Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, 101, Daehak-Ro, Jongno-gu, Seoul, 03080, South Korea.
Department of Internal Medicine, Sanggye Paik Hospital, Inje University College of Medicine, 1342 Dongil-ro, Nowon-gu, Seoul, 01757, South Korea.
BMC Gastroenterol. 2019 Jul 26;19(1):136. doi: 10.1186/s12876-019-1051-8.
Risk stratification for patients with nonvariceal upper gastrointestinal (NVUGI) bleeding is crucial for successful prognosis and treatment. Recently, the AIMS65 score has been used to predict mortality risk and rebleeding. The purpose of this study was to compare the performance of the AIMS65 score with the Glasgow-Blatchford score (GBS), Rockall score, and pre-endoscopic Rockall score in Korea.
We retrospectively studied 512 patients with NVUGI bleeding who were treated at a university hospital between 2013 and 2016. The AIMS65, GBS, Rockall score, and pre-endoscopic Rockall score were used to stratify patients based on their bleeding risk. The primary outcome was in-hospital mortality. The secondary outcomes were composite clinical outcomes of mortality, rebleeding, and intensive care unit (ICU) admission. Each scoring system was compared using the receiver-operating curve (ROC).
A total of 17 patients (3.3%) died and rebleeding developed in 65 patients (12.7%). Eighty-six patients (16.8%) required ICU admission. The AIMS65 (area under the curve (AUC) 0.84, 95% confidence interval, 0.81-0.88)) seemed to be superior to the GBS (AUC 0.72, 0.68-0.76), the Rockall score (AUC 0.75, 0.71-0.79), or the pre-endoscopic Rockall score (AUC 0.74, 0.70-0.78) in predicting in-hospital mortality, but there was not a statistically significant difference between the groups (P = 0.07). The AUC value of the AIMS65 was not significantly different from the other scoring systems in prediction of rebleeding, endoscopic intervention, or ICU admission.
The AIMS65 score in NVUGI bleeding patients was comparable to the GBS or Rockall scoring systems when predicting the mortality, rebleeding, or ICU admission. Because AIMS65 is a much easier, readily calculated scoring system compared to the others, we would recommend using the AIMS65 in daily practice.
非静脉曲张性上消化道出血（NVUGI）患者的风险分层对于成功的预后和治疗至关重要。最近，AIMS65 评分被用于预测死亡率和再出血风险。本研究旨在比较 AIMS65 评分与格拉斯哥-布拉奇福德评分（GBS）、Rockall 评分和内镜前 Rockall 评分在韩国的表现。
我们回顾性研究了 2013 年至 2016 年在一所大学医院接受治疗的 512 例 NVUGI 出血患者。使用 AIMS65、GBS、Rockall 评分和内镜前 Rockall 评分根据出血风险对患者进行分层。主要结局是住院死亡率。次要结局是死亡率、再出血和重症监护病房（ICU）入院的复合临床结局。使用受试者工作特征曲线（ROC）比较每个评分系统。
共有 17 例患者（3.3%）死亡，65 例患者（12.7%）再出血。86 例患者（16.8%）需要入住 ICU。AIMS65（曲线下面积（AUC）0.84，95%置信区间，0.81-0.88）似乎优于 GBS（AUC 0.72，0.68-0.76）、Rockall 评分（AUC 0.75，0.71-0.79）或内镜前 Rockall 评分（AUC 0.74，0.70-0.78）预测住院死亡率，但组间差异无统计学意义（P=0.07）。AIMS65 预测再出血、内镜干预或 ICU 入院的 AUC 值与其他评分系统无显著差异。
在预测 NVUGI 出血患者的死亡率、再出血或 ICU 入院方面，AIMS65 评分与 GBS 或 Rockall 评分系统相当。由于 AIMS65 是一种比其他评分系统更容易、更容易计算的评分系统，因此我们建议在日常实践中使用 AIMS65。
