比较AIMS65评分与GBS评分对急诊抢救室上消化道出血患者临床不良事件的预测价值

Compare of AIMS 65 and Glasgow-Blatchford score for predicting clinical outcomes in patients with upper gastrointestinal bleeding in the emergency room

目的:比较AIMS65评分与Glasgow-Blatchford(GBS)评分对急诊抢救室上消化道出血患者临床不良事件的预测价值。方法:我们回顾性研究了2018年1月-2019年9月期间在我院急诊抢救室治疗的719例上消化道出血患者临床资料,根据不良事件发生率(输血治疗,手术/介入干预及死亡),比较AIMS65和Glasgow-Blatchford评分对患者预后的预测价值。使用受试者工作特征曲线(ROC)下面积对两个评分系统进行比较。结果:AIMS65评分与GBS评分评估不良事件发生率的ROC曲线下面积分别为0.75,0.74,差异无统计学意义(P=0.78);AIMS 65评分与GBS评分评估输血治疗的ROC曲线下面积分别为0.65,0.72,差异有统计学意义(P=0.0044);AIMS 65评分与GBS评分评估手术/介入干预的ROC曲线下面积分别为0.70、0.63,差异无统计学意义(P=0.071);AIMS65评分与GBS评分预测死亡的ROC曲线下面积分别为0.96,0.88,差异有统计学意义(P=0.034);AIMS65评分与GBS评分最佳临界值分别为2.5与12.5。结论:预测上消化道出血患者在抢救室不良事件发生率时AIMS 65评分与GBS评分相当,在预测死亡风险方面AIMS 65更佳,在输血治疗上GBS评分有更好预测价值。

Objective:This study aimed to compare AIMS65 score and Glasgow-Blatchford score(GBS)in predicting clinical adverse outcomes in patients with upper gastrointestinal bleeding(UGIB)in emergency room.Methods:We retrospectively studied 719 patients with UGIB in the emergency room from January 2018 to September 2019 in our hospital.The AIMS 65 score and the GBS were used to stratify patients based on their bleeding risk.Compare their prediction value for adverse events,including blood transfusion,operation and death.The areas under the receiver operating characteristics curve(AUC)of two scoring systems were computed to compare their predictive power.Results:The AIMS 65(AUC 0.96)was superior to the GBS(AUC 0.88)in predicting mortality(P=0.034).The AUC value of the AIMS65 was not significantly different from that of the GBS in predicting of adverse events(0.75 vs.0.74,P=0.78)and operation(0.70 vs.0.63,P=0.070).The AUC of the AIMS65 and the GBS was performed respectively was 0.65 and 0.72,respectively,in predicting blood transfusion,with statistically significant(P=0.0044).The optimal cut-off value of the AIMS 65 and the GBS was 2.5 and 12.5,respectively.Conclusion:AIMS 65 and GBS were all acceptable for predicting clinical outcomes for UGIB in the emergency room.AIMS 65 was better in predicting mortality.GBS was better in predicting blood transfusion.