Department of Emergency Medicine, Asan Medical Center, College of Medicine, University of Ulsan.
Department of Emergency Medicine, College of Medicine, Hanyang University, Seoul, Korea.
Eur J Gastroenterol Hepatol. 2019 Jul;31(7):781-785. doi: 10.1097/MEG.0000000000001422.
Risk assessment in nonvariceal upper gastrointestinal bleeding (UGIB) is not well validated and remains unclear in hemodynamically stable patients at emergency department admission. We compared the prognostic value of risk-scoring systems for predicting adverse outcomes in patients with nonvariceal UGIB and normotension.
A single-center prospective observational study was carried out. Patients with consecutive nonvariceal UGIB, presenting with normotension (systolic blood pressure ≥90 mmHg) to the emergency department, were included. We compared the areas under the curves (AUC) of Glasgow Blatchford score (GBS), the pre-endoscopy Rockall score, AIMS65, the shock index, and the modified shock index with respect to adverse outcomes defined as embolization, surgery, ICU admission, rebleeding, and in-hospital mortality.
In total, 1233 patients were included. Adverse outcomes occurred in 165 (13.4%) patients; in-hospital mortality was 1.2%. AUC of the GBS for adverse outcome was higher than that of the shock index, but not significantly different (0.647 vs. 0.569, P=0.23). AUC values of the modified shock index, AIMS65, and the pre-endoscopy Rockall score were 0.565, 0.593, and 0.533, respectively. The cut-off value of the GBS (≥8) was associated with 85% sensitivity and 35% specificity for predicting adverse outcome.
Pre-existing risk scores have shown suboptimal predictive ability for adverse events in normotensive patients with nonvariceal UGIB. The GBS (≥8) might help to identify patients prone to adverse events; however, further studies with risk scores or new scores are needed because of the low accuracy of these scores.
非静脉曲张性上消化道出血（UGIB）的风险评估尚未得到充分验证，在急诊科入院时血流动力学稳定的患者中仍不清楚。我们比较了风险评分系统在预测非静脉曲张性 UGIB 和血压正常患者不良预后方面的预测价值。
进行了一项单中心前瞻性观察性研究。纳入了连续出现非静脉曲张性 UGIB 且血压正常（收缩压≥90mmHg）到急诊科就诊的患者。我们比较了格拉斯哥 Blatchford 评分（GBS）、内镜前 Rockall 评分、AIMS65、休克指数和改良休克指数的曲线下面积（AUC）与不良结局（定义为栓塞、手术、入住 ICU、再出血和住院死亡率）的关系。
共纳入 1233 例患者。165 例（13.4%）患者发生不良结局；住院死亡率为 1.2%。GBS 预测不良结局的 AUC 高于休克指数，但无统计学差异（0.647 与 0.569，P=0.23）。改良休克指数、AIMS65 和内镜前 Rockall 评分的 AUC 值分别为 0.565、0.593 和 0.533。GBS（≥8）的截断值与预测不良结局的 85%敏感性和 35%特异性相关。
在非静脉曲张性 UGIB 血压正常患者中，现有的风险评分对不良事件的预测能力不佳。GBS（≥8）可能有助于识别易发生不良事件的患者；然而，由于这些评分的准确性较低，需要进一步研究风险评分或新的评分。
