Li Chenyang, Zhang Ningning, Zhang Yuying, Guo Nan, Sun Xiaomeng, Li Shuling, Xu Yan, Wang Tao, Chen Chao
Department of Gastroenterology, The First Medical Center of Chinese PLA General Hospital, Beijing, China.
Department of Gastroenterology, The Fourth Medical Center of PLA General Hospital, Beijing, China.
Heliyon. 2024 Oct 9;10(20):e38877. doi: 10.1016/j.heliyon.2024.e38877. eCollection 2024 Oct 30.
Acute lower gastrointestinal bleeding is a common emergency in gastroenterology. Currently, there is insufficient information to predict adverse outcomes in patients with acute lower gastrointestinal bleeding. Our study aimed to compare the effectiveness of the clinical risk scores currently utilized and their ability to predict significant outcomes in lower gastrointestinal bleeding.
We conducted a prognostic study of patients hospitalized for acute lower gastrointestinal bleeding who underwent colonoscopy or angiography at a single-center hospital between January 2015 and October 2023. Adverse outcomes associated with ALGIB included rebleeding, blood transfusion, hemostatic interventions, and in-hospital death. We calculated three risk scores at admission (Oakland, Birmingham, SALGIB). We measured the accuracy of these scores using the area under the receiver operating characteristic curve (AUC) and compared them with DeLong's test.
222 patients with confirmed lower gastrointestinal bleeding (aged 64 years, 53-75) were finally included. The most common diagnoses were colorectal cancer (28 %) and hemorrhoids (14 %). The Oakland score, Birmingham score, and SALGIB score displayed comparable performance in predicting any adverse outcome (AUC = 0.54, 0.53, 0.55). However, none of the scores were able to sufficiently discriminate rebleeding, blood transfusion, or hemostatic intervention. Using the Youden index, cutoff points for predicting undesired results were identified for the Oakland score at 13, Birmingham score at 3, and SALGIB score at 2.
None of the three scores demonstrated satisfactory discrimination for adverse outcomes. Therefore, it is necessary to develop novel risk stratification scores with higher performance to improve risk stratification in acute lower gastrointestinal bleeding.
急性下消化道出血是胃肠病学中常见的急症。目前，关于预测急性下消化道出血患者不良结局的信息不足。我们的研究旨在比较目前使用的临床风险评分的有效性及其预测下消化道出血重大结局的能力。
我们对2015年1月至2023年10月在单中心医院因急性下消化道出血住院并接受结肠镜检查或血管造影的患者进行了一项预后研究。与急性下消化道出血相关的不良结局包括再出血、输血、止血干预和住院死亡。我们在入院时计算了三个风险评分（奥克兰、伯明翰、SALGIB）。我们使用受试者操作特征曲线下面积（AUC）测量这些评分的准确性，并通过德龙检验进行比较。
最终纳入222例确诊为下消化道出血的患者（年龄64岁，53 - 75岁）。最常见的诊断是结直肠癌（28%）和痔疮（14%）。奥克兰评分、伯明翰评分和SALGIB评分在预测任何不良结局方面表现相当（AUC = 0.54、0.53、0.55）。然而，没有一个评分能够充分区分再出血、输血或止血干预。使用约登指数，确定奥克兰评分预测不良结果的截断点为13，伯明翰评分为3，SALGIB评分为2。
这三个评分均未显示出对不良结局有令人满意的区分能力。因此，有必要开发性能更高的新型风险分层评分，以改善急性下消化道出血的风险分层。
