不同评分系统对急性非静脉曲张性上消化道出血患者结局的预测价值和新型结局预测模型的构建

Predictive Value of Different Scoring Systems for Outcome of Acute Non-variceal Upper Gastrointestinal Bleeding Patients and Construction of New Outcome Prediction Model

目的:探讨不同评分系统对急性非静脉曲张性上消化道出血(ANVUGIB)患者结局的预测价值,构建新型结局预测模型以识别高低风险患者。方法:选取2021年7月—2023年3月贵州航天医院消化内科收治的135例ANVUGIB患者作为研究对象,根据患者结局分为高风险组、低风险组,收集患者基本信息,采用Rockall、AIMS65、Blatchford评分系统对患者进行测评并分析各评分系统对ANVUGIB患者结局的预测价值。采用Logistic回归分析三种评分中各项指标与ANVUGIB患者结局的关系,分析高风险的独立危险因素,构建新型结局预测模型。结果:高风险组呕血发生率、心率、尿素氮水平高于低风险组,差异有统计学意义(P<0.05)。高风险组Rockall、AIMS65、Blatchford评分高于低风险组,差异有统计学意义(P<0.001)。Rockall、AIMS65、Blatchford评分预测ANVUGIB患者结局的曲线下面积(AUC)分别为0.699、0.688、0.702,预测价值较低。Logistic回归分析显示,呕血、心率高、尿素氮水平高是ANVUGIB患者高风险结局的独立危险因素(P<0.05)。受试者工作曲线显示,ANVUGIB新型结局预测模型预测ANVUGIB患者高风险结局发生风险的AUC>0.90(AUC=0.919),预测价值较高。结论:Rockall、AIMS65、Blatchford评分对ANVUGIB患者结局均具有一定预测价值,但价值较低,根据呕血、心率、尿素氮水平构建新型结局预测模型,可获得较高的预测价值。

Objective:To investigate the predictive value of different scoring systems for the outcome of patients with acute nonvariceal upper gastrointestinal bleeding(ANVUGIB),and to establish a new outcome prediction model to identify high-risk and low-risk patient.Methods:A total of 135 ANVUGIB patients admitted to the Department of Gastroenterology of Guizhou Aerospace Hospital from July 2021 to March 2023 were selected as the study subject.Patients were divided into high risk group and low risk group according to the patient's outcome.Basic information of these patients was collected and patients were evaluated by Rockall,AIMS65,and Blatchford scoring systems.The predictive value of different scoring systems for the outcome of ANVUGIB patients was analyzed.Logistic regression analysis was performed for the relationship between the three scoring indexes and the outcome of ANVUGIB patients.The independent risk factors of high risk were analyzed and a new outcome prediction model was constructed.Results:The incidence of hematemesis,heart rate,and urea nitrogen levels in the high-risk group were higher than those in the low-risk group,and the difference was statistically significant(P<0.05).Rockall score,AIMS65 score and Blatchford score in high-risk group were higher than those in low-risk group,and the difference was statistically significant(P<0.001).The area under curve(AUC)of Rockall score,AIMS65 score and Blatchford score to predict the outcome of ANVUGIB patients was 0.699,0.688 and 0.702,respectively,with a low predictive value.Logistic regression analysis showed that hematemesis,high heart rate and high urea nitrogen levels were independent risk factors for high risk outcome in ANVUGIB patients(P<0.05).The receiver operating characteristic curve found that the AUC of new ANVUGIB outcome prediction model to predict the risk of high-risk outcome in ANVUGIB patients was>0.90(AUC=0.919),with a high predictive value.Conclusion:Rockall score,AIMS65 score and Blatchford score have some predictive value for the outcome of ANVUGIB patients,but the value is low.A new outcome prediction model constructed based on hematemesis,heart rate and urea nitrogen level can obtain a high predictive value.