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Xue Z, Che H, Xie D, Ren J, Si Q. Prediction of 30-day in-hospital mortality in older UGIB patients using a simplified risk score and comparison with AIMS65 score. BMC Geriatr 2024; 24:534. [PMID: 38902633 PMCID: PMC11188522 DOI: 10.1186/s12877-024-04971-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 04/12/2024] [Indexed: 06/22/2024] Open
Abstract
BACKGROUND Upper gastrointestinal bleeding (UGIB) in older patients is associated with substantial in-hospital morbidity and mortality. This study aimed to develop and validate a simplified risk score for predicting 30-day in-hospital mortality in this population. METHODS A retrospective analysis was conducted on data from 1899 UGIB patients aged ≥ 65 years admitted to a single medical center between January 2010 and December 2019. An additional cohort of 330 patients admitted from January 2020 to October 2021 was used for external validation. Variable selection was performed using five distinct methods, and models were generated using generalized linear models, random forest, support vector machine, and k-nearest neighbors approaches. The developed score, "ABCAP," incorporated Albumin < 30 g/L, Blood Urea Nitrogen (BUN) > 7.5 mmol/L, Cancer presence, Altered mental status, and Pulse rate > 100/min, each assigned a score of 1. Internal and external validation procedures compared the ABCAP score with the AIMS65 score. RESULTS In internal validation, the ABCAP score demonstrated robust predictive capability with an area under the curve (AUC) of 0.878 (95% CI: 0.824-0.932), which was significantly better than the AIMS65 score (AUC: 0.827, 95% CI: 0.751-0.904), as revealed by the DeLong test (p = 0.048). External validation of the ABCAP score resulted in an AUC of 0.799 (95% CI: 0.709-0.889), while the AIMS65 score yielded an AUC of 0.743 (95% CI: 0.647-0.838), with no significant difference between the two scores based on the DeLong test (p = 0.16). However, the ABCAP score at the 3-5 score level demonstrated superior performance in identifying high-risk patients compared to the AIMS65 score. This score exhibited consistent predictive accuracy across variceal and non-variceal UGIB subgroups. CONCLUSIONS The ABCAP score incorporates easily obtained clinical variables and demonstrates promising predictive ability for 30-day in-hospital mortality in older UGIB patients. It allows effective mortality risk stratification and showed slightly better performance than the AIMS65 score. Further cohort validation is required to confirm generalizability.
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Affiliation(s)
- Zaiyao Xue
- Medical School of Chinese PLA, Beijing, China
| | - Hebin Che
- Medical Big Data Research Center, Chinese PLA General Hospital, Beijing, China
| | - Deyou Xie
- Beijing Research Center For Circulation Economy, Beijing, China
| | - Jiefeng Ren
- Medical School of Chinese PLA, Beijing, China
| | - Quanjin Si
- The Third Healthcare Department, Second Medical Center of Chinese PLA General Hospital, National Clinical Research Center for Geriatric Diseases, Beijing, China.
