格拉斯哥-布拉奇福德评分可预测住院心力衰竭患者出院后胃肠道出血情况。
Glasgow-Blatchford Score Predicts Post-Discharge Gastrointestinal Bleeding in Hospitalized Patients with Heart Failure.
作者信息
Hotsuki Yu, Sato Yu, Yoshihisa Akiomi, Watanabe Koichiro, Kimishima Yusuke, Kiko Takatoyo, Yokokawa Tetsuro, Misaka Tomofumi, Sato Takamasa, Kaneshiro Takashi, Oikawa Masayoshi, Kobayashi Atsushi, Yamaki Takayoshi, Kunii Hiroyuki, Nakazato Kazuhiko, Takeishi Yasuchika
机构信息
Department of Cardiovascular Medicine, Fukushima Medical University, Fukushima 960-1247, Japan.
Department of Advanced Cardiac Therapeutics, Fukushima Medical University, Fukushima 960-1247, Japan.
出版信息
J Clin Med. 2020 Dec 17;9(12):4083. doi: 10.3390/jcm9124083.
BACKGROUND
The Glasgow-Blatchford Score (GBS) is one of the most widely used scoring systems for predicting clinical outcomes for gastrointestinal bleeding (GIB). However, the clinical significance of the GBS in predicting GIB in patients with heart failure (HF) remains unclear.
METHODS AND RESULTS
We conducted a prospective observational study in which we collected the clinical data of a total of 2236 patients (1130 men, median 70 years old) who were admitted to Fukushima Medical University Hospital for acute decompensated HF. During the post-discharge follow-up period of a median of 1235 days, seventy-eight (3.5%) patients experienced GIB. The GBS was calculated based on blood urea nitrogen, hemoglobin, systolic blood pressure, heart rate, and history of hepatic disease. The survival classification and regression tree analysis revealed that the accurate cut-off point of the GBS in predicting post-discharge GIB was six points. The patients were divided into two groups: the high GBS group (GBS > 6, = 702, 31.4%) and the low GBS group (GBS ≤ 6, = 1534, 68.6%). The Kaplan-Meier analysis showed that GIB rates were higher in the high GBS group than in the low GBS group. Multivariate Cox proportional hazards analysis adjusted for age, malignant tumor, and albumin indicated that a high GBS was an independent predictor of GIB (hazards ratio 2.258, 95% confidence interval 1.326-3.845, = 0.003).
CONCLUSIONS
A high GBS is an independent predictor and useful risk stratification score of post-discharge GIB in patients with HF.
背景
格拉斯哥-布拉奇福德评分（GBS）是预测胃肠道出血（GIB）临床结局最广泛使用的评分系统之一。然而，GBS在预测心力衰竭（HF）患者GIB方面的临床意义仍不明确。
方法与结果
我们进行了一项前瞻性观察性研究，收集了总共2236例（1130例男性，中位年龄70岁）因急性失代偿性HF入住福岛医科大学医院患者的临床数据。在中位1235天的出院后随访期内，78例（3.5%）患者发生了GIB。GBS基于血尿素氮、血红蛋白、收缩压、心率和肝病病史进行计算。生存分类和回归树分析显示，GBS预测出院后GIB的准确截断点为6分。患者分为两组：高GBS组（GBS>6，n = 702，31.4%）和低GBS组（GBS≤6，n = 1534，68.6%）。Kaplan-Meier分析表明，高GBS组的GIB发生率高于低GBS组。对年龄、恶性肿瘤和白蛋白进行校正的多变量Cox比例风险分析表明，高GBS是GIB的独立预测因素（风险比2.258，95%置信区间1.326 - 3.845，P = 0.003）。
结论
高GBS是HF患者出院后GIB的独立预测因素和有用的风险分层评分。
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