Chandnani Sanjay, Rathi Pravin, Sonthalia Nikhil, Udgirkar Suhas, Jain Shubham, Contractor Qais, Jain Samit, Singh Anupam Kumar
Department of Gastroenterology, Topiwala National Medical College and B Y L Nair Charitable Hospital, Dr Anandrao Laxman Nair Marg, Mumbai, 400 008, India.
Department of Medicine, Santosh Medical College, Ghaziabad, 201 009, India.
Indian J Gastroenterol. 2019 Apr;38(2):117-127. doi: 10.1007/s12664-019-00951-w. Epub 2019 May 24.
To study the upper gastrointestinal bleeding (UGIB) characteristics and to validate the Rockall and Glasgow-Blatchford scores (GBS), Progetto Nazionale Emorragica Digestiva (PNED) and albumin, international normalized ratio (INR), mental status, systolic blood pressure, and age > 65 (AIMS65) risk scores in predicting outcomes in patients with UGIB.
Three hundred subjects with hematemesis and/or melena were prospectively enrolled and followed up for 30 days. All patients were assessed by hematological investigations, imaging, and endoscopy and risk scores were calculated.
The mean age was 43.5 ± 17.2 years, and 207 (69%) were males. Hematemesis was the most common presentation (94%). Variceal bleeding was the most common etiology (47.7%). Thirty patients died (10%) and 50 had rebleeding (16.7%). On univariate analysis, serum albumin ≤ 2.7 gm% (p = 0.008), Glasgow Coma scale ≤ 13.9 (p = 0.001), serum bilirubin > 3 mg/dL (p = 0.004), serum bicarbonate ≤ 15.7 mEq/L (p = 0.001), systolic blood pressure < 90 mmHg (p = 0.004), and arterial pH ≤ 7.3 (p = 0.003) were found to be the predictors of mortality. No variable was found significant on multivariate analysis. All four scores were significant in predicting mortality, but Rockall (area under receiver operating characteristic [AUROC] 0.728) was better than others. Rebleeding was better predicted by PNED (modified) (AUROC 0.705). In predicting the need for transfusion and surgical or radiological intervention, GBS score > 0 was significant while score of < 2 classified patients into low risk for mortality with high negative predictive value.
Our study showed that the variceal bleeding was the commonest cause of UGIB. Rockall score was more significant in predicting mortality while PNED for rebleeding. Low risk for mortality, need for blood transfusion, or interventions were accurately predicted by GBS.
研究上消化道出血（UGIB）的特征，并验证Rockall评分、格拉斯哥-布拉奇福德评分（GBS）、意大利国家消化性出血研究计划（PNED）以及白蛋白、国际标准化比值（INR）、精神状态、收缩压和年龄>65岁（AIMS65）风险评分在预测UGIB患者预后方面的作用。
前瞻性纳入300例有呕血和/或黑便的患者，并进行30天的随访。所有患者均通过血液学检查、影像学检查和内镜检查进行评估，并计算风险评分。
平均年龄为43.5±17.2岁，男性207例（69%）。呕血是最常见的表现（94%）。静脉曲张出血是最常见的病因（47.7%）。30例患者死亡（10%），50例再次出血（16.7%）。单因素分析显示，血清白蛋白≤2.7g%（p=0.008）、格拉斯哥昏迷量表评分≤13.9（p=0.001）、血清胆红素>3mg/dL（p=0.004）、血清碳酸氢盐≤15.7mEq/L（p=0.001）、收缩压<90mmHg（p=0.004）和动脉血pH≤7.3（p=0.003）是死亡的预测因素。多因素分析未发现有显著意义的变量。所有四种评分在预测死亡率方面均有显著意义，但Rockall评分（受试者工作特征曲线下面积[AUROC]为0.728）优于其他评分。PNED（改良版）对再出血的预测效果更好（AUROC为0.705）。在预测输血需求以及手术或放射介入需求方面，GBS评分>0具有显著意义，而评分<2可将患者归类为低死亡风险，且具有较高的阴性预测价值。
我们的研究表明，静脉曲张出血是UGIB最常见的原因。Rockall评分在预测死亡率方面更具显著意义，而PNED对再出血的预测效果更佳。GBS能够准确预测低死亡风险、输血需求或介入需求。
