BMJ：上消化道出血患者风险评分系统哪家强？

2017-01-05 xing.T MedSci原创

Glasgow Blatchford评分在预测以医院为基础的干预和死亡率方面具有较高的预测精度。其评分≤1分是引导患者门诊就诊的的最佳阈值。对于其他终点这些评分的AUROCS均低于0.80，因此这些结果的临床效用较为有限。

最近，顶级医学期刊BMJ上发表了一篇研究文章，研究人员比较了五种风险评分系统在上消化道出血患者评估中的预测准确性和临床应用价值。

该研究采用国际多中心前瞻性研究，分别在欧洲、北美洲、亚洲和大洋洲的六个大型医院内完成。该研究在12个月内共纳入了3012例连续就诊的上消化道出血患者。研究者比较了内镜前评分（admission Rockall、AIMS65和Glasgow Blatchford评分）和内镜后评分（全Rockall和PNED评分）对预设临床终点的预测能力，预设的临床终点包括：复合终点（输血、内镜治疗、介入、手术或30天死亡率），内镜治疗，30天死亡率，再出血，以及住院时间。研究人员也确定了区分低风险和高风险的患者的最佳评分阈值。

研究人员发现Glasgow Blatchford评分在预测干预或死亡方面的能力最佳（ROC曲线下面积（AUROC）为0.86），相比于全Rockall评分（0.70）、PNED评分（0.69）、admission Rockall评分（0.66）和AIMS65评分（0.68）（P＜0.001）。

Glasgow Blatchford评分≤1是预测没有干预的生存最佳阈值（敏感性为98.6%，特异性为34.6%）。Glasgow Blatchford评分能更好地预测内镜治疗（AUROC为0.75）相比于AIMS65评分（0.62）和admission Rockall评分（0.61）（P＜0.001）。Glasgow Blatchford评分≥7是预测内镜治疗的最佳阈值（敏感性为80%，特异性为57%）。

PNED评分（AUROC为0.77）和AIMS65评分（0.77）是预测死亡率的最佳评分，其都优于admission Rockall评分（0.72）和Glasgow Blatchford评分（0.64；P＜0.001）。对于PNED评分≥4、AIMS65评分≥2、admission Rockall评分≥4和全Rockall评分≥5的评分阈值能够最好地预测死亡，其敏感性为65.8-78.6%，特异性为65.0-65.3%。没有评分有助于预测再出血风险或住院时间长短。

由此可见，Glasgow Blatchford评分在预测以医院为基础的干预和死亡率方面具有较高的预测精度。其评分≤1分是引导患者门诊就诊的的最佳阈值。对于其他终点这些评分的AUROCS均低于0.80，因此这些结果的临床效用较为有限。

原始出处：

Adrian J Stanley, et al. Comparison of risk scoring systems for patients presenting with upper gastrointestinal bleeding: international multicentre prospective study. BMJ. 04 January 2017.

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2017-06-07 gaoxiaoe

#BMJ#

29 0
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2017-01-15 zchen

#上消化道#

22 0
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2017-01-14 zibozhouping

学习了，谢谢您，转给我的同事

77 0
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2017-01-07 小树熊

好东西，要分享

72 0
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2017-01-07 changhe715

#消化道#

33 0
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2017-01-07 往日如昨

继续学习中

79 0
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2017-01-06 蔬菜

第一次了解到

84 0
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2017-01-05 thlabcde

好东西学习了！

68 0

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