年龄休克指数预测急性消化道出血患者不良结局的价值研究

Predictive Value of Age Shock Index for Adverse Outcomes in Patients with Acute Gastrointestinal Bleeding

背景急性消化道出血是急诊患者就诊的常见急症之一,如何快速、准确地对急性消化道出血患者进行危险分层,对于改善其预后至关重要。目的比较休克指数(SI)、年龄休克指数(Age-SI)和改良休克指数(MSI)对急性消化道出血患者不良结局的预测价值。方法选取2019—2020年因急性消化道出血就诊于海南省人民医院急诊科的患者进行回顾性研究。急诊科分诊护士测量患者的生命体征,并计算SI、Age-SI和MSI。分析SI、Age-SI和MSI预测急性消化道出血患者不良结局〔入住ICU、接受输血治疗、接受内镜/结肠镜(E/C)干预和死亡〕的价值。结果共纳入302例患者,其中158例(52.32%)至少有1种不良结局,38例(12.58%)入住ICU,136例(45.03%)接受输血治疗,54例(17.88%)接受E/C干预,12例(3.97%)死亡。有不良结局的患者SI、Age-SI和MSI均高于无不良结局的患者(P<0.05)。SI、Age-SI和MSI预测急性消化道出血患者不良结局均有统计学意义(P<0.05);且Age-SI预测急性消化道出血患者不良结局的受试者工作特征曲线下面积(AUC)高于SI(P=0.013)和MSI(P=0.024);SI和MSI预测急性消化道出血患者不良结局的AUC比较,差异无统计学意义(P=0.985)。SI、Age-SI预测急性消化道出血患者入住ICU均有统计学意义(P<0.05)。SI、Age-SI和MSI预测急性消化道出血患者接受输血治疗均有统计学意义(P<0.05)。SI预测急性消化道出血患者接受E/C干预有统计学意义(P<0.05)。Age-SI预测急性消化道出血患者不良结局的临界值为45.12。Spearman秩相关分析结果显示,急性消化道出血患者不良结局数量与SI(r_(s)=0.255,P=0.002)、Age-SI(r_(s)=0.360,P<0.001)和MSI(r_(s)=0.246,P=0.002)呈正相关。结论Age-SI预测急性消化道出血患者出现不良结局的价值优于SI和MSI,且Age-SI在分诊中易于计算。

Background Acute gastrointestinal bleeding(AGB)is one of the common emergencies for patients of emergency department.How to quickly and accurately stratify the risk of AGB is essential to improving the prognosis.Therefore,a simple,fast and easy-to-operate method is needed to early detect emergency patients at high-risk of AGB.Objective To compare the predictive value of shock index(SI),age shock index(ASI)and modified shock index(MSI)in the stratification of adverse outcomes in patients with AGB.Methods A retrospective design was used.Participants with AGB were selected from Department of Emergency,Hainan General Hospital from 2019 to 2020.Vital signs and calculated SI,ASI and MSI of patients were collected by the triage nurse,and their predictive values for the admission to the ICU,blood transfusion,endoscopic/colonoscopy(E/C)intervention and death were comparatively analyzed.Results Altogether,302 cases were enrolled.Among them,158(52.32%)had at least one adverse outcome,38(12.58%)were admitted to the ICU,136(45.03%)received blood transfusion,54(17.88%)received E/C intervention,and 12(3.97%)died.The average SI,ASI and MSI of patients with adverse outcomes were all higher than those without(P<0.05).SI,ASI and MSI were all of statistical significance in predicting the adverse outcomes(P<0.05).Specifically,ASI had a larger AUC than SI(P=0.013)and MSI(P=0.024)for predicting adverse outcomes in AGB,but the AUC of SI was similar to that of MSI(P=0.985).Both SI and ASI were of statistical significance in predicting theadmission to the ICU(P<0.05).SI,ASI and MSI were all of statistical significance in predicting the requirement for blood transfusion(P<0.05).SI was of statistical significance in predicting the requirement for E/C intervention(P<0.05).The cut-off point of ASI predicting adverse outcomes in AGB was 45.12.Spearman correlation analysis indicated that the number of adverse outcomes in AGB had a positive relation with SI(r_(s)=0.255,P=0.002),ASI(r_(s)=0.360,P<0.001)and MSI(r_(s)=0.246,P=0.002).Conclusion ASI is easy to be calculated during the triage phase,and it may be superior to both SI and MSI in terms of predicting adverse outcomes in AGB.