对于上消化道出血患者，年龄、血液检查、合并症及AIMS65风险评分比格拉斯哥-布拉奇福德评分和内镜检查前罗卡尔评分表现更优。
Age, blood tests and comorbidities and AIMS65 risk scores outperform Glasgow-Blatchford and pre-endoscopic Rockall score in patients with upper gastrointestinal bleeding.
作者信息
Morarasu Bianca Codrina, Sorodoc Victorita, Haisan Anca, Morarasu Stefan, Bologa Cristina, Haliga Raluca Ecaterina, Lionte Catalina, Marciuc Emilia Adriana, Elsiddig Mohammed, Cimpoesu Diana, Dimofte Gabriel Mihail, Sorodoc Laurentiu
机构信息
Department of Internal Medicine and Toxicology, Saint Spiridon University Regional Emergency Hospital, Faculty of Medicine, "Grigore T. Popa" University of Medicine and Pharmacy, Iasi 700111, Romania.
Department of Emergency Medicine, Saint Spiridon University Regional Emergency Hospital, Faculty of Medicine, "Grigore T. Popa" University of Medicine and Pharmacy, Iasi 700111, Romania.
出版信息
World J Clin Cases. 2023 Jul 6;11(19):4513-4530. doi: 10.12998/wjcc.v11.i19.4513.
BACKGROUND
Upper gastrointestinal (GI) bleeding is a life-threatening condition with high mortality rates.
AIM
To compare the performance of pre-endoscopic risk scores in predicting the following primary outcomes: In-hospital mortality, intervention (endoscopic or surgical) and length of admission (≥ 7 d).
METHODS
We performed a retrospective analysis of 363 patients presenting with upper GI bleeding from December 2020 to January 2021. We calculated and compared the area under the receiver operating characteristics curves (AUROCs) of Glasgow-Blatchford score (GBS), pre-endoscopic Rockall score (PERS), albumin, international normalized ratio, altered mental status, systolic blood pressure, age older than 65 (AIMS65) and age, blood tests and comorbidities (ABC), including their optimal cut-off in variceal and non-variceal upper GI bleeding cohorts. We subsequently analyzed through a logistic binary regression model, if addition of lactate increased the score performance.
RESULTS
All scores had discriminative ability in predicting in-hospital mortality irrespective of study group. AIMS65 score had the best performance in the variceal bleeding group (AUROC = 0.772; < 0.001), and ABC score (AUROC = 0.775; < 0.001) in the non-variceal bleeding group. However, ABC score, at a cut-off value of 5.5, was the best predictor (AUROC = 0.770, = 0.001) of in-hospital mortality in both populations. PERS score was a good predictor for endoscopic treatment (AUC = 0.604; = 0.046) in the variceal population, while GBS score, (AUROC = 0.722; = 0.024), outperformed the other scores in predicting surgical intervention. Addition of lactate to AIMS65 score, increases by 5-fold the probability of in-hospital mortality ( < 0.05) and by 12-fold if added to GBS score ( < 0.003). No score proved to be a good predictor for length of admission.
CONCLUSION
ABC score is the most accurate in predicting in-hospital mortality in both mixed and non-variceal bleeding population. PERS and GBS should be used to determine need for endoscopic and surgical intervention, respectively. Lactate can be used as an additional tool to risk scores for predicting in-hospital mortality.
背景
上消化道（GI）出血是一种危及生命的疾病，死亡率很高。
目的
比较内镜检查前风险评分在预测以下主要结局方面的表现：住院死亡率、干预措施（内镜或手术）和住院时间（≥7天）。
方法
我们对2020年12月至2021年1月期间363例上消化道出血患者进行了回顾性分析。我们计算并比较了格拉斯哥-布拉奇福德评分（GBS）、内镜检查前罗卡尔评分（PERS）、白蛋白、国际标准化比值、精神状态改变、收缩压、65岁以上年龄（AIMS65）以及年龄、血液检查和合并症（ABC）的受试者操作特征曲线下面积（AUROCs），包括它们在静脉曲张性和非静脉曲张性上消化道出血队列中的最佳截断值。随后，我们通过逻辑二元回归模型分析了添加乳酸是否能提高评分表现。
结果
无论研究组如何，所有评分在预测住院死亡率方面都具有判别能力。AIMS65评分在静脉曲张出血组中表现最佳（AUROC = 0.772；<0.001），而ABC评分（AUROC = 0.775；<0.001）在非静脉曲张出血组中表现最佳。然而，ABC评分在截断值为5.5时，是两组人群住院死亡率的最佳预测指标（AUROC = 0.770，= 0.001）。PERS评分是静脉曲张人群内镜治疗的良好预测指标（AUC = 0.604；= 0.046），而GBS评分（AUROC = 0.722；= 0.024）在预测手术干预方面优于其他评分。将乳酸添加到AIMS65评分中，住院死亡率的概率增加5倍（<0.05），添加到GBS评分中则增加12倍（<0.003）。没有评分被证明是住院时间的良好预测指标。
结论
ABC评分在预测混合性和非静脉曲张性出血人群的住院死亡率方面最为准确。PERS和GBS评分应分别用于确定是否需要内镜和手术干预。乳酸可作为风险评分的附加工具用于预测住院死亡率。
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