Pemmada Vikas, Shetty Athish, Shetty Shiran, C Ganesh Pai, Musunuri Balaji, Rajpurohit Siddheesh, Bhat Ganesh
Department of Gastroenterology and Hepatology, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, 576 104, India.
Indian J Gastroenterol. 2024 Dec 19. doi: 10.1007/s12664-024-01703-1.
Acute upper gastrointestinal bleeding (UGIB) still has a mortality rate of about 10%. Several pre-endoscopy scoring systems have been developed to predict the outcome, but none accurately predict mortality. The present study was aimed at comparing the new ABC score (age, blood tests and comorbidities) with other pre-existing scoring systems to predict mortality.
This prospective single-center study was done at a tertiary hospital in India in 2022-2023. Patients > 18 years presenting with UGIB within 48 hours were included in the study. They were divided into variceal and non-variceal UGIB cohorts and were followed for 30 days after receiving standard-of-care treatment.
Out of 296 patients, 168 (56.7%) had variceal (V) bleed, while 128 (43.2%) individuals had a non-variceal (NV) type of GI bleed. The mortality rate was 9.8% (n = 29), which was higher among the V bleed group compared to the NV bleed group (8.7% vs. 1.1%). The area under the receiver operating characteristics (AUROC) for ABC score was the highest (0.75) compared to other scoring systems and was also more significant among deaths related to V bleed (0.76) than NV bleed (0.64). Hypoalbuminemia and > 3 blood transfusions are significant factors in predicting mortality.
Our study demonstrates that the ABC score is superior to other scores in predicting 30-day mortality in patients with UGIB. ABC score may be a better predictor of mortality among V bleed patients than NV bleeds.
急性上消化道出血（UGIB）的死亡率仍约为10%。已经开发了几种内镜检查前评分系统来预测结果，但没有一种能准确预测死亡率。本研究旨在比较新的ABC评分（年龄、血液检查和合并症）与其他现有评分系统对死亡率的预测情况。
这项前瞻性单中心研究于2022年至2023年在印度的一家三级医院进行。纳入48小时内出现UGIB的18岁以上患者。他们被分为静脉曲张性和非静脉曲张性UGIB队列，并在接受标准治疗后随访30天。
在296例患者中，168例（56.7%）为静脉曲张性（V）出血，而128例（43.2%）为非静脉曲张性（NV）胃肠道出血。死亡率为9.8%（n = 29），V出血组的死亡率高于NV出血组（8.7%对1.1%）。与其他评分系统相比，ABC评分的受试者工作特征曲线下面积（AUROC）最高（0.75），在与V出血相关的死亡中（0.76）也比NV出血（0.64）更显著。低白蛋白血症和输血超过3次是预测死亡率的重要因素。
我们的研究表明，ABC评分在预测UGIB患者30天死亡率方面优于其他评分。ABC评分在预测V出血患者的死亡率方面可能比NV出血患者更好。