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Zhang YY, Zhang QX, Li JT, Wang Y, Zhuang ZH, Zhuang JY. Clinical Pathway for Enhanced Recovery in the Management of Non-Variceal Upper Gastrointestinal Bleeding: A Randomized Controlled Trial. Risk Manag Healthc Policy 2023; 16:2579-2591. [PMID: 38034895 PMCID: PMC10683656 DOI: 10.2147/rmhp.s433068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 11/02/2023] [Indexed: 12/02/2023] Open
Abstract
Purpose To explore the effects of the clinical pathway on the outcomes of patients with non-variceal upper gastrointestinal bleeding. Materials and Methods Randomized controlled trial. The study was conducted in two medical centers in China from 1 June 2022 to 31 December 2022. Patients with a diagnosis of non-variceal upper gastrointestinal bleeding who provided written informed consent were consecutively assigned to the intervention group. The patients in the intervention group were treated using the clinical pathway, while the control group received routine care and follow-up. Time, cost, complications, and prognostic indicators were analyzed. Intentional-to-treat analysis and per-protocol analysis were used for data analysis. Results A total of 114 eligible patients with non-variceal upper gastrointestinal bleeding were randomly divided into two groups and included in the intention-to-treat analysis. In addition, 106 patients were included in the per-protocol analysis. The median age of the 106 patients was 57 years (range, 18-92 years) and 83.0% were male. There were no significant differences between groups regarding the baseline characteristics. The intervention group demonstrated a statistically significantly shorter length of stay, lower hospital cost (ie, cost during hospitalization, cost in the emergency room, and cost in the ward), significantly fewer cases of complications, and a higher level of patient satisfaction when compared with the control group. There was no significant difference between the two groups in the rates of transfusion, repeat endoscopy, rebleeding readmission, and mortality. Conclusion The implementation of the clinical pathway for patients with non-variceal upper gastrointestinal bleeding may help improve patient outcomes and satisfaction. Trial Registration Number ChiCTR2200060316. Registration Link https://www.chictr.org.cn/.
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Affiliation(s)
- Yan-Yan Zhang
- School of Nursing, Fujian Medical University, Fuzhou, Fujian, People’s Republic of China
- School of Nursing, Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian, People’s Republic of China
| | - Qiao-Xian Zhang
- Department of Nursing, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, People’s Republic of China
| | - Jun-Ting Li
- School of Nursing, Fujian Medical University, Fuzhou, Fujian, People’s Republic of China
| | - Yan Wang
- School of Nursing, Fujian Medical University, Fuzhou, Fujian, People’s Republic of China
| | - Ze-Hao Zhuang
- Endoscopy Center, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, People’s Republic of China
- Department of Gastroenterology, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian, People’s Republic of China
| | - Jia-Yuan Zhuang
- School of Nursing, Fujian Medical University, Fuzhou, Fujian, People’s Republic of China
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Boustany A, Alali AA, Almadi M, Martel M, Barkun AN. Pre-Endoscopic Scores Predicting Low-Risk Patients with Upper Gastrointestinal Bleeding: A Systematic Review and Meta-Analysis. J Clin Med 2023; 12:5194. [PMID: 37629235 PMCID: PMC10456043 DOI: 10.3390/jcm12165194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 08/01/2023] [Accepted: 08/03/2023] [Indexed: 08/27/2023] Open
Abstract
BACKGROUND Several risk scores have attempted to risk stratify patients with acute upper gastrointestinal bleeding (UGIB) who are at a lower risk of requiring hospital-based interventions or negative outcomes including death. This systematic review and meta-analysis aimed to compare predictive abilities of pre-endoscopic scores in prognosticating the absence of adverse events in patients with UGIB. METHODS We searched MEDLINE, EMBASE, Central, and ISI Web of knowledge from inception to February 2023. All fully published studies assessing a pre-endoscopic score in patients with UGIB were included. The primary outcome was a composite score for the need of a hospital-based intervention (endoscopic therapy, surgery, angiography, or blood transfusion). Secondary outcomes included: mortality, rebleeding, or the individual endpoints of the composite outcome. Both proportional and comparative analyses were performed. RESULTS Thirty-eight studies were included from 2153 citations, (n = 36,215 patients). Few patients with a low Glasgow-Blatchford score (GBS) cutoff (0, ≤1 and ≤2) required hospital-based interventions (0.02 (0.01, 0.05), 0.04 (0.02, 0.09) and 0.03 (0.02, 0.07), respectively). The proportions of patients with clinical Rockall (CRS = 0) and ABC (≤3) scores requiring hospital-based intervention were 0.19 (0.15, 0.24) and 0.69 (0.62, 0.75), respectively. GBS (cutoffs 0, ≤1 and ≤2), CRS (cutoffs 0, ≤1 and ≤2), AIMS65 (cutoffs 0 and ≤1) and ABC (cutoffs ≤1 and ≤3) scores all were associated with few patients (0.01-0.04) dying. The proportion of patients suffering other secondary outcomes varied between scoring systems but, in general, was lowest for the GBS. GBS (using cutoffs 0, ≤1 and ≤2) showed excellent discriminative ability in predicting the need for hospital-based interventions (OR 0.02, (0.00, 0.16), 0.00 (0.00, 0.02) and 0.01 (0.00, 0.01), respectively). A CRS cutoff of 0 was less discriminative. For the other secondary outcomes, discriminative abilities varied between scores but, in general, the GBS (using cutoffs up to 2) was clinically useful for most outcomes. CONCLUSIONS A GBS cut-off of one or less prognosticated low-risk patients the best. Expanding the GBS cut-off to 2 maintains prognostic accuracy while allowing more patients to be managed safely as outpatients. The evidence is limited by the number, homogeneity, quality, and generalizability of available data and subjectivity of deciding on clinical impact. Additional, comparative and, ideally, interventional studies are needed.
