Brullet Enric, Garcia-Iglesias Pilar, Calvet Xavier, Papo Michel, Planella Montserrat, Pardo Albert, Junquera Félix, Montoliu Silvia, Ballester Raquel, Martinez-Bauer Eva, Suarez David, Campo Rafel
Hospital de Sabadell, Corporació Sanitària Universitària Parc Taulí, 08208 Sabadell, Spain.
Departament de Medicina, Universitat Autònoma de Barcelona, 08208 Sabadell, Spain.
J Clin Med. 2020 Feb 3;9(2):408. doi: 10.3390/jcm9020408.
Guidelines recommend using prognostic scales for risk stratification in patients with non-variceal upper gastrointestinal bleeding. It remains unclear whether risk scores offer greater accuracy than clinical evaluation. Compare the diagnostic accuracy of the endoscopist's judgment against different risk-scoring systems (Rockall, Glasgow-Blatchford, Baylor and the Cedars-Sinai scores) for predicting outcomes in peptic ulcer bleeding (PUB). Between February 2006 and April 2010 we prospectively recruited 401 patients with peptic ulcer bleeding; 225 received endoscopic treatment. The endoscopist recorded his/her subjective assessment ("endoscopist judgment") of the risk of rebleeding and death immediately after endoscopy for each patient. Independent evaluators calculated the different scores. Area under the receiver-operating-characteristics (ROC) curve, sensitivity, specificity, positive and negative predictive values were calculated for rebleeding and mortality. : The areas under ROC curve of the endoscopist's clinical judgment for rebleeding (0.67-0.75) and mortality (0.84-0.9) were similar or even superior to the different risk scores in both the whole group and in patients receiving endoscopic therapy. The accuracy of the currently available risk scores for predicting rebleeding and mortality in PUB patients was moderate and not superior to the endoscopist's judgment. More precise prognostic scales are needed.
指南建议对非静脉曲张性上消化道出血患者使用预后量表进行风险分层。风险评分是否比临床评估具有更高的准确性仍不清楚。比较内镜医师判断与不同风险评分系统（Rockall评分、格拉斯哥-布拉奇福德评分、贝勒评分和雪松西奈评分）对消化性溃疡出血（PUB）预后的诊断准确性。在2006年2月至2010年4月期间，我们前瞻性招募了401例消化性溃疡出血患者；225例接受了内镜治疗。内镜医师在每次内镜检查后立即记录其对每位患者再出血和死亡风险的主观评估（“内镜医师判断”）。独立评估者计算不同的评分。计算再出血和死亡率的受试者操作特征（ROC）曲线下面积、敏感性、特异性、阳性和阴性预测值。：在内镜治疗的全组患者和患者中，内镜医师对再出血（0.67-0.75）和死亡率（0.84-0.9）的临床判断的ROC曲线下面积与不同风险评分相似甚至更高。目前可用的风险评分预测PUB患者再出血和死亡率的准确性中等，并不优于内镜医师的判断。需要更精确的预后量表。
