Department of Gastroenterology, National Disaster Medical Center, 3256 Midoricho, Tachikawa-shi, Tokyo, 190-0014, Japan.
Division of Biochemistry, Department of Biomedical Sciences, Nihon University School of Medicine, 30-1 Oyaguchi-kamicho, Itabashi-ku, Tokyo, 173-8610, Japan.
BMC Gastroenterol. 2022 Jul 11;22(1):337. doi: 10.1186/s12876-022-02413-8.
Gastrointestinal bleeding is one of the major gastrointestinal diseases. In this study, our objective was to compare Glasgow-Blatchford score (GBS), AIMS65 score, MAP score, Modified GBS, and Iino score as outcome measures for upper gastrointestinal bleeding. In addition, we extracted factors associated with hemostatic procedures including endoscopy, and proposed a new robust score model.
From January 2015 to December 2019, 675 patients with symptoms such as hematemesis who visited the National Hospital Organization Disaster Medical Center and underwent urgent upper endoscopy with diagnosis of suspected non-variceal upper gastrointestinal bleeding were retrospectively reviewed. We evaluated the GBS, AIMS65 score, MAP score, Modified GBS, and Iino score, and assessed the outcomes of patients requiring hemostatic treatments at the subsequent emergency endoscopy. We performed logistic regression analysis of factors related to endoscopic hemostasis and upper gastrointestinal bleeding, created a new score model, and evaluated the prediction of hemostatic treatment and mortality in the new score and the existing scores.
The factors associated with endoscopic treatment were hematemesis, heart rate, HB (hemoglobin), blood pressure, blood urea nitrogen (BUN). Based on these predictors and the partial regression coefficients, a new score named H3B2 (using the initial letters of hematemesis, heart rate, HB, blood pressure, and BUN) was generated. H3B2 score was slightly more discriminatory compared to GBS and Modified GBS (area under the receiver operating characteristic curves (AUROC): 0.73 versus 0.721 and 0.7128, respectively) in predicting hemostatic treatment in emergency endoscopy. The H3B2 score also showed satisfactory prediction accuracy for subsequent deaths (AUROC: 0.6857. P < 0.001).
We proposed a new score, the H3B2 score, consisting of simple and objective indices in cases of suspected upper gastrointestinal bleeding. The H3B2 score is useful in identifying high-risk patients with suspected upper gastrointestinal bleeding who require urgent hemostatic treatment including emergency endoscopy.
胃肠道出血是一种主要的胃肠道疾病。本研究旨在比较 Glasgow-Blatchford 评分（GBS）、AIMS65 评分、MAP 评分、改良 GBS 和 Iino 评分作为上消化道出血的结局指标。此外，我们还提取了与内镜治疗相关的因素，并提出了一种新的稳健评分模型。
从 2015 年 1 月至 2019 年 12 月，回顾性分析了因呕血症状就诊于国立医院组织灾害医疗中心并接受紧急上内镜检查诊断为疑似非静脉曲张性上消化道出血的 675 例患者。我们评估了 GBS、AIMS65 评分、MAP 评分、改良 GBS 和 Iino 评分，并评估了需要后续紧急内镜止血治疗的患者的结局。我们对与内镜止血相关的因素进行了逻辑回归分析，创建了一个新的评分模型，并评估了新评分和现有评分在预测止血治疗和死亡率方面的效果。
与内镜治疗相关的因素包括呕血、心率、HB（血红蛋白）、血压、血尿素氮（BUN）。基于这些预测因子和偏回归系数，我们生成了一个新的评分，命名为 H3B2（使用呕血、心率、HB、血压和 BUN 的首字母）。与 GBS 和改良 GBS 相比，H3B2 评分在预测紧急内镜止血治疗方面的区分度略有提高（受试者工作特征曲线下面积（AUROC）：0.73 与 0.721 和 0.7128 相比）。H3B2 评分对随后的死亡也有较好的预测准确性（AUROC：0.6857，P < 0.001）。
我们提出了一种新的评分，即 H3B2 评分，由疑似上消化道出血病例中的简单和客观指标组成。H3B2 评分可用于识别疑似上消化道出血需要紧急止血治疗（包括紧急内镜治疗）的高危患者。
