比较非内镜评分对三级转诊医院急诊上消化道出血患者预后的预测价值：一项前瞻性队列研究。

COMPARISON OF NON-ENDOSCOPIC SCORES FOR THE PREDICTION OF OUTCOMES IN PATIENTS OF UPPER GASTROINTESTINAL BLEED IN AN EMERGENCY OF A TERTIARY CARE REFERRAL HOSPITAL: A PROSPECTIVE COHORT STUDY.

机构信息

Post Graduate Institute of Medical Education and Research, Department of Gastroenterology, Chandigarh, India.

Post Graduate Institute of Medical Education and Research, Department of Internal Medicine, Chandigarh, India.

出版信息

Arq Gastroenterol. 2021 Oct-Dec;58(4):534-540. doi: 10.1590/S0004-2803.202100000-95.

DOI:10.1590/S0004-2803.202100000-95

PMID:34909862

Abstract

BACKGROUND

Traditionally peptic ulcer disease was the most common cause of upper gastrointestinal (UGI) bleed but with the changing epidemiology; other etiologies of UGI bleed are emerging. Many scores have been described for predicting outcomes and the need for intervention in UGI bleed but prospective comparison among them is scarce.

OBJECTIVE

This study was planned to determine the etiological pattern of UGI bleed and to compare Glasgow Blatchford score, Pre-Endoscopy Rockall score, AIMS65, and Modified Early Warning Score (MEWS) as predictors of outcome.

METHODS

In this prospective cohort study 268 patients of UGI bleed were enrolled and followed up for 8 weeks. Glasgow Blatchford score, Endoscopy Rockall score, AIMS65, and MEWS were calculated for each patient, and the area under the receiver operating characteristic (AUC-ROC) curve for each score was compared.

RESULTS

The most common etiology for UGI bleed were gastroesophageal varices 150 (63.55%) followed by peptic ulcer disease 29 (12.28%) and mucosal erosive disease 27 (11.44%). Total 38 (15.26%) patients had re-bleed and 71 (28.5%) patients died. Overall, 126 (47%) patients required blood component transfusion, 25 (9.3%) patients required mechanical ventilation and 2 (0.74%) patients required surgical intervention. Glasgow Blatchford score was the best in predicting the need for transfusion (cut off - 10, AUC-ROC= 0.678). Whereas AIMS65 with a score of ≥2 was best in predicting re-bleed (AUC-ROC=0.626) and mortality (AUC-ROC=0.725).

CONCLUSION

Gastrointestinal bleed was most commonly of variceal origin at our tertiary referral center in Northern India. AIMS65 was the best & simplest score with a score of ≥2 for predicting re-bleed and mortality.

摘要

背景

传统上，消化性溃疡病是上消化道（UGI）出血的最常见原因，但随着流行病学的变化，UGI 出血的其他病因也在出现。已经描述了许多评分来预测 UGI 出血的结果和干预需求，但它们之间的前瞻性比较很少。

目的

本研究旨在确定 UGI 出血的病因模式，并比较格拉斯哥布拉德福评分、内镜前罗克厄尔评分、AIMS65 和改良早期预警评分（MEWS）作为预后预测指标。

方法

在这项前瞻性队列研究中，共纳入 268 例 UGI 出血患者，并进行了 8 周的随访。为每位患者计算了格拉斯哥布拉德福评分、内镜前罗克厄尔评分、AIMS65 和 MEWS，并比较了每个评分的受试者工作特征曲线下面积（AUC-ROC）。

结果

UGI 出血的最常见病因是胃食管静脉曲张 150 例（63.55%），其次是消化性溃疡病 29 例（12.28%）和黏膜糜烂性疾病 27 例（11.44%）。共有 38 例（15.26%）患者再次出血，71 例（28.5%）患者死亡。总体而言，126 例（47%）患者需要输血，25 例（9.3%）患者需要机械通气，2 例（0.74%）患者需要手术干预。格拉斯哥布拉德福评分是预测输血需求的最佳评分（截断值为-10，AUC-ROC=0.678）。而 AIMS65 的评分≥2 是预测再出血（AUC-ROC=0.626）和死亡率（AUC-ROC=0.725）的最佳评分。