Smith Christopher, Leggett Gillian, Jayaprakash Anthoor, Khan Mohammed, Thomson John M, Vijayan Balasubramaniam, Fraser Andrew, Leeds John S
Department of Gastroenterology Aberdeen Royal Infirmary Aberdeen UK.
Department of Gastroenterology Northumbria Healthcare Cramlington UK.
DEN Open. 2023 Dec 11;4(1):e323. doi: 10.1002/deo2.323. eCollection 2024 Apr.
Lower gastrointestinal bleeding is a common presentation with little data concerning risk factors for adverse outcomes. The aim was to derive and validate a scoring system to stratify risk in lower gastrointestinal bleeding and compare it to the Oakland score.
A total of 2385 consecutive patients (mean age 65 years, 1140 males) were used to derive the score using multivariate logistic regression modeling then internally and externally validated. The Oakland score was applied and area under receiver operating characteristic (AUROC) curves were calculated and compared. A score of <1 was compared with an Oakland score of <9 to assess 30-day rebleeding and mortality rates.
Rebleeding was associated with age, inpatient bleeding, syncope, malignancy, tachycardia, hypotension, lower hemoglobin and mortality with age, inpatient bleeding, liver/gastrointestinal disease, tachycardia, and hypotension. The area under the receiver operating characteristic curves was 0.742 for rebleeding and 0.802 for mortality. A score <1 was associated with rebleeding (0.0%-2.2%) and mortality (0%). The Oakland score had a significantly lower area under the receiver operating characteristic curve for rebleeding of 0.687 but not for mortality; 0.757. A score <1 was associated with a lower 30-day rebleeding risk compared to an Oakland score <9 (4/379 vs. 15/355, = 0.009) but not mortality (0/365 vs. 1/355, = 0.493).
Our score predicts 30-day rebleeding and mortality rate with low scores associated with very low risk. The Aberdeen score is superior to the Oakland score for predicting rebleeding. Prospective evaluation of both scores is required.
下消化道出血是一种常见病症，但关于不良结局危险因素的数据较少。本研究旨在推导并验证一种用于对下消化道出血风险进行分层的评分系统，并将其与奥克兰评分进行比较。
共纳入2385例连续患者（平均年龄65岁，男性1140例），采用多因素逻辑回归模型推导该评分，然后进行内部和外部验证。应用奥克兰评分并计算和比较受试者操作特征曲线下面积（AUROC）。将评分<1与奥克兰评分<9进行比较，以评估30天再出血率和死亡率。
再出血与年龄、住院期间出血、晕厥、恶性肿瘤、心动过速、低血压、血红蛋白降低有关，死亡率与年龄、住院期间出血、肝脏/胃肠道疾病、心动过速和低血压有关。再出血的受试者操作特征曲线下面积为0.742，死亡率为0.802。评分<1与再出血（0.0%-2.2%）和死亡率（0%）相关。奥克兰评分在再出血方面的受试者操作特征曲线下面积显著较低，为0.687，但在死亡率方面并非如此；为0.757。与奥克兰评分<9相比，评分<1与30天再出血风险较低相关（4/379 vs. 15/355，P = 0.009），但与死亡率无关（0/365 vs. 1/355，P = 0.493）。
我们的评分可预测30天再出血率和死亡率，低分与极低风险相关。在预测再出血方面，阿伯丁评分优于奥克兰评分。需要对这两种评分进行前瞻性评估。
