Department of Gastroenterology, Zhong Da Hospital, Medical School, Southeast University, Nanjing, PR China.
Ann Med. 2021 Dec;53(1):1806-1815. doi: 10.1080/07853890.2021.1990394.
Acute variceal bleeding (AVB) is a life-threatening condition that needs risk stratification to guide clinical treatment. Which risk system could reflect the prognosis more accurately remains controversial. We aimed to conduct a meta-analysis of the predictive value of GBS, AIMS65, Rockall (clinical Rockall score and full Rockall score), CTP and MELD.
PubMed, Web of Science, Embase, Cochrane library, WANGFANG and CNKI were searched. Twenty-eight articles were included in the study. The Meta-DiSc software and MedCalc software were used to pool the predictive accuracy.
Concerning in-hospital mortality, CTP, AIMS65, MELD, Full-Rockall and GBS had a pooled AUC of 0.824, 0.793, 0.788, 0.75 and 0.683, respectively. CTP had the highest sensitivity of 0.910 (95% CI: 0.864-0.944) with a specificity of 0.666 (95% CI: 0.635-0.696). AIMS65 had the highest specificity of 0.774 (95% CI: 0.749-0.798) with a sensitivity of 0.679 (95% CI: 0.617-0.736). For follow-up mortality, MELD, AIMS65, CTP, Clinical Rockall, Full-Rockall and GBS showed a pooled AUC of 0.798, 0.77, 0.746, 0.704, 0.678 and 0.618, respectively. CTP had the highest specificity (0.806, 95% CI: 0.763-0.843) with a sensitivity of 0.722 (95% CI: 0.628-0.804). GBS had the highest sensitivity 0.800 (95% CI: 0.696-0.881) with a specificity of 0.412 (95% CI: 0.368-0.457). As for rebleeding, no score performed particularly well.
No risk scores were ideally identified by our systematic review. CTP was superior to other risk scores in identifying AVB patients at high risk of death in hospital and patients at low risk within follow-up. Guidelines have recommended the use of GBS to risk stratification of patients with upper gastrointestinal bleeding. However, if the cause of upper gastrointestinal bleeding is suspected oesophageal and gastric varices, extra care should be taken. Because in this meta-analysis, the ability of GBS was limited.Key messageCTP was superior in identifying AVB patients at high risk of death in hospital and low risk within follow-up.GBS, though recommended by the Guidelines, should be cautiously used when assessing AVB patients.
急性静脉曲张出血 (AVB) 是一种危及生命的疾病，需要进行风险分层以指导临床治疗。哪种风险系统能更准确地反映预后仍存在争议。我们旨在对 GBS、AIMS65、Rockall（临床 Rockall 评分和全 Rockall 评分）、CTP 和 MELD 的预测价值进行荟萃分析。
检索PubMed、Web of Science、Embase、Cochrane 图书馆、WANGFANG 和 CNKI。共纳入 28 篇文章进行研究。使用 Meta-DiSc 软件和 MedCalc 软件对预测准确性进行汇总。
关于院内死亡率，CTP、AIMS65、MELD、全 Rockall 和 GBS 的 AUC 分别为 0.824、0.793、0.788、0.75 和 0.683。CTP 的敏感性最高为 0.910（95%CI：0.864-0.944），特异性为 0.666（95%CI：0.635-0.696）。AIMS65 的特异性最高为 0.774（95%CI：0.749-0.798），敏感性为 0.679（95%CI：0.617-0.736）。对于随访死亡率，MELD、AIMS65、CTP、临床 Rockall、全 Rockall 和 GBS 的 AUC 分别为 0.798、0.77、0.746、0.704、0.678 和 0.618。CTP 的特异性最高（0.806，95%CI：0.763-0.843），敏感性为 0.722（95%CI：0.628-0.804）。GBS 的敏感性最高为 0.800（95%CI：0.696-0.881），特异性为 0.412（95%CI：0.368-0.457）。至于再出血，没有评分表现特别好。
本系统评价未确定理想的风险评分。CTP 在识别 AVB 患者院内死亡风险高和随访期间风险低方面优于其他风险评分。指南建议使用 GBS 对上消化道出血患者进行风险分层。但是，如果怀疑上消化道出血的病因是食管和胃静脉曲张，应格外小心。因为在这项荟萃分析中，GBS 的能力有限。
CTP 更擅长识别院内死亡风险高和随访期间风险低的 AVB 患者。GBS 虽然被指南推荐，但在评估 AVB 患者时应谨慎使用。
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