Rockall和Blatchford评分系统对急性非静脉曲张性上消化道出血的风险评价比较

Comparative Study on Rockall and Blatchford Scoring System for Risk Assessment of Acute Nonvariceal Upper Gastrointestinal Bleeding

背景:急性非静脉曲张性上消化道出血(ANVUGIB)是消化科常见的临床急症,Rockall和Blatchford评分系统常用于ANVUGIB风险分层。目的:探讨Rockall和Blatchford评分系统对ANVUGIB患者的输血、外科手术和死亡的预测价值。方法:采用Rockall和Blatchford评分系统对590例ANVUGIB住院患者进行危险程度分级评分,应用受试者工作特征(ROC)曲线下面积(AUC)评估两个评分系统对输血、外科手术和死亡的预测价值。结果:输血、外科手术和死亡的ANVUGIB患者Rockall和Blatchford评分显著高于相应未输血、未行外科手术和存活者(P<0.01)。Rockall评分系统预测输血、外科手术和死亡的AUC分别为0.785(95%CI:0.743~0.828,P=0.000)、0.765(95%CI:0.693~0.837,P=0.000)、0.835(95%CI:0.703~0.966,P=0.005);Blatchford评分系统预测输血、外科手术和死亡的AUC分别为0.812(95%CI:0.775~0.848,P=0.000)、0.870(95%CI:0.811~0.930,P=0.000)、0.784(95%CI:0.614~0.954,P=0.017)。结论:Rockall和Blatchford评分系统对ANVUGIB患者的输血、外科手术和死亡有较好的预测价值;Rockall评分系统对死亡的预测价值高于Blatchford评分系统,Blatchford评分系统对输血、外科手术的预测价值高于Rockall评分系统。

Background： Acute nonvariceal upper gastrointestinal bleeding（ ANVUGIB） is a commonly seen gastrointestinal emergency. Rockall and Blatchford scoring system are commonly used for risk stratification in ANVUGIB. Aims： To investigate the predictive values of Rockall and Blatchford scoring system for assessing the risk of blood transfusion,surgical intervention and mortality in patients with ANVUGIB. Methods： Five hundred and ninety hospitalized patients with ANVUGIB were scored by Rockall and Blatchford scoring system,respectively. Predictive values of these two scoring systems for assessing the risk of blood transfusion,surgical intervention and mortality were assessed by area under the receiver operating characteristic（ ROC） curve（ AUC）. Results： Rockall and Blatchford scores in patients with blood transfusion,surgical intervention and died were significantly higher than those in patients without blood transfusion,surgical intervention and survived（ P〈 0. 01）. The AUC of Rockall scoring system for predicting blood transfusion,surgical intervention and mortality were 0. 785（ 95% CI： 0. 743-0. 828,P = 0. 000）,0. 765（ 95% CI： 0. 693-0. 837,P =0. 000）,0. 835（ 95% CI： 0. 703-0. 966,P = 0. 005）,respectively. The AUC of Blatchford scoring system for predicting blood transfusion,surgical intervention and mortality were 0. 812（ 95% CI： 0. 775-0. 848,P = 0. 000）,0. 870（ 95% CI：0. 811-0. 930,P = 0. 000）,0. 784（ 95% CI： 0. 614-0. 954,P = 0. 017）,respectively. Conclusions： Rockall and Blatchford scoring system have high predictive value for blood transfusion,surgical intervention and mortality in patients with ANVUGIB. Rockall scoring system is better for predicting mortality,while Blatchford scoring system is better for predicting blood transfusion and surgical intervention.