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Affiliation(s)
- Antoine Boustany
- Department of Medicine, Cleveland Clinic Foundation, Cleveland, OH 44195, USA;
| | - Ali A. Alali
- Department of Medicine, Faculty of Medicine, Kuwait University, Jabriyah 13110, Kuwait;
| | - Majid Almadi
- Department of Medicine, King Saud University, Riyadh 11421, Saudi Arabia;
| | - Myriam Martel
- Research Institute of the McGill University Health Center, Montreal, QC H3G 1A4, Canada;
| | - Alan N. Barkun
- Division of Gastroenterology, McGill University Health Center, McGill University, Montréal, QC H3G 1A4, Canada
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Ito N, Funasaka K, Fujiyoshi T, Furukawa K, Kakushima N, Furune S, Ishikawa E, Mizutani Y, Sawada T, Maeda K, Ishikawa T, Yamamura T, Ohno E, Nakamura M, Kawashima H, Miyahara R, Hirooka Y, Haruta JI, Fujishiro M. Modified N score is helpful for identifying patients who need endoscopic intervention among those with black stools without hematemesis. Dig Endosc 2022; 34:1157-1165. [PMID: 35396885 DOI: 10.1111/den.14323] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Revised: 04/02/2022] [Accepted: 04/07/2022] [Indexed: 02/08/2023]
Abstract
OBJECTIVES Although black stools are one of the signs of upper gastrointestinal bleeding, not all patients without hematemesis need endoscopic intervention. There is no apparent indicator to select who needs treatment thus far. The aim of this study was to establish a novel score that predicts the need for endoscopic intervention in patients with black stools without hematemesis. METHODS We retrospectively enrolled 721 consecutive patients with black stools without hematemesis who underwent emergency endoscopy from two facilities. In the development stage (from January 2016 to December 2018), risk factors that predict the need for endoscopic intervention were determined from the data of 422 patients by multivariate logistic regression analysis, and a novel scoring system, named the modified Nagoya University score (modified N score), was developed. In the validation stage (from January 2019 to September 2020), we evaluated the diagnostic value of the modified N score for 299 patients. RESULTS Multivariate logistic regression analysis revealed four predictive factors for endoscopic intervention: syncope, the blood urea nitrogen (BUN) level, and the BUN/creatinine ratio as positive indicators and anticoagulant drug use as a negative indicator. In the validation stage, the area under the curve of the modified N score was 0.731, and the modified N score showed a sensitivity of 82.0% and a specificity of 58.8%. CONCLUSIONS Our modified N score, which consists of only four factors, can identify patients who need endoscopic intervention among those with black stools without hematemesis.
