Gastroenterology, Imperial College Healthcare NHS Trust, London, UK.
Imperial College London - South Kensington Campus, London, UK.
BMJ Open Gastroenterol. 2023 Mar;10(1). doi: 10.1136/bmjgast-2022-001008.
Acute upper gastrointestinal bleeding (AUGIB) is a common medical emergency, which takes up considerable healthcare resources. However, only approximately 20%-30% of bleeds require urgent haemostatic intervention. Current standard of care is for all patients admitted to hospital to undergo endoscopy within 24 hours for risk stratification, but this is difficult to achieve in practice, invasive and costly.
To develop a novel non-endoscopic risk stratification tool for AUGIB to predict the need for haemostatic intervention by endoscopic, radiological or surgical treatments. We compared this with the Glasgow-Blatchford Score (GBS).
Model development was carried out using a derivation (n=466) and prospectively collected validation cohort (n=404) of patients who were admitted with AUGIB to three large hospitals in London, UK (2015-2020). Univariable and multivariable logistic regression analysis was used to identify variables that were associated with increased or decreased chances of requiring haemostatic intervention. This model was converted into a risk scoring system, the London Haemostat Score (LHS).
The LHS was more accurate at predicting need for haemostatic intervention than the GBS, in the derivation cohort (area under the receiver operating curve (AUROC) 0.82; 95% CI 0.78 to 0.86 vs 0.72; 95% CI 0.67 to 0.77; p<0.001) and validation cohort (AUROC 0.80; 95% CI 0.75 to 0.85 vs 0.72; 95% CI 0.67 to 0.78; p<0.001). At cut-off scores at which LHS and GBS identified patients who required haemostatic intervention with 98% sensitivity, the specificity of the LHS was 41% vs 18% with the GBS (p<0.001). This could translate to 32% of inpatient endoscopies for AUGIB being avoided at a cost of only a 0.5% false negative rate.
The LHS is accurate at predicting the need for haemostatic intervention in AUGIB and could be used to identify a proportion of low-risk patients who can undergo delayed or outpatient endoscopy. Validation in other geographical settings is required before routine clinical use.
急性上消化道出血（AUGIB）是一种常见的医疗急症，需要大量的医疗资源。然而，只有大约 20%-30%的出血需要紧急止血干预。目前的标准治疗方案是所有住院患者在 24 小时内进行内镜检查以进行风险分层，但实际上这很难实现，而且具有侵入性和昂贵。
开发一种新的非内镜下风险分层工具，用于预测 AUGIB 需要通过内镜、放射或手术治疗进行止血干预的可能性。我们将其与格拉斯哥-布拉奇福德评分（GBS）进行了比较。
使用来自英国伦敦三家大型医院的 466 名患者的推导（n=466）和前瞻性收集的验证队列（n=404）进行模型开发（2015-2020 年）。使用单变量和多变量逻辑回归分析来确定与增加或减少止血干预可能性相关的变量。该模型被转换为风险评分系统，即伦敦止血评分（LHS）。
LHS 在预测需要止血干预方面比 GBS 更准确，在推导队列中（接受者操作特征曲线下面积（AUROC）0.82；95%CI 0.78 至 0.86 与 0.72；95%CI 0.67 至 0.77；p<0.001）和验证队列（AUROC 0.80；95%CI 0.75 至 0.85 与 0.72；95%CI 0.67 至 0.78；p<0.001）。在 LHS 和 GBS 以 98%的灵敏度识别需要止血干预的患者的截断分数下，LHS 的特异性为 41%，而 GBS 的特异性为 18%（p<0.001）。这可以将 AUGIB 住院患者内镜检查的 32%避免，而假阴性率仅为 0.5%。
LHS 能够准确预测 AUGIB 患者止血干预的需求，并可用于识别可以进行延迟或门诊内镜检查的低风险患者。在常规临床使用之前，需要在其他地理环境中进行验证。
