BACKGROUND Acute non-variceal upper gastrointestinal bleeding(ANVUGIB)represents a sig-nificant clinical challenge due to its unpredictability and potentially severe out-comes.The Rockall risk score has emerged as a c...BACKGROUND Acute non-variceal upper gastrointestinal bleeding(ANVUGIB)represents a sig-nificant clinical challenge due to its unpredictability and potentially severe out-comes.The Rockall risk score has emerged as a critical tool for prognostic asse-ssment in patients with ANVUGIB,aiding in the prediction of rebleeding and mo-rtality.However,its applicability and accuracy in the Chinese population remain understudied.AIM To assess the prognostic value of the Rockall risk score in a Chinese cohort of patients with ANVUGIB.METHODS A retrospective analysis of 168 ANVUGIB patients’medical records was condu-cted.The study employed statistical tests,including the t-test,χ^(2) test,spearman correlation,and receiver operating characteristic(ROC)analysis,to assess the re-lationship between the Rockall score and clinical outcomes,specifically focusing on rebleeding events within 3 months post-assessment.RESULTS Significant associations were found between the Rockall score and various clinical outcomes.High Rockall scores were significantly associated with rebleeding events(r=0.735,R2=0.541,P<0.001)and strongly positively correlated with adverse outcomes.Low hemoglobin levels(t=2.843,P=0.005),high international normalized ratio(t=3.710,P<0.001),active bleeding during endoscopy(χ^(2)=7.950,P=0.005),large ulcer size(t=6.348,P<0.001),and requiring blood transfusion(χ^(2)=6.381,P=0.012)were all significantly associated with rebleeding events.Furthermore,differences in treatment and management strategies were identified between patients with and without rebleeding events.ROC analysis indicated the excellent discriminative power(sensitivity:0.914;specificity:0.816;area under the curve:0.933;Youden index:0.730)of the Rockall score in predicting rebleeding events within 3 months.CONCLUSION This study provides valuable insights into the prognostic value of the Rockall risk score for ANVUGIB in the Chinese population.The results underscore the potential of the Rockall score as an effective tool for risk strati-fication and prognostication,with implications for guiding risk-appropriate management strategies and optimizing care for patients with ANVUGIB.展开更多
BACKGROUND Upper gastrointestinal(GI)bleeding is a life-threatening condition with high mortality rates.AIM To compare the performance of pre-endoscopic risk scores in predicting the following primary outcomes:In-hosp...BACKGROUND Upper gastrointestinal(GI)bleeding is a life-threatening condition with high mortality rates.AIM To compare the performance of pre-endoscopic risk scores in predicting the following primary outcomes:In-hospital mortality,intervention(endoscopic or surgical)and length of admission(≥7 d).METHODS We performed a retrospective analysis of 363 patients presenting with upper GI bleeding from December 2020 to January 2021.We calculated and compared the area under the receiver operating characteristics curves(AUROCs)of Glasgow-Blatchford score(GBS),pre-endoscopic Rockall score(PERS),albumin,international normalized ratio,altered mental status,systolic blood pressure,age older than 65(AIMS65)and age,blood tests and comorbidities(ABC),including their optimal cut-off in variceal and non-variceal upper GI bleeding cohorts.We subsequently analyzed through a logistic binary regression model,if addition of lactate increased the score performance.RESULTS All scores had discriminative ability in predicting in-hospital mortality irrespective of study group.AIMS65 score had the best performance in the variceal bleeding group(AUROC=0.772;P<0.001),and ABC score(AUROC=0.775;P<0.001)in the non-variceal bleeding group.However,ABC score,at a cut-off value of 5.5,was the best predictor(AUROC=0.770,P=0.001)of inhospital mortality in both populations.PERS score was a good predictor for endoscopic treatment(AUC=0.604;P=0.046)in the variceal population,while GBS score,(AUROC=0.722;P=0.024),outperformed the other scores in predicting surgical intervention.Addition of lactate to AIMS65 score,increases by 5-fold the probability of in-hospital mortality(P<0.05)and by 12-fold if added to GBS score(P<0.003).No score proved to be a good predictor for length of admission.CONCLUSION ABC score is the most accurate in predicting in-hospital mortality in both mixed and non-variceal bleeding population.PERS and GBS should be used to determine need for endoscopic and surgical intervention,respectively.Lactate can be used as an additional tool to risk scores for predicting inhospital mortality.展开更多