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Affiliation(s)
- Nobuhito Ito
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Aichi, Japan
| | - Kohei Funasaka
- Department of Gastroenterology and Hepatology, Fujita Health University School of Medicine, Aichi, Japan
| | - Toshihisa Fujiyoshi
- Japanese Red Cross Aichi Medical Center Nagoya Daiichi Hospital, Aichi, Japan
| | - Kazuhiro Furukawa
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Aichi, Japan
| | - Naomi Kakushima
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Aichi, Japan
| | - Satoshi Furune
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Aichi, Japan
| | - Eri Ishikawa
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Aichi, Japan
| | - Yasuyuki Mizutani
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Aichi, Japan
| | - Tsunaki Sawada
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Aichi, Japan
| | - Keiko Maeda
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Aichi, Japan
| | - Takuya Ishikawa
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Aichi, Japan
| | - Takeshi Yamamura
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Aichi, Japan
| | - Eizaburo Ohno
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Aichi, Japan
| | - Masanao Nakamura
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Aichi, Japan
| | - Hiroki Kawashima
- Department of Endoscopy, Nagoya University Hospital, Aichi, Japan
| | - Ryoji Miyahara
- Department of Gastroenterology and Hepatology, Fujita Health University School of Medicine, Aichi, Japan
| | - Yoshiki Hirooka
- Department of Gastroenterology and Hepatology, Fujita Health University School of Medicine, Aichi, Japan
| | - Jun-Ichi Haruta
- Japanese Red Cross Aichi Medical Center Nagoya Daiichi Hospital, Aichi, Japan
| | - Mitsuhiro Fujishiro
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Aichi, Japan
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Liu S, Zhang X, Walline JH, Yu X, Zhu H. Fresh Frozen Plasma in Cases of Acute Upper Gastrointestinal Bleeding Does Not Improve Outcomes. Front Med (Lausanne) 2022; 9:934024. [PMID: 35911402 PMCID: PMC9330331 DOI: 10.3389/fmed.2022.934024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 06/13/2022] [Indexed: 11/16/2022] Open
Abstract
Background Blood products are commonly transfused in patients with acute upper gastrointestinal bleeding (UGIB). There exists considerable practice variation and less evidence to guide fresh frozen plasma transfusion in patients with UGIB. The aim of this study was to explore any association between fresh frozen plasma transfusion following acute UGIB and clinical outcomes. Methods This was a prospective, observational, multicenter study conducted at 20 tertiary hospitals in China. Patients with acute UGIB with an international normalized ratio ≤ 2.0 at emergency department admission were included. Multivariate logistic regression models were used to examine and quantify any clinical associations. Results A total of 976 patients (61.57 ± 15.79 years old, 73.05% male) were included, of whom 17.42% received fresh frozen plasma transfusion. The overall 90-day mortality and rebleeding rates were 10.20 and 12.19%, respectively. After adjusting for confounding factors, transfusion of fresh frozen plasma during hospitalization was associated with higher 90-day mortality [odd ratio (OR), 2.36; 95% confidence interval (CI), 1.36–4.09; p = 0.002] but not rebleeding (OR, 1.5; 95% CI; 0.94-2.54; p = 0.085). In a subgroup analysis, patients with an international normalized ratio <1.5 who were treated with fresh frozen plasma were associated with both significantly higher 90-day mortality (OR, 2.78; 95% CI, 1.49–5.21; p = 0.001) and rebleeding (OR, 2.02; 95% CI, 1.16–3.52; p = 0.013), whereas in patients with an international normalized ratio between 1.5 and 2, we did not find any significant correlation. Conclusion This study found an association between fresh frozen plasma transfusion following acute UGIB and elevated 90-day mortality. Both 90-day mortality and rebleeding risk were significantly higher in patients with an international normalized ratio < 1.5. Fresh frozen plasma transfusion in acute UGIB does not improve the poor outcomes (Chinese Clinical Trial registry, Number ChiCTR1900028676).
