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J Korean Soc Emerg Med > Volume 30(5); 2019 > Article
Journal of The Korean Society of Emergency Medicine 2019;30(5): 401-410.
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
김동훈1 , 하영록1 , 안정환2 , 김영식1 , 신태용1 , 정루비1 , 이규현1 , 유우성1 , 윤영탁1
1분당제생병원 응급의학과
2아주대학교 의과대학 응급의학교실
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
Donghoon Kim1 , Young Rock Ha1 , Jung Hwan Ahn2 , Young Sik Kim1 , Tae Yong Shin1 , Ru Bi Jung1 , Kyu-Hyun Lee1 , Woosung Yu1 , Young Tak Yoon1
1Department of Emergency Medicine, Daejin Medical Center, Bundang Jesaeng General Hostpital, Seongnam, Korea
2Department of Emergency Medicine, Ajou University School of Medicine, Suwon, Korea
Correspondence  Young Rock Ha ,Tel: 031-779-0183, Fax: 031-779-6528, Email: youngrock.ha@gmail.com,
Received: May 24, 2019; Revised: July 22, 2019   Accepted: July 30, 2019.  Published online: October 31, 2019.
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.
Key words: Gastrointestinal hemorrhage; Emergency medicine; Predictive value; Lactic acid
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