Evaluation of scoring systems without endoscopic findings for predicting outcomes in patients with upper gastrointestinal bleeding

BMC Gastroenterology

Jin Hee Han¹  Min Seob Kwak²  Bok Soon Chang²  Joung Il Lee²  Hyun Phil Shin²  Jung Won Jeon²  Jin Young Yoon²  Jae Myung Cha²  Sung-Eun Kim³  Il-Gyu Ko³  Sang Hyun Kim⁴ 

[1] Department of Anesthesiology and Pain Medicine, College of Medicine, Kyung Hee University;Department of Internal Medicine, Kyung Hee University Hospital at Gangdong, College of Medicine, Kyung Hee University;Department of Physiology, College of Medicine, Kyung Hee University;Department of Surgery, Kyung Hee University Hospital at Gangdong, College of Medicine, Kyung Hee University;

关键词: Upper gastrointestinal bleeding;    Need of interventions;    30-day mortality;    Prediction;    Scoring system;   

DOI  :  10.1186/s12876-017-0716-4

来源: DOAJ

【 摘 要 】

Abstract Background Risk scoring systems are used to evaluate patients with upper gastrointestinal bleeding (UGIB). We compared Glasgow-Blatchford score (GBS), modified GBS (mGBS), and Pre-endoscopy Rockall score (Pre-E RS) for immediate application without endoscopic findings in predicting the need of interventions and the 30-day mortality in patients with UGIB. Methods Patients who visited the emergency room with UGIB from January 2007 to June 2016 were included. GBS, mGBS, and Pre-E RS were obtained for all patients. The area under the receiver-operating characteristic curves (AUC) was used to assess the accuracy of the scoring systems to determine the need for interventions and 30-day mortality. Also, we investigated the potential cutoff scores for predicting 30-day mortality and the need for interventions. Results In predicting the need for interventions, GBS (AUC = 0.727) and mGBS (AUC = 0.733) outperformed Pre-E RS (AUC = 0.564, P < 0.0001). In predicting 30-day mortality, Pre-E RS (AUC = 0.929) outperformed GBS (AUC = 0.664, P < 0.0001) and mGBS (AUC = 0.652, P < 0.0001). Based on AUC analyses of sensitivities and specificities, the optimal cutoff mGBS and GBS for the need for interventions was 9 (70.71% sensitivity, 89.35% specificity) and 9 (73.57% sensitivity, 82.90% specificity) respectively, and optimal cutoff Pre-E RS for 30-day mortality was 4 (88.0% sensitivity, 97.52% specificity). Conclusions GBS and mGBS are considered to be moderately accurate in making an early decision about the need of interventions in patients with UGIB. Pre-E RS is considered to be highly accurate in early detection of patients at high risk for 30-day mortality without endoscopic findings. In addition, we suggested potential cutoff scores to predict the need of interventions for GBS and mGBS, and 30-day mortality for Pre-E RS. Further studies are needed to confirm the clinical applicability of results.

【 授权许可】

Unknown