文摘BACKGROUND Acute non-variceal upper gastrointestinal bleeding(ANVUGIB)represents a sig-nificant clinical challenge due to its unpredictability and potentially severe out-comes.The Rockall risk score has emerged as a critical tool for prognostic asse-ssment in patients with ANVUGIB,aiding in the prediction of rebleeding and mo-rtality.However,its applicability and accuracy in the Chinese population remain understudied.AIM To assess the prognostic value of the Rockall risk score in a Chinese cohort of patients with ANVUGIB.METHODS A retrospective analysis of 168 ANVUGIB patients’medical records was condu-cted.The study employed statistical tests,including the t-test,χ^(2) test,spearman correlation,and receiver operating characteristic(ROC)analysis,to assess the re-lationship between the Rockall score and clinical outcomes,specifically focusing on rebleeding events within 3 months post-assessment.RESULTS Significant associations were found between the Rockall score and various clinical outcomes.High Rockall scores were significantly associated with rebleeding events(r=0.735,R2=0.541,P<0.001)and strongly positively correlated with adverse outcomes.Low hemoglobin levels(t=2.843,P=0.005),high international normalized ratio(t=3.710,P<0.001),active bleeding during endoscopy(χ^(2)=7.950,P=0.005),large ulcer size(t=6.348,P<0.001),and requiring blood transfusion(χ^(2)=6.381,P=0.012)were all significantly associated with rebleeding events.Furthermore,differences in treatment and management strategies were identified between patients with and without rebleeding events.ROC analysis indicated the excellent discriminative power(sensitivity:0.914;specificity:0.816;area under the curve:0.933;Youden index:0.730)of the Rockall score in predicting rebleeding events within 3 months.CONCLUSION This study provides valuable insights into the prognostic value of the Rockall risk score for ANVUGIB in the Chinese population.The results underscore the potential of the Rockall score as an effective tool for risk strati-fication and prognostication,with implications for guiding risk-appropriate management strategies and optimizing care for patients with ANVUGIB.
文摘BACKGROUND Upper gastrointestinal(GI)bleeding is a life-threatening condition with high mortality rates.AIM To compare the performance of pre-endoscopic risk scores in predicting the following primary outcomes:In-hospital mortality,intervention(endoscopic or surgical)and length of admission(≥7 d).METHODS We performed a retrospective analysis of 363 patients presenting with upper GI bleeding from December 2020 to January 2021.We calculated and compared the area under the receiver operating characteristics curves(AUROCs)of Glasgow-Blatchford score(GBS),pre-endoscopic Rockall score(PERS),albumin,international normalized ratio,altered mental status,systolic blood pressure,age older than 65(AIMS65)and age,blood tests and comorbidities(ABC),including their optimal cut-off in variceal and non-variceal upper GI bleeding cohorts.We subsequently analyzed through a logistic binary regression model,if addition of lactate increased the score performance.RESULTS All scores had discriminative ability in predicting in-hospital mortality irrespective of study group.AIMS65 score had the best performance in the variceal bleeding group(AUROC=0.772;P<0.001),and ABC score(AUROC=0.775;P<0.001)in the non-variceal bleeding group.However,ABC score,at a cut-off value of 5.5,was the best predictor(AUROC=0.770,P=0.001)of inhospital mortality in both populations.PERS score was a good predictor for endoscopic treatment(AUC=0.604;P=0.046)in the variceal population,while GBS score,(AUROC=0.722;P=0.024),outperformed the other scores in predicting surgical intervention.Addition of lactate to AIMS65 score,increases by 5-fold the probability of in-hospital mortality(P<0.05)and by 12-fold if added to GBS score(P<0.003).No score proved to be a good predictor for length of admission.CONCLUSION ABC score is the most accurate in predicting in-hospital mortality in both mixed and non-variceal bleeding population.PERS and GBS should be used to determine need for endoscopic and surgical intervention,respectively.Lactate can be used as an additional tool to risk scores for predicting inhospital mortality.
