不同内镜前评分方法对危险性急性上消化道出血的预后评估价值

doi:10.3969/j.issn.1002-1949.2019.02.006

Chinese Journal of Critical Care Medicine

2019, Vol. 39

Issue (2): 124-129 DOI: 10.3969/j.issn.1002-1949.2019.02.006

The prognostic value of three pre-endoscopic scoring systems for high-risk acute upper gastrointestinal bleeding

Li Jia-chang, Lv Jing-jun, Jiang Jie, Ye Lu, Wei Jie

Department of Emergency Medicine, Renmin Hospital of Wuhan University, Wuhan 430060, China

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Abstract Objective This study aimed to compare the performances of three scoring systems (Glasgow–Blatchford Bleeding score, pre-endoscopic Rockall score and AIMS65 score) in predicting clinical outcomes in patients with high-risk acute upper gastrointestinal bleeding (AUGIB), and analyzed risk factors of mortality. Methods The clinical data of a total 261 cases of high-risk acute AUGIB patients in Intensive Care Unit of Renmin Hospital of Wuhan University from January 2015 to December 2017 were collected. The 30-day death and/or rebleeding were taken as the study endpoints, and compared of clinical value among the three scores was carried out by plotting their ROC and calculating the AUC. Results For this study, male was 211 cases (80.84%), the mortality rate was 10.72%(28 cases), rebleeding rate was 10.34%(27 cases). According to the results of endoscopy, the top three causes of bleeding were variceal bleeding caused by cirrhosis (93 cases, 49.21%), duodenal ulcer (47 cases, 24.87%) and gastric ulcer (20 cases, 10.58%). Patients underwent endoscopy had low mortality. The effect of endoscopy timing on the mortality was not statistically significant. In predicting 30-day mortality, the capabilities of was AIMS65 (0.736), and Pre-Rockall (0.715), are near GBS (0.655) in high-risk acute AUGIB patients. AMIS65 was the best scoring system for predicting 30-day mortality in variceal group (0.888). There was no difference and poor in predicting rebleeding among these three scoring systems. After multivariate Logistic regression analysis, ultra-TnI, malignant tumor, and AIMS65≥2 were the risk factors of mortality in high-risk acute AUGIB patients (P<0.05). Conclusion The risk factors of mortality in high-risk acute AUGIB patients are ultra-TnI, malignant tumor, and AIMS65≥2. AIMS65 is the best scoring systems for predicting mortality accurately with easy practice in AUGIB. AIMS65≥2 is high-risk groups, it is suitable for early identification of high-risk groups in emergency department, in order to achieve treatment of multidisciplinary team in the early stage and reduce the mortality rate.

Key words： Acute upper gastrointestinal bleeding (AUGIB) Pre-endoscopic scoring systems Risk factors of mortality Prognostic assessment Multidisciplinary team

Corresponding Authors: Lv Jing-jun, E-mail: lvjingjun@whu.edu.cn

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Cite this article:

Li Jia-chang,Lv Jing-jun,Jiang Jie, et al. The prognostic value of three pre-endoscopic scoring systems for high-risk acute upper gastrointestinal bleeding[J]. Chinese Journal of Critical Care Medicine, 2019, 39(2): 124-129.

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http://www.cnemergency.org.cn/EN/10.3969/j.issn.1002-1949.2019.02.006 OR http://www.cnemergency.org.cn/EN/Y2019/V39/I2/124

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