Rout Gyanranjan, Sharma Sanchit, Gunjan Deepak, Kedia Saurabh, Nayak Baibaswata
Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, 110 049, India.
Indian J Gastroenterol. 2019 Apr;38(2):158-166. doi: 10.1007/s12664-018-0928-8. Epub 2019 Mar 4.
Various prognostic scores like Glasgow-Blatchford bleeding score (GBS), modified Glasgow-Blatchford bleeding score (mGBS), full Rockall score (FRS) including endoscopic findings, clinical Rockall score (CRS), and albumin, international normalized ratio (INR), mental status, systolic blood pressure, age >65 (AIMS65) are used for risk stratification in patients with upper gastrointestinal bleeding (UGIB). The utility of these scores in variceal UGIB (VUGIB) is not well defined. In this prospective study, we aimed to assess the performance of these scores in patients with non-variceal (NVUGIB) and VUGIB.
We included 1011 patients (during March 2017 and August 2018) including 439 with NVUGIB and 572 VUGIB. Performance of GBS, mGBS, FRS, CRS, and AIMS65 for various outcome measures was analyzed using the area under receiver operator characteristic curve (AUROC).
The accuracy of prognostic scores in predicting the composite outcome including the need of hospital-based intervention and 42-day mortality was higher in NVUGIB as compared with VUGIB, AUROC: CRS: 0.641 vs. 0.537; FRS: 0.669 vs. 0.625; GBS: 0.719 vs. 0.587; mGBS: 0.711 vs. 0.594; AIMS65: 0.567 vs. 0.548. GBS and mGBS at a cut-off score of 1 had the highest negative predictive value, 91.7% and 91.3%, respectively, for predicting composite outcome in NVUGIB. Similarly, these scores had better accuracy for predicting 42-day rebleeding in NVUGIB as compared to VUGIB, AUROC: CRS: 0.680 vs. 0.537; FRS: 0.698 vs. 0.565; GBS: 0.661 vs. 0.543; mGBS: 0.627 vs. 0.540; AIMS65: 0.695 vs. 0.606.
The prognostic scores such as CRS, FRS, GBS, mGBS, and AIMS65 predict the need for hospital-based management, rebleeding, and mortality better among patients with NVUGIB than VUGIB.
多种预后评分，如格拉斯哥-布拉奇福德出血评分（GBS）、改良格拉斯哥-布拉奇福德出血评分（mGBS）、包括内镜检查结果的完整罗卡尔评分（FRS）、临床罗卡尔评分（CRS）以及白蛋白、国际标准化比值（INR）、精神状态、收缩压、年龄>65岁（AIMS65），用于上消化道出血（UGIB）患者的风险分层。这些评分在静脉曲张性UGIB（VUGIB）中的效用尚未明确界定。在这项前瞻性研究中，我们旨在评估这些评分在非静脉曲张性（NVUGIB）和VUGIB患者中的表现。
我们纳入了1011例患者（2017年3月至2018年8月期间），其中439例为NVUGIB患者，572例为VUGIB患者。使用受试者操作特征曲线下面积（AUROC）分析GBS、mGBS、FRS、CRS和AIMS65对各种结局指标的表现。
与VUGIB相比，NVUGIB中预后评分预测包括基于医院干预需求和42天死亡率在内的综合结局的准确性更高，AUROC：CRS：0.641对0.537；FRS：0.669对0.625；GBS：0.719对0.587；mGBS：0.711对0.594；AIMS65：0.567对0.548。GBS和mGBS在截断分数为1时，对预测NVUGIB中的综合结局具有最高的阴性预测值，分别为91.7%和91.3%。同样，与VUGIB相比，这些评分在预测NVUGIB中42天再出血方面具有更高的准确性，AUROC：CRS：0.680对0.537；FRS：0.698对0.565；GBS：0.661对0.543；mGBS：0.627对0.540；AIMS65：0.695对0.606。
CRS、FRS、GBS、mGBS和AIMS65等预后评分在NVUGIB患者中比在VUGIB患者中能更好地预测基于医院的管理需求、再出血和死亡率。
