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
目的比较CURB一65评分和强化CURB评分对老年重症社区获得性肺炎（severe community acquired pneumonia，SCAP）预后的临床预测价值。方法回顾性分析2009—12—2015-07入住我院急诊科、呼吸内科以及老年呼吸内科的87例老年SCAP相关临床...目的比较CURB一65评分和强化CURB评分对老年重症社区获得性肺炎（severe community acquired pneumonia，SCAP）预后的临床预测价值。方法回顾性分析2009—12—2015-07入住我院急诊科、呼吸内科以及老年呼吸内科的87例老年SCAP相关临床资料，分别统计每例患者的CURB-65评分、强化CURB评分，以患者28d预后为临床观察终点，绘制受试者工作特征（receiver operator characteristic，ROC）曲线，通过比较曲线下面积（area under the curve，AUC）分析两种评分工具对老年SCAP预后的预测价值。结果87例患者CURB一65评分为3（2—3）分，强化CURB评分为11（10～12）分。死亡组中CURB-65评分和强化CURB评分均明显高于存活组，差异有统计学意义（P〈0．05）。强化CURB评分AUC为0．722，最佳截断值为12，敏感度为58．82％，特异度为69．81％，P=0．0001；CURB-65评分AUC为0．660，最佳截断值为3，敏感度为73．53％，特异度为49．06％，P=0．0091。强化CURB评分AUC大于CURB-65评分，差异有统计学意义（0．722vs．0．660，Z=2．176，P=0．029）。结论CURB-65评分和强化CURB评分均可预测老年SCAP预后，强化CURB评分预测价值高于CURB-65评分，且其特异度高于CURB-65评分。展开更多
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.
文摘目的比较CURB一65评分和强化CURB评分对老年重症社区获得性肺炎（severe community acquired pneumonia，SCAP）预后的临床预测价值。方法回顾性分析2009—12—2015-07入住我院急诊科、呼吸内科以及老年呼吸内科的87例老年SCAP相关临床资料，分别统计每例患者的CURB-65评分、强化CURB评分，以患者28d预后为临床观察终点，绘制受试者工作特征（receiver operator characteristic，ROC）曲线，通过比较曲线下面积（area under the curve，AUC）分析两种评分工具对老年SCAP预后的预测价值。结果87例患者CURB一65评分为3（2—3）分，强化CURB评分为11（10～12）分。死亡组中CURB-65评分和强化CURB评分均明显高于存活组，差异有统计学意义（P〈0．05）。强化CURB评分AUC为0．722，最佳截断值为12，敏感度为58．82％，特异度为69．81％，P=0．0001；CURB-65评分AUC为0．660，最佳截断值为3，敏感度为73．53％，特异度为49．06％，P=0．0091。强化CURB评分AUC大于CURB-65评分，差异有统计学意义（0．722vs．0．660，Z=2．176，P=0．029）。结论CURB-65评分和强化CURB评分均可预测老年SCAP预后，强化CURB评分预测价值高于CURB-65评分，且其特异度高于CURB-65评分。
