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Scoring systems for peptic ulcer bleeding: which one to use?

World Journal of Gastroenterology 2017年第41期23卷 7450-7458页

作者： Ivan Budimir Sanja Stojsavljevic Neven Barsic Alen Biscanin Gorana Mirosevic Sven Bohnec Lora Stanka Kirigin Tajana Pavic Neven Ljubicic Division of Gastroent-erology Department of Internal Medicine 'Sestre Milosrdnice' University Hospital Center Division of Endo-crinology Department of Internal Medicine 'Sestre Milosrdnice' University Hospital Center gastronterologie Allgemeine Innere Medizin und Geriatrie Rems -Murr Klinik Winnenden

AIM To compare the Glasgow-Blatchford score(GBS), Rockall score(RS) and Baylor bleeding score(BBS) in predicting clinical outcomes and need for interventions in patients with bleeding peptic ulcers. METHODS Between January 2008 and December 2013, 1012consecutive patients admitted with peptic ulcer bleeding(PUB) were prospectively followed. The pre-endoscopic RS, BBS and GBS, as well as the post-endoscopic diagnostic scores(RS and BBS) were calculated for all patients according to their urgent upper endoscopy findings. Area under the receiver-operating characteristics(AUROC) curves were calculated for the prediction of lethal outcome, rebleeding, needs for blood transfusion and/or surgical intervention, and the optimal cutoff values were *** PUB accounted for 41.9% of all upper gastrointestinal tract bleeding, 5.2% patients died and 5.4% patients underwent surgery. By comparing the AUROC curves of the aforementioned pre-endoscopic scores, the RS best predicted lethal outcome(AUROC 0.82 vs 0.67 vs0.63, respectively), but the GBS best predicted need for hospital-based intervention or 30-d mortality(AUROC0.84 vs 0.57 vs 0.64), rebleeding(AUROC 0.75 vs 0.61 vs 0.53), need for blood transfusion(AUROC 0.83 vs0.63 vs 0.58) and surgical intervention(0.82 vs 0.63 vs 0.52) The post-endoscopic RS was also better than the post-endoscopic BBS in predicting lethal outcome(AUROC 0.82 vs 0.69, respectively).CONCLUSION The RS is the best predictor of mortality and the GBS is the best predictor of rebleeding, need for blood transfusion and/or surgical intervention in patients with PUB. There is no one 'perfect score' and we suggest that these two tests be used concomitantly.

关键词： Upper gastrointestinal bleeding Peptic ulcer bleeding Glasgow-Blatchford score Rockall score Baylor bleeding score

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