不同内镜前评分方法对危险性急性上消化道出血的预后评估价值

The prognostic value of three pre-endoscopic scoring systems for high-risk acute upper gastrointestinal bleeding

目的比较三种内镜前评分方法[Pre-Rockall、Glasgow-Blatchford(GBS)、AIMS65评分]对危险性急性上消化道出血(AUGIB)患者预后评估的准确性和临床价值,并分析死亡危险因素。方法回顾性分析2015年1月至2017年12月武汉大学人民医院收治的危险性AUGIB患者261例临床资料,以院内或30d内死亡和(或)再出血为终点,绘制ROC曲线,比较曲线下面积(AUC),以评价三种方法的优劣。结果261例危险性AUGIB患者,男性211例(80.84%)。根据内镜检查结果,导致上消化道出血前三位病因分别为:肝硬化并静脉曲张破裂93例(49.21%)、十二指肠溃疡47例(24.87%)、胃溃疡20例(10.58%)。30d内病死率10.72%(28例),再出血率10.34%(27例)。不同时间行内镜检查对患者死亡的影响差异无统计学意义。预测危险性AUGIB患者院内或30d内死亡,AIMS65评分(AUC=0.736)和Pre-Rockall评分(AUC=0.715),能力相当;亚组分析,预测静脉曲张组院内或30d内死亡,AIMS65评分最优(AUC=0.888)。在预测院内或30d内再出血方面,三种评分方法AUC值相当,预测能力均不高。多因素Logistic回归分析显示,超敏肌钙蛋白I(ultra-TnI)、恶性肿瘤、AIMS65评分≥2分为危险性AUGIB死亡的危险因素(P<0.05)。结论危险性AUGIB死亡危险因素是超敏肌钙蛋白I、恶性肿瘤、AIMS65评分≥2分。AIMS65评分系统简单客观,是预测静脉曲线性AUGIB患者病死率最佳的内镜前评分方法。AIMS65评分≥2分为高危人群,适用于急诊科快速病情评估,早期识别高危人群,实现多学科综合治疗,以降低病死率。

Objective This study'aimed to compare the performances of three scoring systems (Glasgow -Blatchford Bleeding score,pre -endoscopic Rockall score and AIMS65 score)in predicting clinical outcomes in patients with high -risk acute upper gastrointestinal bleeding (AUGIB),and analyzed risk factors of mortality.Methods The clinical data of a total 261 cases of high -risk acute AUGIB patients in Intensive Care Unit of Renmin Hospital of Wuhan University from January 2015 to December 2017 were collected.The 30 -day death and/or rebleeding were taken as the study endpoints, and compared of clinical value among the three scores was carried out by plotting their ROC and calculating the AUC.Results For this study,male was 211 cases (80.84%),the mortality rate was 10.72%(28 cases),rebleeding rate was 10.34%(27 cases).According to the results of endoscopy, the top three causes of bleeding were variceal bleeding caused by cirrhosis (93 cases,49.21%),duodenal ulcer (47 cases,24.87%)and gastric ulcer (20 cases,10.58%).Patients underwent endoscopy had low mortality.The effect of endoscopy timing on the mortality was not statistically significant.In predicting 30 -day morality,the capabilities of was AIMS65 (0.736),and Pre - Rockall (0.715),are near GBS (0.655)in high -risk acute AUGIB patients.AMIS65 was the best scoring system for predicting 30 -day mortality in variceal group (0.888).There was no difference and poor in predicting rebleeding among these three scoring systems.After multivariate Logistic regression analysis,ultra -TnI,malignant tumor,and AIMS65 ≥2 were the risk factors of mortality in high -risk acute AUGIB patients (P <0.05 ).Conclusion The risk factors of mortality in high -risk acute AUGIB patients are ultra-TnI,malignant tumor,and AIMS65 ≥2.AIMS65 is the best scoring systems for predicting mortality,accurately with easy practice in AUGIB.AIMS65 ≥2 is high -risk groups,it is suitable for early identification of high -risk groups in emergency department,in order to achieve treatment of muhidisciplinary team in the early stage and reduce the mortality rate.