急性上消化道出血死亡相关危险因素分析

Risk factors for death in patients with acute upper gastrointestinal bleeding

目的分析急性上消化道出血的死亡相关因素，并预测评估其病死率。方法回顾性收集2013—01—2017—07在北京积水潭医院诊治的急性上消化道出血患者，采集患者入院时的临床特征、既往史、诊治情况及转归，根据有无肝病，将患者分为肝病组和非肝病组，再以院内／30d内死亡作为结局，将肝病组分为死亡组和存活组，采用SPSS18．0软件进行数据分析，并绘制生存曲线和ROC曲线。分别计算AIMS65、Glasgow—Blachford（GBS）、Pre—Rockall和ALBI等四种评分的数值，以院内／30d内死亡为终点，绘制ROC曲线，比较曲线下面积（AUC）以评价四种方法的优劣。结果共选人240例患者，非肝病组179例（74．58％），死亡5例（2．79％），肝病组61例（25．42％），死亡16例（26．20％），两组病死率比较差异有统计学意义（P〈0．05）。肝病组在发病2～5d内存活率较非肝病组明显下降。肝病组中，死亡组的年龄、呕血、意识障碍、晕厥、总胆红素升高等与生存组比较差异均有统计学意义（P〈0．05）。ALBI评分可有效地预测总体患者和肝病组患者的病死率，AUC均〉0．8，与AMIS65、Pre—Rockall评分相当。但在非肝病组中，AUC值为0．742，低于其他三种评分。结论急性上消化道出血的死亡危险因素有肝病病史、年龄增大、呕血、合并意识障碍、血总胆红素升高等。ALBI评分、AMIS65评分、Pre—Rockall评分均可以有效地预测病死率，ALBI评分简单客观，适合应用于急诊科快速病情评估。

Objective To analyze the risk factors for death in patients with acute upper gastrointestinal bleeding, and to predict its mortality. Methods The clinical data including clinical features, previous history, examination, and treatment of the patients with acute upper gastrointestinal bleeding in our hospital from January 2013 to July 2017 were analyzed. All the patients were divided into non -Liver Disease group and Liver Disease group according to chronic liver disease. Then the patients with liver disease were divided into death group and survival group based on the death occurring in hospital or within 30 days after admission. Univariate comparison analyses were performed to evaluate the differences between the groups. And the survival curves and ROCs were plotted. Respectively calculated their AIMS65, Glasgow- Blachford （GBS）, Pre- Rockall scores and ALBI scores, took the in - hospital/30 - days death as the study endpoint. Compared the clinical value of the four scores by plotting their ROCs and calculating the AUC. Results Among the 240 eligible patients, there were 179 （74.58%） in non - Liver Disease group and 61 （25.42%） in Liver Disease group. Their mortality was 2.79% （5 deaths） and 26.2% （ 16 deaths） （P 〈 0.05）, respectively. The survival rate of Liver Disease group in 2 - 5 days was significantly lower than that of non - Liver Disease group. In liver disease group, the age, hematemesis, consciousness disorder, syncope and total bilirubin elevation showed significantly difference in the death and survival group （ all P 〈 0. 05 ）. The ALBI scoreeffectively predicted the mortality of patients both in the overall patient and Liver Disease group （ AUC 〉 0. 8 ） and was comparable to the AMIS65 and Pre - Rockall score. But in the non - liver disease group, AUC of ALBI score was 0. 742, lower than the other three scoring systems. Conclusion The risk factors for death of acute upper gastrointestinal bleeding include history of liver disease, old age, hematemesis, consciousness disorder and elevated blood bilirubin. ALBI score, AMIS65 score, Pre - Rockall scorecan effectively predict mortality, and ALBI score is more simple and objective, which is suitable for the rapid assessment of the emergency department.