Abstract
Background Acute non-variceal upper gastrointestinal bleeding (ANVUGIB) in adults is a common clinical emergency characterized by acute onset,fast-changing conditions,and threatening life when it is serious.How to quickly and accurately assess the condition,rapid diagnosis,and develop a reasonable treatment regimen is the key to improving the prognosis of ANVUGIB patients by effectively utilizing existing medical resources.Objective To compare the accuracy of Glasgow-Blatchford bleeding score(GBS),AIMS65 and Rockall scoring systems for the risk prediction of outcome in ANVUGIB patients.Methods We conducted the risk stratification of 246 patients with ANVUGIB admitted in Department of Emergency,Tianjin Medical University General Hospital from 2013 to 2015 by using GBS,AIMS65,Rockall scoring systems,respectively based on analyzing the baseline characteristics of the patients.We compared the sensitivity,specificity,positive predictive value,negative predictive value and area under the curve(AUC) of the receiver operating characteristic (ROC) of these 3 scoring systems in the prediction of the probability of needing interventions,rebleeding and death.Results Of the 246 patients,95(38.6%) received interventions,15(6.1%) had rebleeding,and 4(1.6%) died.When the patients had GBS <2 points,no one needed interventions,had rebleeding and died;when the patients had AIMS65 score <2 points,19 patients needed interventions,1 had rebleeding and 2 died;but when the patients had Rockall score <2 points,6 needed interventions,1 had rebreeding and no one died.When the GBS,AIMS65 score and Rockall score of the patients were all ≤2 points,in terms of predicting the probability of needing interventions in the ANVUGIB patients,the sensitivity of GBS,AIMS65 and Rockall scoring systems were 100.0%,80.0%,93.7%,respectively,the specificity of them were 26.5%,45.7%,15.9%,respectively,positive predictive value of them were 46.1%,48.1%,and 41.2%,respectively,negative predictive value of them were 100.0%,78.4%,80.0%,respectively,AUC of them were 0.675〔95%CI(0.580,0.679)〕,0.643〔95%CI(0.545,0.741)〕,0.653〔95%CI(0.553,0.752)〕,respectively;in regard to predicting the probability of rebleeding in the ANVUGIB patients,the sensitivity of GBS,AIMS65 and Rockall scoring systems were 100.0%,93.3%,93.3%,respectively,the specificity of them were 17.3%,37.7%,12.6%,respectively,positive predictive value of them were 7.3%,8.9%,6.5%,respectively,negative predictive value of them were 100.0%,98.9% and 96.7%,respectively,AUC of them were 0.809〔95%CI(0.638,0.941)〕,0.720〔95%CI(0.643,0.873)〕,0.800〔95%CI(0.597,0.907)〕,respectively;in the aspect of predicting the probability of death in the ANVUGIB patients,the sensitivity of GBS,AIMS65 and Rockall scoring systems were 100.0%,100.0%,and 75.0%,respectively,the specificity of them were 16.5%,36.0%,12.4%,respectively,positive predictive value of them were 1.9%,1.9%,and 1.8%,respectively,negative predictive value of them were 100.0%,98.9% and 100.0%,respectively,AUC of them were 0.848〔95%CI(0.707,0.930)〕,0.804〔95%CI(0.723,0.976)〕,0.838〔95%CI(0.597,0.968)〕,respectively.Conclusion GBS is more suitable for emergency predicting the risk of outcome in patients with ANVUGIB.Patients with GBS ≤2 points can be considered as low-risk patients.They can receive outpatient treatment,by which bed shortages can be relieved and medical resources can be saved to some extent.关键词
胃肠出血/急性非静脉曲张性上消化道出血/GBS/AIMS65/Rockall/危险分层Key words
Gastrointestinal hemorrhage/ANVUGIB/GBS/AIMS65/Rockall/Risk stratification分类
医药卫生
