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상부위장관 출혈로 내원한 정상 혈압 환자에서 활동성 출혈을 예측하기 위한 Glasgow Blatchford score, Pre-Rockall score, AIMS65 score의 유용성 검정 및 새로운 예측인자 개발을 위한 제언

Validation of Glasgow-Blatchford score, Pre-Rockall score, and AIMS65 score to predict active bleeding in patients with upper gastrointestinal bleeding in normotensive patients and suggestion for developing new predictors

대한응급의학회지 2019년 30권 5호 p.401 ~ 410
김동훈 ( Kim Dong-Hoon ) - 분당제생병원 응급의학과

하영록 ( Ha Young-Rock ) - 분당제생병원 응급의학과
안정환 ( Ahn Jung-Hwan ) - 아주대학교 의과대학 응급의학교실
김영식 ( Kim Young-Sik ) - 분당제생병원 응급의학과
신태용 ( Shin Tae-Yong ) - 분당제생병원 응급의학과
정루비 ( Jeong Ru-Bi ) - 분당제생병원 응급의학과
이규현 ( Lee Kyu-Hyun ) - 분당제생병원 응급의학과
유우성 ( Yu Woo-Sung ) - 분당제생병원 응급의학과
윤영탁 ( Yoon Young-Tak ) - 분당제생병원 응급의학과

Abstract


Objective: The aim of this study was to validate the Glasgow-Blatchford score (GBS), Pre-Rockall score (PRS), and AIMS65 score to predict active bleeding in patients with normotension and upper gastrointestinal bleeding (UGIB), and analyze the variables that can predict active bleeding to help develop new predictive factors.

Method: Data were collected retrospectively from January 2015 to December 2017. A systolic blood pressure ≥90 mmHg were defined as normotension, and the patients were divided into active bleeding and not-active bleeding groups based on an esophagogastroduodenoscopy and levin-tube irrigation. The GBS, PRS, and AIMS65 of each group were calculated. The receiver operator characteristic (ROC) curve and area under the curve (AUC) were also calculated to obtain the predictive power for active bleeding. Furthermore, the factors that can predict active bleeding were analyzed by multivariate logistic regression. The ROC curve and AUC were calculated using the variables that were adopted as useful factors.

Results: Of the 250 patients included, 85 were active bleeding and 165 were not-active bleeding. The ROC curve showed GBS (AUC, 0.54; 95% confidence interval [CI], 0.47-0.61), PRS (AUC, 0.58; 95% CI, 0.50-0.65), and AIMS65 (AUC, 0.51; 95% CI, 0.43-0.59) to have low predictive power for active bleeding. Multivariate logistic regression revealed the lactate (odds ratio [OR], 1.10; 95% CI, 1.01-1.20) and shock indices (OR, 4.15; 95% CI, 1.12-15.40) to be significant predictors of active bleeding. When calculating the probability of predicting active bleeding through these variables, AUC 0.64 (95% CI, 0.57-0.71) showed higher prediction power than the previous scores.

Conclusion: The conventional scoring systems that predict the prognosis of UGIB showed low predictability in predicting active bleeding in UGIB patients with a systolic blood pressure ≥90 mmHg. Further study suggests the development of new score using factors, such as the lactate and shock indices.

키워드

Gastrointestinal hemorrhage; Emergency medicine; Predictive value; Lactic acid
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