Abstract:Objective We aimed to identify the clinical, biochemical, and endoscopic features associated with in-hospital mortality after acute upper gastrointestinal bleeding (AUGIB), focusing on cross-validation of the Glasgow-Blatchford score (GBS), full Rockall score (RS), and Cedars-Sinai Medical Center Predictive Index (CSMCPI) scoring systems. Methods Our prospective cross-sectional study included 156 patients with AUGIB. Several statistical approaches were used to assess the predictive accuracy of the scoring syst… Show more
“…A multicenter study which assessed the accuracy of 5 scores (GBS, Pre-RS, full-RS, AIM65, and PNED) for both intervention and mortality found that GBS was superior in predicting intervention or death [ 34 ]. Another study which analyzed the performance of 3 scores (GBS, full Rockall score and CS) for the prediction of in-hospital mortality found that all scores had an AUC > 0.9 but CS was superior to RS and GBS [ 4 ].…”
Section: Discussionmentioning
confidence: 99%
“…Upper gastrointestinal bleeding (UGIB) represents a common cause of hospital admissions in the gastroenterology and intensive care unit (ICU), with mortality ranging from 3 to 15% [ 1 , 2 , 3 , 4 ]. In most cases, early treatment and early endoscopy during the first 24 h is recommended according to current guidelines.…”
Section: Introductionmentioning
confidence: 99%
“…Therefore, the patients with no endoscopy performed represent a heterogenous group, with few studies regarding both mortality and the role of risk (non-endoscopic) scores in the prognostic evaluation. The mortality risk in the subgroup of patients without endoscopy is poorly evaluated in the literature; most studies included only patients with UGIB with endoscopy performed, and the absence of endoscopy represents one of the exclusion criteria in studies evaluating the performance of risk scores [ 1 , 3 , 4 , 10 , 24 , 25 , 26 , 27 ]. In this setting, a study evaluating the accuracy of prognostic scores for mortality in a subgroup of patients without endoscopy and with no known etiology for bleeding can be useful in order to predict the risk of death.…”
(1) Background: The assessment of mortality and rebleeding rate in upper gastrointestinal bleeding (UGIB) is essential, and several prognostic scores have been proposed. Some patients with UGIB did not undergo endoscopy, either because they refused the procedure, suffered from alcohol withdrawal symptoms or altered general status, or because the bleeding was severe enough to cause death before the endoscopy. The mortality risk in the subgroup of patients without endoscopy is poorly evaluated in the literature. (2) Methods: The purpose of the study was to identify the most useful scores for the assessment of in-hospital mortality in patients with UGIB with no endoscopy performed and no known etiology. A total of 198 patients with UGIB and no endoscopy performed were admitted between January 2017 and December 2021 and the accuracy of 12 prognostic scores and the Charlson comorbidity index for in-hospital mortality prediction were analyzed, as well as Child–Pugh Turcotte (CPT) and Meld scores in patients with cirrhosis. (3) Results: The mortality rate was 37.9%, higher than in variceal (21.9%, p < 0.0001) and non-variceal bleeding (7.4%, p < 0.0001). The most accurate scores by AUC were the International Bleeding score (INBS, 0.844), Glasgow Blatchford (0.783), MAP score (0.78), Iino (0.766), AIM65 and modified N-score (0.745 each), modified Glasgow-Blatchford (0.73), H3B2 and N-score (0.701); Rockall, Baylor, and T-score had an AUC below 0.7. MELD score was superior to CPT in patients with cirrhosis (AUC 0.811 versus 0.670). (4) Conclusions: The mortality rate in UGIB with no endoscopy was higher than in both variceal and non-variceal bleeding and was higher in the pandemic period but with no statistical significance (45.3% versus 32.14%, p = 0.0586), mainly because of positive cases. Only one case of rebleeding was noted; the hospitalization period was significantly shorter. The most accurate score was International Bleeding Score; the MELD score had a higher but moderate accuracy compared with CPT in patients with cirrhosis.
“…A multicenter study which assessed the accuracy of 5 scores (GBS, Pre-RS, full-RS, AIM65, and PNED) for both intervention and mortality found that GBS was superior in predicting intervention or death [ 34 ]. Another study which analyzed the performance of 3 scores (GBS, full Rockall score and CS) for the prediction of in-hospital mortality found that all scores had an AUC > 0.9 but CS was superior to RS and GBS [ 4 ].…”
Section: Discussionmentioning
confidence: 99%
“…Upper gastrointestinal bleeding (UGIB) represents a common cause of hospital admissions in the gastroenterology and intensive care unit (ICU), with mortality ranging from 3 to 15% [ 1 , 2 , 3 , 4 ]. In most cases, early treatment and early endoscopy during the first 24 h is recommended according to current guidelines.…”
Section: Introductionmentioning
confidence: 99%
“…Therefore, the patients with no endoscopy performed represent a heterogenous group, with few studies regarding both mortality and the role of risk (non-endoscopic) scores in the prognostic evaluation. The mortality risk in the subgroup of patients without endoscopy is poorly evaluated in the literature; most studies included only patients with UGIB with endoscopy performed, and the absence of endoscopy represents one of the exclusion criteria in studies evaluating the performance of risk scores [ 1 , 3 , 4 , 10 , 24 , 25 , 26 , 27 ]. In this setting, a study evaluating the accuracy of prognostic scores for mortality in a subgroup of patients without endoscopy and with no known etiology for bleeding can be useful in order to predict the risk of death.…”
(1) Background: The assessment of mortality and rebleeding rate in upper gastrointestinal bleeding (UGIB) is essential, and several prognostic scores have been proposed. Some patients with UGIB did not undergo endoscopy, either because they refused the procedure, suffered from alcohol withdrawal symptoms or altered general status, or because the bleeding was severe enough to cause death before the endoscopy. The mortality risk in the subgroup of patients without endoscopy is poorly evaluated in the literature. (2) Methods: The purpose of the study was to identify the most useful scores for the assessment of in-hospital mortality in patients with UGIB with no endoscopy performed and no known etiology. A total of 198 patients with UGIB and no endoscopy performed were admitted between January 2017 and December 2021 and the accuracy of 12 prognostic scores and the Charlson comorbidity index for in-hospital mortality prediction were analyzed, as well as Child–Pugh Turcotte (CPT) and Meld scores in patients with cirrhosis. (3) Results: The mortality rate was 37.9%, higher than in variceal (21.9%, p < 0.0001) and non-variceal bleeding (7.4%, p < 0.0001). The most accurate scores by AUC were the International Bleeding score (INBS, 0.844), Glasgow Blatchford (0.783), MAP score (0.78), Iino (0.766), AIM65 and modified N-score (0.745 each), modified Glasgow-Blatchford (0.73), H3B2 and N-score (0.701); Rockall, Baylor, and T-score had an AUC below 0.7. MELD score was superior to CPT in patients with cirrhosis (AUC 0.811 versus 0.670). (4) Conclusions: The mortality rate in UGIB with no endoscopy was higher than in both variceal and non-variceal bleeding and was higher in the pandemic period but with no statistical significance (45.3% versus 32.14%, p = 0.0586), mainly because of positive cases. Only one case of rebleeding was noted; the hospitalization period was significantly shorter. The most accurate score was International Bleeding Score; the MELD score had a higher but moderate accuracy compared with CPT in patients with cirrhosis.
