Liver Unit, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy.
Internal Medicine Unit, Ospedale Vito Fazzi, Lecce, Italy.
Sci Rep. 2024 Aug 30;14(1):20225. doi: 10.1038/s41598-024-70577-2.
Upper gastrointestinal bleeding (UGIB) is a common cause of hospital admission worldwide and several risk scores have been developed to predict clinically relevant outcomes. Despite the geriatric population being a high-risk group, age is often overlooked in the assessment of many risk scores. In this study we aimed to compare the predictive accuracy of six pre-endoscopic risk scoring systems in a geriatric population hospitalised with UGIB. We conducted a multi-center cross-sectional study and recruited 136 patients, 67 of these were 65-81.9 years old ("< 82 years"), 69 were 82-100 years old ("≥ 82 years"). We performed six pre-endoscopic risk scores very commonly used in clinical practice (i.e. Glasgow-Blatchford Bleeding and its modified version, T-score, MAP(ASH), Canada-United Kingdom-Adelaide, AIMS65) in both age cohorts and compared their accuracy in relevant outcomes predictions: 30-days mortality since hospitalization, a composite outcome (need of red blood transfusions, endoscopic treatment, rebleeding) and length of hospital stay. T-score showed a significantly worse performance in mortality prediction in the "≥ 82 years" group (AUROC 0.53, 95% CI 0.27-0.75) compared to "< 82 years" group (AUROC 0.88, 95% CI 0.77-0.99). In the composite outcome prediction, except for T-score, younger participants had higher sensitivities than those in the "≥ 82 years" group. All risk scores showed low performances in the prediction of length of stay (AUROCs ≤ 0.70), and, except for CANUKA score, there was a significant difference in terms of accuracy among age cohorts. Most used UGIB risk scores have a low accuracy in the prediction of clinically relevant outcomes in the geriatric population; hence novel scores should account for age or advanced age in their assessment.
上消化道出血（UGIB）是全球范围内导致住院的常见原因，已经开发了几种风险评分来预测具有临床意义的结局。尽管老年人群是高风险群体，但在评估许多风险评分时，年龄往往被忽视。在这项研究中，我们旨在比较 6 种内镜前风险评分系统在因 UGIB 住院的老年人群中的预测准确性。我们进行了一项多中心横断面研究，共招募了 136 名患者，其中 67 名年龄在 65-81.9 岁（“<82 岁”），69 名年龄在 82-100 岁（“≥82 岁”）。我们对这两个年龄组进行了六种非常常用的内镜前风险评分（即格拉斯哥-布拉奇福德出血评分及其改良版、T 评分、MAP(ASH)、加拿大-英国-阿德莱德、AIMS65），并比较了它们在相关结局预测中的准确性：住院后 30 天死亡率、复合结局（需要输血、内镜治疗、再出血）和住院时间。T 评分在“≥82 岁”组中预测死亡率的表现明显较差（AUROC 0.53，95%CI 0.27-0.75），而在“<82 岁”组中则表现较好（AUROC 0.88，95%CI 0.77-0.99）。在复合结局预测中，除了 T 评分外，年轻患者的敏感性高于“≥82 岁”组。所有风险评分在预测住院时间方面表现不佳（AUROCs≤0.70），除了 CANUKA 评分外，不同年龄组之间的准确性存在显著差异。大多数用于 UGIB 的风险评分在预测老年人群中具有临床意义的结局方面准确性较低；因此，新的评分应在评估中考虑年龄或高龄。
