Sönmez Bedriye Müge, Hamzaçebioğlu Kayışoğlu Elif, Akçay Gülşen, Güner Necip Gökhan
Department of Emergency Medicine, Dışkapı Yıldırım Beyazıt Training and Research Hospital, University of Health Sciences, Ankara, Turkey.
Department of Emergency Medicine, University of Sakarya, Sakarya, Turkey.
Int J Gen Med. 2025 Aug 28;18:4873-4884. doi: 10.2147/IJGM.S532949. eCollection 2025.
There is a controversy about risk scores for risk stratification of acute upper gastrointestinal bleeding (AUGIB) in the emergency department (ED). This study aimed to compare the prognostic utility of UGIB scores with perfusion index (PI) and shock index (SI) in these patient groups in the ED.
A prospective cross-sectional study was conducted on a convenience sample of patients with AUGIB who were admitted to the ED of a tertiary care hospital. Areas under the receiver operating characteristic curve (AUROC) were used to evaluate the predictive performance of pre- and post-endoscopic risk scores, as well as hemodynamic indexes (PI and SI), in terms of composite endpoints.
Rockall Score (RS), Cedars Sinai Medical Centre Predictive Index (CSMCPI), Progetto nazionale emorragia digestiva score (PNED), Glasgow Blatchford Score (GBS), and albumin, international normalized ratio, mental status, systolic blood pressure, age ≥65 years score (AIMS65) were significantly higher for endoscopic intervention (p=0.002, p<0.001, p=0.001, p=0.002, p=0.004, respectively). RS, Cedarsiani, PNED, and GBS were significantly higher in hospitalized patients (p = 0.001, p < 0.001, p = 0.021, p = 0.002, respectively). RS, PNED, and AIMS65 scores were significantly higher for recurrent hemorrhage (p = 0.019, p = 0.005, p = 0.008, respectively). RS, Baylor Bleeding Score (BBS), Cedarsinai, PNED, and AIMS65 were significantly higher for mortality (p = 0.01, p = 0.013, p = 0.026, p = 0.005, p = 0.003, respectively). SI was statistically significant only for the transfusion need of patients (p = 0.019).
AIMS-65 seems to be more valuable and feasible than the others in the ED. Hemodynamic indexes should be used in conjunction with risk scores.
急诊科（ED）中急性上消化道出血（AUGIB）风险分层的风险评分存在争议。本研究旨在比较UGIB评分与灌注指数（PI）和休克指数（SI）在急诊科这些患者群体中的预后效用。
对一家三级护理医院急诊科收治的AUGIB患者便利样本进行前瞻性横断面研究。采用受试者操作特征曲线下面积（AUROC）来评估内镜检查前后风险评分以及血流动力学指标（PI和SI）对复合终点的预测性能。
内镜干预时，罗卡尔评分（RS）、雪松西奈医疗中心预测指数（CSMCPI）、国家消化出血项目评分（PNED）、格拉斯哥布拉奇福德评分（GBS）以及白蛋白、国际标准化比值、精神状态、收缩压、年龄≥65岁评分（AIMS65）显著更高（分别为p = 0.002、p < 0.001、p = 0.001、p = 0.002、p = 0.004）。住院患者中，RS、雪松西奈评分、PNED和GBS显著更高（分别为p = 0.001、p < 0.001、p = 0.021、p = 0.002）。复发出血时，RS、PNED和AIMS65评分显著更高（分别为p = 0.019、p = 0.005、p = 0.008）。死亡时，RS、贝勒出血评分（BBS）、雪松西奈评分、PNED和AIMS65显著更高（分别为p = 0.01、p = 0.013、p = 0.026、p = 0.005、p = 0.003）。SI仅对患者输血需求具有统计学意义（p = 0.019）。
在急诊科，AIMS - 65似乎比其他指标更有价值且更可行。血流动力学指标应与风险评分联合使用。
