为训练组（70%）和测试组（30%）数据。训练组数据用于生成多元逻辑回归模型和在测试组数据上进行验证的风险评分。
总体而言，581例患者到急诊室就诊625次，平均年龄61岁（±22岁），男性占49%。训练组数据中的患者，72%不需要基于医院的干预措施。低风险患者（不需要基于医院的干预措施）的独立预测因素为收缩压≥100mmHg（比值比[OR]4.9）、血红蛋白>12g/dL（OR 103）、血红蛋白10.5 - 12.0g/dL（OR 19）、未使用抗血小板药物（OR 3.7）、未使用抗凝剂（OR 2.2）、脉搏≤100（OR 2.9）以及在急诊室有可见出血（OR 3.8）。在测试组数据上验证该评分时，仅有2%被错误预测为低风险，阴性预测值为96%，曲线下面积为0.83。
已开发出一种针对LGIB的新风险评分，这可能有助于在急诊室识别可在门诊处理的低风险患者，从而减少不必要的住院治疗。