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Affiliation(s)
- Shuang Liu
- Emergency Department, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Xiaoming Zhang
- Department of Nursing, Peking Union Medical College Hospital, Beijing, China
| | - Joseph Harold Walline
- Accident and Emergency Medicine Academic Unit, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Xuezhong Yu
- Emergency Department, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
- *Correspondence: Xuezhong Yu
| | - Huadong Zhu
- Emergency Department, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
- Huadong Zhu
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Comparing the Performance of the ABC, AIMS65, GBS, and pRS Scores in Predicting 90-day Mortality Or Rebleeding Among Emergency Department Patients with Acute Upper Gastrointestinal Bleeding: A Prospective Multicenter Study. J Transl Int Med 2021; 9:114-122. [PMID: 34497750 PMCID: PMC8386323 DOI: 10.2478/jtim-2021-0026] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Background and Objectives Acute upper gastrointestinal bleeding (UGIB) is a common problem that can cause significant morbidity and mortality. We aimed to compare the performance of the ABC score (ABC), the AIMS65 score (AIMS65), the Glasgow-Blatchford score (GBS), and the pre-endoscopic Rockall score (pRS) in predicting 90-day mortality or rebleeding among patients with acute UGIB. Methods This was a prospective multicenter study conducted at 20 tertiary hospitals in China. Data were collected between June 30, 2020 and February 10, 2021. An area under the receiver operating characteristic curve (AUC) analysis was used to compare the performance of the four scores in predicting 90-day mortality or rebleeding. Results Among the 1072 patients included during the study period, the overall 90-day mortality rate was 10.91% (117/1072) and the rebleeding rate was 12.03% (129/1072). In predicting 90-day mortality, the ABC and pRS scores performed better with an AUC of 0.722 (95% CI 0.675-0.768; P<0.001) and 0.711 (95% CI 0.663-0.757; P<0.001), respectively, compared to the AIMS-65 (AUC, 0.672; 95% CI, 0.624-0.721; P<0.001) and GBS (AUC, 0.624; 95% CI, 0.569-0.679; P<0.001) scores. In predicting rebleeding in 90 days, the AUC of all scores did not exceed 0.70. Conclusion In patients with acute UGIB, ABC and pRS performed better than AIMS-65 and GBS in predicting 90-day mortality. The performance of each score is not satisfactory in predicting rebleeding, however. Newer predictive models are needed to predict rebleeding after UGIB.
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Carlsen NV, Laursen SB, Schaffalitzky de Muckadell OB. Hypotension develops one to two hours before other symptoms in peptic ulcer rebleeding; a matched cohort study. Scand J Gastroenterol 2021; 56:1011-1016. [PMID: 34282993 DOI: 10.1080/00365521.2021.1948607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Rebleeding is a frequent complication of peptic ulcer bleeding (PUB) and is associated with increased mortality. Blood pressure and heart rate are two easy non-invasive measurements to evaluate the hemodynamics and therefore a standard observation during hospitalization. OBJECTIVE We aimed to investigate the dynamics of systolic blood pressure and heart rate up to time of peptic ulcer rebleeding. DESIGN Retrospective matched cohort study. Hemodynamics in patients with peptic ulcer rebleeding was compared to hemodynamics in a matched control group consisting of patients with PUB without rebleeding. Blood pressure and heart rate in the six hours up to diagnosis of rebleeding was compared with baseline in the case cohort as well as with the matched control group. RESULTS Thirty-eight patients with peptic ulcer rebleeding and 66 controls were included. Mean age was 75 years, 62% were males and 30-day mortality was 23%. Baseline systolic blood pressure in cases was 114 mmHg. Compared to baseline, we found significant decrease in systolic blood pressure two hours before rebleeding (4 mmHg; p = 0.041) and one hour before rebleeding (14 mmHg; p = 0.0002). Mean systolic blood pressure 30 min before rebleeding was 89 mmHg. No significant change was found in heart rate (p = 0.99). In the control group no change was found in systolic blood pressure or heart rate. CONCLUSION In patients with peptic ulcer rebleeding, hypotension develops 1-2 h before other symptoms of rebleeding. Thus, close monitoring of blood pressure is needed in order to ensure early identification of rebleeding in high-risk patients.
