Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan; Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA.
Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan.
Gastrointest Endosc. 2020 Sep;92(3):578-588.e4. doi: 10.1016/j.gie.2020.03.3846. Epub 2020 Mar 30.
Although upper GI bleeding (UGIB) is a significant cause of inpatient admissions, no scoring method has proven to be accurate and simple as a standard for triage purposes. Therefore, we compared a previously described 3-variable score (1 point each for absence of daily proton pump inhibitor use in the week before the index presentation, shock index [heart rate/systolic blood pressure] ≥1, and blood urea nitrogen/creatinine ≥30 [urea/creatinine≥140]), the Horibe gAstRointestinal BleedING scoRe (HARBINGER), with the 8-variable Glasgow-Blatchford Score (GBS) and 5-variable AIMS65 to evaluate and validate the accuracy in predicting high-risk features that warrant admission and urgent endoscopy.
Consecutive patients presenting with suspected UGIB between 2012 and 2015 were prospectively enrolled in 3 acute care Japanese hospitals. On presentation to the emergency setting, an endoscopy was performed in a timely fashion. The primary outcome was the prediction of high-risk endoscopic stigmata.
Of 1486 enrolled patients, 637 (43%) harbored high-risk endoscopic stigmata according to international consensus statements. The area under the receiver operating characteristic curve (AUC) for the HARBINGER was .76 (95% confidence interval [CI], .72-.79), which was significantly superior to both the GBS (AUC, .68; 95% CI, .64-.71; P < .001) and the AIMS65 (AUC, .54; 95% CI, .50-.58; P < .001). When the HARBINGER cutoff value was set at 1 to rule out patients who needed admission and urgent endoscopy, its sensitivity and specificity was 98.8% (95% CI, 97.9-99.6) and 15.5% (95% CI, 13.1-18.0), respectively.
The HARBINGER, a simple 3-variable score, provides a more accurate method for triage of patients with suspected UGIB than both the GBS and AIMS65.
尽管上消化道出血（UGIB）是导致住院的重要原因，但尚无评分方法被证明能够准确、简单地作为分诊标准。因此，我们比较了一种先前描述的 3 变量评分（在指数表现前一周内每天未使用质子泵抑制剂 1 分，休克指数[心率/收缩压]≥1，尿素氮/肌酐≥30[尿素/肌酐≥140]）、Horibe 胃肠道出血评分（HARBINGER）、8 变量 Glasgow-Blatchford 评分（GBS）和 5 变量 AIMS65，以评估和验证预测需要住院和紧急内镜检查的高危特征的准确性。
2012 年至 2015 年期间，连续前瞻性纳入 3 家日本急性护理医院疑似 UGIB 的患者。在急诊时及时进行内镜检查。主要结局是预测高危内镜下特征。
1486 例患者中，637 例（43%）根据国际共识声明存在高危内镜下特征。HARBINGER 的受试者工作特征曲线下面积（AUC）为 0.76（95%置信区间 [CI]，0.72-0.79），明显优于 GBS（AUC，0.68；95% CI，0.64-0.71；P<.001）和 AIMS65（AUC，0.54；95% CI，0.50-0.58；P<.001）。当将 HARBINGER 截断值设定为 1 以排除需要住院和紧急内镜检查的患者时，其敏感性和特异性分别为 98.8%（95% CI，97.9-99.6）和 15.5%（95% CI，13.1-18.0）。
HARBINGER 是一种简单的 3 变量评分，比 GBS 和 AIMS65 更能准确地对疑似 UGIB 患者进行分诊。
