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- Title
Evaluation of scoring systems without endoscopic findings for predicting outcomes in patients with upper gastrointestinal bleeding.
- Authors
Il-Gyu Ko; Sung-Eun Kim; Bok Soon Chang; Min Seob Kwak; Jin Young Yoon; Jae Myung Cha; Hyun Phil Shin; Joung Il Lee; Sang Hyun Kim; Jin Hee Han; Jung Won Jeon; Ko, Il-Gyu; Kim, Sung-Eun; Chang, Bok Soon; Kwak, Min Seob; Yoon, Jin Young; Cha, Jae Myung; Shin, Hyun Phil; Lee, Joung Il; Kim, Sang Hyun
- Abstract
<bold>Background: </bold>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.<bold>Methods: </bold>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.<bold>Results: </bold>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).<bold>Conclusions: </bold>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.
- Subjects
GASTROINTESTINAL diseases; GASTROINTESTINAL disease treatment; ENDOSCOPY; MORTALITY; HOSPITAL emergency services; PATIENTS; GASTROINTESTINAL hemorrhage diagnosis; GASTROINTESTINAL hemorrhage treatment; BLOOD transfusion; GASTROINTESTINAL hemorrhage; SURGICAL hemostasis; PHARMACOKINETICS; PROGNOSIS; RISK assessment; RETROSPECTIVE studies; SEVERITY of illness index; RECEIVER operating characteristic curves; ENDOSCOPIC gastrointestinal surgery
- Publication
BMC Gastroenterology, 2017, Vol 17, p1
- ISSN
1471-230X
- Publication type
journal article
- DOI
10.1186/s12876-017-0716-4