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Affiliation(s)
- Nikolaj Vestergaard Carlsen
- Department of Clinical Research, University of Southern Denmark, Odence, Denmark.,Department of Gastroenterology S, Odense University Hospital, Odence C, Denmark
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Prealbumin and D-dimer as Prognostic Indicators for Rebleeding in Patients with Nonvariceal Upper Gastrointestinal Bleeding. Dig Dis Sci 2021; 66:1949-1956. [PMID: 32583220 DOI: 10.1007/s10620-020-06420-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2019] [Accepted: 06/14/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND Determining the risk stratification of nonvariceal upper gastrointestinal bleeding (NVUGIB) plays a vital role in treating upper gastrointestinal bleeding (UGIB). Traditional scores like Glasgow-Blatchford score (GBS), Rockall score (RS), and AIMS65 score have been widely utilized in UGIB practice, however exhibiting limited practical use due to relative lack of user-friendly characters. Prealbumin as a nutritional indicator and d-dimer as a fibrinolytic activity monitor, are generally used to evaluate the overall nutritional and fibrinolytic condition in UGIB patients. AIMS Here, we explored the predictive value of these two markers in NVUGIB for evaluating severity and prognosis including rebleeding and surgery intervention. METHODS One hundred and eighty-five patients suffering NVUGIB were enrolled. Their GBS, RS, and AIMS65 score, routine laboratory test results including prealbumin and d-dimer were determined after admission. Multivariate regression analysis was performed to define the independent predictors of rebleeding. ROC curves were generated to compare the suitability of prealbumin, d-dimer, and scores for rebleeding prediction. RESULTS The NVUGIB patients with rebleeding exhibited higher scores, white blood cell counts, d-dimer, CRP, proportion of surgery intervention, and longer hospital stay, but lower hematocrit, hemoglobin, calcium, prealbumin, and fibrinogen than those without rebleeding. The multivariate regression analysis demonstrated that prealbumin and d-dimer were independent predictors for rebleeding. Values of prealbumin and d-dimer were correlated with hospital stay, ulcer degrees, and surgery demand. The ROC curve analyses showed that prealbumin and d-dimer exhibited superior prediction value over the scoring systems. CONCLUSIONS Prealbumin and d-dimer are promising predictors for severity and prognosis in NVUGIB practice.
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Kim MS, Choi J, Shin WC. AIMS65 scoring system is comparable to Glasgow-Blatchford score or Rockall score for prediction of clinical outcomes for non-variceal upper gastrointestinal bleeding. BMC Gastroenterol 2019; 19:136. [PMID: 31349816 PMCID: PMC6660932 DOI: 10.1186/s12876-019-1051-8] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Accepted: 07/21/2019] [Indexed: 12/17/2022] Open
Abstract
Background Risk stratification for patients with nonvariceal upper gastrointestinal (NVUGI) bleeding is crucial for successful prognosis and treatment. Recently, the AIMS65 score has been used to predict mortality risk and rebleeding. The purpose of this study was to compare the performance of the AIMS65 score with the Glasgow-Blatchford score (GBS), Rockall score, and pre-endoscopic Rockall score in Korea. Methods We retrospectively studied 512 patients with NVUGI bleeding who were treated at a university hospital between 2013 and 2016. The AIMS65, GBS, Rockall score, and pre-endoscopic Rockall score were used to stratify patients based on their bleeding risk. The primary outcome was in-hospital mortality. The secondary outcomes were composite clinical outcomes of mortality, rebleeding, and intensive care unit (ICU) admission. Each scoring system was compared using the receiver-operating curve (ROC). Results A total of 17 patients (3.3%) died and rebleeding developed in 65 patients (12.7%). Eighty-six patients (16.8%) required ICU admission. The AIMS65 (area under the curve (AUC) 0.84, 95% confidence interval, 0.81–0.88)) seemed to be superior to the GBS (AUC 0.72, 0.68–0.76), the Rockall score (AUC 0.75, 0.71–0.79), or the pre-endoscopic Rockall score (AUC 0.74, 0.70–0.78) in predicting in-hospital mortality, but there was not a statistically significant difference between the groups (P = 0.07). The AUC value of the AIMS65 was not significantly different from the other scoring systems in prediction of rebleeding, endoscopic intervention, or ICU admission. Conclusions The AIMS65 score in NVUGI bleeding patients was comparable to the GBS or Rockall scoring systems when predicting the mortality, rebleeding, or ICU admission. Because AIMS65 is a much easier, readily calculated scoring system compared to the others, we would recommend using the AIMS65 in daily practice.
