A simple scoring system to assess the need for an endoscopic intervention in suspected upper gastrointestinal bleeding: A prospective cohort study

Masayasu Horibe, Tetsuji Kaneko, Naoto Yokogawa, Takuya Yokota, Osamu Okawa, Yukihiro Nakatani, Yuki Ogura, Juntaro Matsuzaki, Eisuke Iwasaki, Naoki Hosoe, Tatsuhiro Masaoka, John M. Inadomi, Hidekazu Suzuki, Takanori Kanai, Shin Namiki

研究成果: Article査読

12 被引用数 (Scopus)

抄録

Background Assessment of the emergent endoscopy for upper gastrointestinal bleeding (UGIB) patients has important clinical implications. There is no validated criterion to triage. Aims To develop a simple score predicting an endoscopic intervention. Methods A prospective cohort study was conducted at a tertiary care centre. Primary outcome was the high-risk stigmata which were well-established endoscopic findings to determine the need for an endoscopic intervention. We created a simple score by multivariable logistic regression and compared with the Glasgow Blatchford Score (GBS). External validation was performed in a second cohort. Results 284 of consecutive 568 patients with suspected UGIB had the high-risk stigmata. Three variables were selected: “no daily use of proton pump inhibitors during one week before examination (+1 point)”, “shock index (heart rate/systolic blood pressure) ≥ 1 (+1 point)” and “urea/creatinine ≥ 140 (blood urea nitrogen/creatinine ≥ 30) (+1 point)”. The accumulating score (range 0–3) achieved an area under the receiver–operating characteristic curve (AUC) of 0.74 (95% confidence interval [CI], 0.70–0.78), which was superior to the GBS (AUC, 0.63; 95% CI, 0.59–0.68; p < 0.001). Validation in an external cohort demonstrated superiority to the GBS (AUC, 0.78 vs. 0.59; p < 0.001). Conclusions The simple score has greater accuracy than the GBS for assessing the need for an endoscopic intervention in cases of suspected UGIB. Further external validation should be performed to verify generalizability.

本文言語English
ページ(範囲)1180-1186
ページ数7
ジャーナルDigestive and Liver Disease
48
10
DOI
出版ステータスPublished - 2016 10 1

ASJC Scopus subject areas

  • 肝臓学
  • 消化器病学

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