Department of Emergency Medicine, Bezmialem Vakıf University, Faculty of Medicine, Istanbul, Turkey..
Department of Emergency Medicine, Bezmialem Vakıf University, Faculty of Medicine, Istanbul, Turkey.
Am J Emerg Med. 2021 Jul;45:29-36. doi: 10.1016/j.ajem.2021.02.016. Epub 2021 Feb 15.
Upper gastrointestinal bleeding is one of the common causes of mortality and morbidity. The Rockall score (RS) and Glasgow-Blatchford score (GBS) are frequently used in determining the prognosis and predicting in-hospital adverse events, such as mortality, re-bleeding, hospital stay, and blood transfusion requirements. The quick Sepsis Related Organ Failure Assessment (qSOFA) score is easy and swift to calculate. The commonly used scores and the qSOFA score were compared and why and when these scores are most useful was investigated.
133 patients admitted to the emergency department with upper gastrointestinal bleeding over the period of a year, were evaluated in this retrospective study. The RS, GBS and qSOFA score were calculated for each patient, and their relationship with in-hospital adverse events, such as length of hospitalization, rebleeding, endoscopic treatment, blood transfusion requirements, and mortality, was investigated.
The mean overall GBS was 9.72 ± 3.72 (0-19), while that of patients who did not survive was 14.0 ± 1.1 (13-16), with an area under the curve (AUC) of 0.901, a cutoff value of 12.5, and specificity (Spe) and sensitivity (Sen) of 1 and 0.82, respectively. The median value of the GBS, in terms of transfusion need, was 7.12 ± 4.01 (0-15). (AUC = 0.752, cut-off = 9.5, Spe = 0.79, Sen = 0.69). The median value of the qSOFA score, in terms of intensive care need, was 1.73 ± 0.7 (0-3) (AUC = 0.921, cut-off = 0.5, Spe = 0.93, Sen = 0.79). The RS median, in terms of re-bleeding, was 8.22 ± 0.97 (6-9).
Early use of risk stratification scores in upper gastrointestinal bleeding is important due to the high risk of morbidity and mortality. All scoring systems were effective in predicting mortality, the need for intensive care, and re-bleeding. The GBS had a greater predictive power in terms of mortality and transfusion need, the qSOFA score for intensive care need, and the RS for re-bleeding. The simpler, more efficient, and more easily calculated qSOFA score can be used to estimate the severity of patients with upper gastrointestinal bleeding.
上消化道出血是导致死亡率和发病率的常见原因之一。Rockall 评分（RS）和 Glasgow-Blatchford 评分（GBS）常用于判断预后和预测院内不良事件，如死亡率、再出血、住院时间和输血需求。快速脓毒症相关器官衰竭评估（qSOFA）评分易于计算。比较了常用评分和 qSOFA 评分，并探讨了这些评分的用途和何时最有用。
本回顾性研究纳入了 1 年内因上消化道出血入住急诊科的 133 例患者。计算每位患者的 RS、GBS 和 qSOFA 评分，并调查其与院内不良事件（如住院时间、再出血、内镜治疗、输血需求和死亡率）的关系。
总体 GBS 平均值为 9.72±3.72（0-19），未存活患者为 14.0±1.1（13-16），曲线下面积（AUC）为 0.901，截断值为 12.5，特异性（Spe）和敏感性（Sen）分别为 1 和 0.82。GBS 中位数（输血需求）为 7.12±4.01（0-15）（AUC=0.752，截断值=9.5，Spe=0.79，Sen=0.69）。qSOFA 评分中位数（重症监护需求）为 1.73±0.7（0-3）（AUC=0.921，截断值=0.5，Spe=0.93，Sen=0.79）。RS 中位数（再出血）为 8.22±0.97（6-9）。
由于上消化道出血的高发病率和死亡率，早期使用风险分层评分很重要。所有评分系统在预测死亡率、重症监护需求和再出血方面均有效。GBS 在死亡率和输血需求方面具有更强的预测能力，qSOFA 评分在重症监护需求方面，RS 在再出血方面具有更强的预测能力。更简单、更有效、更容易计算的 qSOFA 评分可用于评估上消化道出血患者的严重程度。