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Affiliation(s)
- Min Seong Kim
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, 101, Daehak-Ro, Jongno-gu, Seoul, 03080, South Korea
| | - Jeongmin Choi
- Department of Internal Medicine, Sanggye Paik Hospital, Inje University College of Medicine, 1342 Dongil-ro, Nowon-gu, Seoul, 01757, South Korea.
| | - Won Chang Shin
- Department of Internal Medicine, Sanggye Paik Hospital, Inje University College of Medicine, 1342 Dongil-ro, Nowon-gu, Seoul, 01757, South Korea
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Gu L, Xu F, Yuan J. Comparison of AIMS65, Glasgow-Blatchford and Rockall scoring approaches in predicting the risk of in-hospital death among emergency hospitalized patients with upper gastrointestinal bleeding: a retrospective observational study in Nanjing, China. BMC Gastroenterol 2018; 18:98. [PMID: 29954332 PMCID: PMC6022417 DOI: 10.1186/s12876-018-0828-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2018] [Accepted: 06/20/2018] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND This study aims to compare the performance of AIMS65, Glasgow-Blatchford (GBS) and Rockall scores (RS) in predicting the death risk among emergency-hospitalized patients with upper gastrointestinal bleeding (UGIB) in regional China. METHODS A retrospective study was implemented between January 2014 and December 2015. Eligible participants were those who were hospitalized with UGIB. The outcome variable was in-hospital death, while explanatory variables were AIMS65, GBS and RS scores. Odds ratios (OR) and 95% confidence interval (CI) were estimated to assess the association of AIMS65, GBS and RS with death risk using multivariate logistic regression models. The areas under the receiver operating characteristics curve (AUC) of three scoring systems were computed to compare their predictive power. RESULTS Among 799 UGIB participants, 674 were non-variceal bleeding (NVUGIB) and 125 variceal bleeding (VUGIB) patients. AIMS65 (OR = 14.72, 95% CI = 6.48, 33.43) and RS (OR = 1.60, 95% CI = 1.20, 2.13) were positively associated with the risk of in-hospital death. Moreover, AIMS65 (AUC = 0.91, 95% CI = 0.84, 0.98) performed the best in predicting in-hospital death, followed by RS (AUC = 0.79, 95% CI = 0.72, 0.86) and GBS (AUC = 0.71, 95% CI = 0.59, 0.83) among overall UGIB participants. AIMS65 was also the best indicator to predict in-hospital death among either NVUGIB participants (AUC = 0.89, 95% CI = 0.80, 0.98) or VUGIB participants (AUC = 0.94, 95% CI = 0.89, 1.00). CONCLUSIONS AIMS65, GBS and RS scoring approaches were all acceptable for predicting in-hospital death among UGIB patients irrespective of the subtype of UGIB in China. The AIMS65 might be the most powerful predictor.
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Affiliation(s)
- Lei Gu
- Department of Gastroenterology, Nanjing First Hospital, Nanjing Medical University, 68, Changle Road, Nanjing, 210006 China
| | - Fei Xu
- Nanjing Municipal Center for Disease Control and Prevention, Nanjing, China
- The School of Public Health, Nanjing Medical University, Nanjing, China
| | - Jie Yuan
- Department of Gastroenterology, Nanjing First Hospital, Nanjing Medical University, 68, Changle Road, Nanjing, 210006 China
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