Coşkun Yaş Secdegül, Üçöz Kocaşaban Dilber, Güler Sertaç
Department of Emergency Medicine, University of Health Sciences, Ankara Training and Research Hospital, Ankara, Türkiye.
Med Klin Intensivmed Notfmed. 2025 Mar 24. doi: 10.1007/s00063-025-01267-8.
Upper gastrointestinal bleeding (UGIB) is a common condition in emergency departments (ED). The aim of this study is to evaluate the effectiveness of the red blood cell distribution width (RDW) to albumin ratio and three types of shock index (SI) as predictors of adverse outcomes in patients with UGIB in the ED.
The study was designed as a retrospective, single-center study, and patients were screened using electronic medical records. Glasgow Blatchford, RDW/albumin ratio, SI, modified SI (MSI), and age SI were calculated, and adverse outcomes were defined as ICU admission, red blood cell transfusion, in-hospital mortality, and 30-day mortality. The effectiveness of these parameters in predicting adverse outcomes in UGIB patients admitted to the ED was evaluated.
The study enrolled 174 patients, of whom 17.2% required admission to the ICU, 33.9% received red blood cell transfusions, and 10.3% died within 30 days. Patients with adverse outcomes had significantly higher SI, MSI, age SI, and RDW/albumin ratio values. All four indices were statistically significant predictors of adverse outcomes (area under the curve [AUC] SI: 0.676; AUC MSI: 0.706; AUC age SI: 0.778; AUC RDW/albumin: 0.787). Age SI showed significantly higher prognostic performance in predicting adverse outcomes than SI and MSI.
The present study suggests that SI, MSI, age SI, and RDW/albumin ratio may be useful in predicting adverse outcomes in patients with UGIB. The RDW/albumin ratio was effective in predicting mortality, while age SI showed a higher predictive ability for adverse outcomes compared to SI and MSI.
上消化道出血（UGIB）是急诊科的常见病症。本研究旨在评估红细胞分布宽度（RDW）与白蛋白比值及三种类型的休克指数（SI）作为急诊科UGIB患者不良结局预测指标的有效性。
本研究设计为一项回顾性单中心研究，通过电子病历筛选患者。计算格拉斯哥布莱奇福德评分、RDW/白蛋白比值、SI、改良休克指数（MSI）和年龄休克指数，并将不良结局定义为入住重症监护病房（ICU）、输注红细胞、院内死亡和30天死亡率。评估这些参数在预测急诊科收治的UGIB患者不良结局方面的有效性。
本研究共纳入174例患者，其中17.2%需要入住ICU，33.9%接受了红细胞输注，10.3%在30天内死亡。出现不良结局的患者SI、MSI、年龄休克指数和RDW/白蛋白比值显著更高。所有四个指标均为不良结局的统计学显著预测指标（曲线下面积[AUC]：SI为0.676；AUC MSI为0.706；AUC年龄休克指数为0.778；AUC RDW/白蛋白为0.787）。年龄休克指数在预测不良结局方面的预后性能显著高于SI和MSI。
本研究表明，SI、MSI、年龄休克指数和RDW/白蛋白比值可能有助于预测UGIB患者的不良结局。RDW/白蛋白比值在预测死亡率方面有效，而年龄休克指数在预测不良结局方面的预测能力高于SI和MSI。
