Wakatsuki Toshiyuki, Mannami Tomohiko, Furutachi Shinichi, Numoto Hiroki, Umekawa Tsuyoshi, Mitsumune Mayu, Sakaki Tsukasa, Nagahara Hanako, Fukumoto Yasushi, Yorifuji Takashi, Shimizu Shin'ichi
Department of Gastroenterology National Hospital Organization Okayama Medical Center Okayama Japan.
Department of Epidemiology, Okayama University Graduate School of Medicine Dentistry and Pharmaceutical Sciences Okayama Japan.
DEN Open. 2022 Nov 14;3(1):e185. doi: 10.1002/deo2.185. eCollection 2023 Apr.
The Glasgow-Blatchford score (GBS) is a widely used risk assessment tool for patients with upper gastrointestinal bleeding. However, it only identifies a relatively low proportion of patients at low risk for adverse events and poor outcomes. We developed a simple diagnostic algorithm combining the GBS and nasogastric aspirate and evaluated its diagnostic performance.
A total of 115 consecutive patients with suspected nonvariceal upper gastrointestinal bleeding who underwent nasogastric tube placement and upper endoscopy at our emergency department were prospectively evaluated. We compared the diagnostic accuracy of the GBS and our algorithm for predicting high-risk endoscopic lesions (HRELs) using receiver operating characteristic curve analysis.
Thirty-five patients had HRELs. Compared with the GBS, our algorithm showed superior performance with respect to the prediction of HRELs (area under the curve, 0.639 and 0.854, respectively; < 0.001). With set optimal threshold values, the algorithm identified a significantly higher proportion of patients who did not have HRELs than the GBS (23.5% vs. 2.6%, < 0.001).
The novel algorithm has improved the diagnostic performance of the GBS and predicted more patients who did not have HRELs than the GBS alone. After further validation, it may be a useful tool for making clinical management decisions for patients with nonvariceal upper gastrointestinal bleeding.
格拉斯哥 - 布拉奇福德评分（GBS）是一种广泛用于上消化道出血患者的风险评估工具。然而，它仅能识别出相对较低比例的不良事件和预后较差风险低的患者。我们开发了一种结合GBS和鼻胃管抽吸物的简单诊断算法，并评估了其诊断性能。
对在我们急诊科接受鼻胃管置入和上消化道内镜检查的115例连续疑似非静脉曲张性上消化道出血患者进行前瞻性评估。我们使用受试者工作特征曲线分析比较了GBS和我们的算法预测高危内镜病变（HRELs）的诊断准确性。
35例患者有HRELs。与GBS相比，我们的算法在预测HRELs方面表现更优（曲线下面积分别为0.639和0.854；P<0.001）。设定最佳阈值时，该算法识别出无HRELs患者的比例显著高于GBS（23.5%对2.6%，P<0.001）。
这种新算法提高了GBS的诊断性能，并且比单独使用GBS预测出更多无HRELs的患者。经过进一步验证后，它可能成为非静脉曲张性上消化道出血患者临床管理决策的有用工具。
