Upper gastrointestinal bleeding etiology score for predicting variceal and non-variceal bleeding

作     者：Supot Pongprasobchai Sireethorn Nimitvilai Jaroon Chasawat Sathaporn Manatsathit 

作者机构：Division of Gastroenterology Department of Internal Medicine Siriraj Hospital Bangkok 10700 Thailand Department of Internal Medicine Siriraj Hospital Bangkok 10700 Thailand 

出 版 物：《World Journal of Gastroenterology》 (世界胃肠病学杂志（英文版）)

年 卷 期：2009年第15卷第9期

页      面：1099-1104页

核心收录：

学科分类：1002[医学-临床医学] 100201[医学-内科学(含：心血管病、血液病、呼吸系病、消化系病、内分泌与代谢病、肾病、风湿病、传染病)] 10[医学] 

主　　题：非静脉曲张破裂出血 上消化道出血病因 预测因子 评分 Logistic回归分析 受试者工作曲线 核型多角体病毒 临床参数 

摘      要：AIM:To identify clinical parameters,and develop an Upper Gastrointesinal Bleeding (UGIB) Etiology Score for predicting the types of UGIB and validate the ***:Patients with UGIB who underwent endoscopy within 72 h were enrolled. Clinical and basic laboratory parameters were prospectively collected. Predictive factors for the types of UGIB were identified by univariate and multivariate analyses and were used to generate the UGIB Etiology Score. The best cutoff of the score was defi ned from the receiver operating curve and prospectively validated in another set of patients with ***:Among 261 patients with UGIB,47 (18%) had variceal and 214 (82%) had non-variceal bleeding. Univariate analysis identified 27 distinct parameters significantly associated with the types of UGIB. Logistic regression analysis identified only 3 independent factors for predicting variceal bleeding; previous diagnosis of cirrhosis or signs of chronic liver disease (OR 22.4,95% CI 8.3-60.4,P 0.001),red vomitus (OR 4.6,95% CI 1.8-11.9,P = 0.02),and red nasogastric (NG) aspirate (OR 3.3,95% CI 1.3-8.3,P = 0.011). The UGIB Etiology Score was calculated from (3.1 × previous diagnosis of cirrhosis or signs of chronic liver disease) + (1.5 × red vomitus) + (1.2 × red NG aspirate),when 1 and 0 are used for the presence and absence of each factor,respectively. Using a cutoff≥ 3.1,the sensitivity,specificity,accuracy,positive predictive value (PPV),and negative predictive value (NPV) in predicting variceal bleeding were 85%,81%,82%,50%,and 96%,respectively. The score was prospectively validated in another set of 195 UGIB cases (46 variceal and 149 non-variceal bleeding). The PPV and NPV of a score ≥ 3.1 for variceal bleeding were 79% and 97%,***:The UGIB Etiology Score,composed of 3 parameters,using a cutoff ≥ 3.1 accurately predicted variceal bleeding and may help to guide the choice of initial therapy for UGIB before endoscopy.