Department of Internal Medicine, College of Medicine, Ewha Womans University, Seoul, Korea.
Korean J Intern Med. 2022 Nov;37(6):1176-1185. doi: 10.3904/kjim.2022.099. Epub 2022 Nov 1.
BACKGROUND/AIMS: Acute upper gastrointestinal (UGI) bleeding is a significant emergency situation with a mortality rate of 2% to 10%. Therefore, initial risk stratification is important for proper management. We aimed to evaluate the role of contrast-enhanced multidetector computed tomography (MDCT) for risk stratification in patients with acute UGI bleeding in the emergency room (ER).
This retrospective study included patients with UGI bleeding in the ER. Glasgow-Blatchford risk score-computed tomography (GBS-CT) was assessed using a combination of GBS and the MDCT scan scoring system.
Of the 297 patients with UGI bleeding, 124 (41.8%) underwent abdominal MDCT. Among them, 90.3% were classified as high-risk by GBS, and five patients died (4.0%). Rebleeding occurred in nine patients (7.3%). The high-risk GBS-CT group had significantly higher in-hospital mortality (10.5% in high-risk vs. 1.4% in moderate risk vs. 0% in low-risk, p = 0.049), transfusion amount (p < 0.001), and endoscopic hemostasis (p < 0.001) compared to the moderate- and low-risk groups.
Adding MDCT scans to the existing validated prognosis model when predicting the risk of UGI bleeding in patients in the ER plays a significant role in determining in-hospital mortality, transfusions, and the need for endoscopic hemostasis.
背景/目的：急性上消化道（UGI）出血是一种具有 2%至 10%死亡率的重大紧急情况。因此，初始风险分层对于适当的管理很重要。我们旨在评估对比增强多排螺旋 CT（MDCT）在急诊室（ER）急性 UGI 出血患者中的风险分层作用。
这项回顾性研究纳入了 ER 中出现 UGI 出血的患者。使用 GBS 和 MDCT 扫描评分系统的组合评估格拉斯哥-布拉奇福德风险评分-计算机断层扫描（GBS-CT）。
在 297 例 UGI 出血患者中，124 例（41.8%）接受了腹部 MDCT 检查。其中，90.3%的患者根据 GBS 被归类为高风险，有 5 例患者死亡（4.0%）。9 例患者发生再出血（7.3%）。高风险 GBS-CT 组的住院死亡率显著更高（高风险组为 10.5%，中风险组为 1.4%，低风险组为 0%，p = 0.049）、输血量更多（p < 0.001），且需要内镜止血（p < 0.001）的比例也更高。
在预测 ER 中 UGI 出血患者的预后时，将 MDCT 扫描添加到现有的验证预后模型中，对于确定住院死亡率、输血需求和内镜止血的必要性具有重要作用。
