University of Health Sciences, Bakırköy Dr. Sadi Konuk Training and Research Hospital, Department of Emergency Medicine - Istanbul, Turkey.
University of Health Sciences, Bakırköy Dr. Sadi Konuk Training and Research Hospital, Department of General Surgery - Istanbul, Turkey.
Rev Assoc Med Bras (1992). 2023 Apr 14;69(4):e20221052. doi: 10.1590/1806-9282.20221052. eCollection 2023.
The aim of this study was to evaluate the performance of the Charlson Comorbidity Index ≥2, in-hospital onset, albumin <2.5 g/dL, altered mental status, Eastern Cooperative Oncology Group performance status ≥2, steroid use score in predicting mortality in patients with nonvariceal upper gastrointestinal bleeding and compare it with the Glasgow-Blatchford score; the albumin, international normalized ratio; alteration in mental status, systolic blood pressure, and age 65 score; the age, blood tests, and comorbidities score; and Complete Rockall score.
The data of patients with acute upper gastrointestinal bleeding who visited the emergency department during the study period were obtained from the hospital automation system by using the classification of disease codes and analyzed in this retrospective study. Adult patients with endoscopically confirmed nonvariceal upper gastrointestinal bleeding were included in the study. Patients with bleeding from the tumor, bleeding after endoscopic resection, or missing data were excluded. The prediction accuracy of the Charlson Comorbidity Index ≥ 2, in-hospital onset, albumin < 2.5 g/dL, altered mental status, Eastern Cooperative Oncology Group performance status ≥ 2, steroid use score was calculated using the area under the receiver operating characteristic curve and compared with that of Glasgow-Blatchford score, the albumin, international normalized ratio; alteration in mental status, systolic blood pressure, and age 65 score, the age, blood tests, and comorbidities score, and Complete Rockall score.
A total of 805 patients were included in the study, and the in-hospital mortality rate was 6.6%. The performance of the Charlson Comorbidity Index ≥ 2, in-hospital onset, albumin < 2.5 g/dL, altered mental status, Eastern Cooperative Oncology Group performance status ≥ 2, steroid use score (area under the receiver operating characteristic curve 0.812, 95%CI 0.783-0.839) was better than Glasgow-Blatchford score (area under the receiver operating characteristic curve 0.683, 95%CI 0.650-0.713, p=0.008), and similar to the the age, blood tests, and comorbidities score (area under the receiver operating characteristic curve 0.829, 95%CI 0.801-0.854, p=0.563), the albumin, international normalized ratio; alteration in mental status, systolic blood pressure, and age 65 score (area under the receiver operating characteristic curve 0.794, 95%CI 0.764-0.821, p=0.672), and Complete Rockall score (area under the receiver operating characteristic curve 0.761, 95%CI 0.730-0.790, p=0.106).
The performance of the Charlson Comorbidity Index ≥ 2, in-hospital onset, albumin < 2.5 g/dL, altered mental status, Eastern Cooperative Oncology Group performance status ≥ 2, steroid use score in predicting in-hospital mortality for our study population is better than Glasgow-Blatchford score and similar to the the age, blood tests, and comorbidities score, the albumin, international normalized ratio; alteration in mental status, systolic blood pressure, and age 65 score, and Complete Rockall score.
本研究旨在评估 Charlson 合并症指数≥2、住院时发病、白蛋白<2.5g/dL、精神状态改变、东部肿瘤协作组体能状态≥2、使用类固醇评分在预测非静脉曲张性上消化道出血患者死亡率方面的表现，并将其与 Glasgow-Blatchford 评分进行比较；比较白蛋白、国际标准化比值；精神状态改变、收缩压和年龄 65 评分；年龄、血液检查和合并症评分；以及完整 Rockall 评分。
通过使用疾病分类代码从医院自动化系统中获取研究期间在急诊科就诊的急性上消化道出血患者的数据，并在这项回顾性研究中进行分析。纳入内镜证实为非静脉曲张性上消化道出血的成年患者。排除肿瘤出血、内镜切除后出血或数据缺失的患者。使用受试者工作特征曲线下面积计算 Charlson 合并症指数≥2、住院时发病、白蛋白<2.5g/dL、精神状态改变、东部肿瘤协作组体能状态≥2、使用类固醇评分的预测准确性，并与 Glasgow-Blatchford 评分、白蛋白、国际标准化比值；精神状态改变、收缩压和年龄 65 评分、年龄、血液检查和合并症评分、完整 Rockall 评分进行比较。
共纳入 805 例患者，院内死亡率为 6.6%。Charlson 合并症指数≥2、住院时发病、白蛋白<2.5g/dL、精神状态改变、东部肿瘤协作组体能状态≥2、使用类固醇评分（受试者工作特征曲线下面积 0.812，95%CI 0.783-0.839）的表现优于 Glasgow-Blatchford 评分（受试者工作特征曲线下面积 0.683，95%CI 0.650-0.713，p=0.008），与年龄、血液检查和合并症评分（受试者工作特征曲线下面积 0.829，95%CI 0.801-0.854，p=0.563）、白蛋白、国际标准化比值；精神状态改变、收缩压和年龄 65 评分（受试者工作特征曲线下面积 0.794，95%CI 0.764-0.821，p=0.672）和完整 Rockall 评分（受试者工作特征曲线下面积 0.761，95%CI 0.730-0.790，p=0.106）相似。
Charlson 合并症指数≥2、住院时发病、白蛋白<2.5g/dL、精神状态改变、东部肿瘤协作组体能状态≥2、使用类固醇评分在预测本研究人群的院内死亡率方面的表现优于 Glasgow-Blatchford 评分，与年龄、血液检查和合并症评分、白蛋白、国际标准化比值；精神状态改变、收缩压和年龄 65 评分和完整 Rockall 评分相似。