“…Despite this, these models often include kidney failure and/or markers altered in kidney disease as inputs, and thus can yield convoluted insights in the dialysis population. 36-40 The appropriate identification and risk classification in patients with kidney failure remains a clinical challenge. The Glasgow Blatchford score (GBS) has been evaluated for predicting the need for admission and endoscopic intervention in kidney failure patients presenting to the hospital with a suspected GIB; this model was found to have reasonable performance (AUROC=0.63, sensitivity=81.2%, and specificity=42.3%) with a GBS cutoff score of ≥14.…”
Gastrointestinal bleeding (GIB) is a clinical challenge in kidney failure. The INSPIRE group assessed if machine learning could assist with determining a hemodialysis (HD) patient's 180-day GIB hospitalization risk. Model was developed using adult HD patient data from United States (2017-2020). Patient data was randomly split (50% training, 30% validation, and 20% testing). HD treatments <=180 days before GIB hospitalization were classified as positive observations, and others were negative observations. Datasets were randomly sampled to build an XGBoost model that considered 386 exposures initially and was refined to the top 50 exposures. Unseen testing dataset was used to determine final model performance. Incidence of 180-day GIB hospitalization was 1.18% in the HD population (n=451,579), and 1.16% among patients in the testing dataset (n=27,991). Model showed an area under the curve=0.69, sensitivity=57.9%, specificity=68.9%, accuracy=68.8% and balanced accuracy=63.4%. Exposures with largest effect size per Shapley values were older age (group mean GIB event=68.2 years vs no GIB event=63.4 years), shorter days since last all-cause hospital admission (group mean GIB event=203.2 days vs no GIB event=253.2 days), and higher serum 25-hydroxy (OH) vitamin D levels from most recent lab (group mean GIB event=33.4 ng/mL vs no GIB event=30.5 ng/mL). Other important predictors included lower hemoglobin and iron indices, longer dialysis vintage, and proton pump inhibitor use. Model appears suitable for early detection of GIB event risk in HD, yet prospective testing is needed. The association between higher 25OH vitamin D and GIB events was unexpected and warrants investigation.
“…A la actualidad de hace uso de scores debidamente validados que tienen utilidad en la toma de decisiones para el manejo del sangrado gastrointestinal (19)(20)(21), entre ellos y de amplio uso tenemos la escala Glasgow Blatchford, cuyo objetivo es identificar pacientes con hemorragia digestiva alta de alto o bajo riesgo de necesidad de manejo de este sangrado, con sensibilidad 99% y especificidad 32%, el punto de corte es 2; es decir pacientes con un puntaje <2 son de bajo riesgo y pueden ser dados de alta, en cambio pacientes con un puntaje > 2 son catalogados como de alto riesgo, y deben ser admitidos para manejo de la hemorragia digestiva. Dentro los parámetros de este score se encuentran urea sérica, hemoglobina, presión arterial, pulso, tacto rectal positivo para melena, este último con un puntaje de 1 pudiendo ser determinante para establecer el tratamiento endoscópico del sangrado gastrointestinal (22).…”
Objetivos del estudio: La hemorragia gastrointestinal se encuentra dentro de las patologías más frecuentes que se atienden en los servicios de emergencia, la misma que previa evaluación del paciente requiere manejo médico y endoscópico, de ahí resalta la importancia del tacto rectal en la evaluación inicial del paciente con sospecha de hemorragia digestiva, para la toma de decisiones y establecer la indicación de manejo endoscópico oportuno. Este estudio tiene como objetivo determinar la utilidad del tacto rectal para diagnosticar hemorragia digestiva en pacientes que acuden al servicio de emergencia del Hospital Nacional Arzobispo Loayza, en el periodo de agosto 2022 a diciembre 2023. Metodología: El diseño del estudio es prospectivo, analítico, de tipo test diagnóstico. Se evaluará la utilidad del tacto rectal, tomando como patrón de oro (gold estándar) a la endoscopia digestiva alta y colonoscopia, a través del cálculo de la sensibilidad, especificidad y likelihood ratio, así como sus intervalos de confianza 95%, p<0.05.
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