Horibe GI bleeding prediction score: a simple score for triage decision-making in patients with suspected upper GI bleeding.,Gastrointestinal Endoscopy

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Horibe GI bleeding prediction score: a simple score for triage decision-making in patients with suspected upper GI bleeding.
Gastrointestinal Endoscopy ( IF 6.7 ) Pub Date : 2020-03-30 , DOI: 10.1016/j.gie.2020.03.3846
Masayasu Horibe ₁ , Eisuke Iwasaki ₂ , Fateh Bazerbachi ₃ , Tetsuji Kaneko ₄ , Juntaro Matsuzaki ₂ , Kazuhiro Minami ₂ , Tatsuhiro Masaoka ₂ , Naoki Hosoe ₅ , Yuki Ogura ₆ , Shin Namiki ₆ , Yasuo Hosoda ₇ , Haruhiko Ogata ₅ , Andrew T Chan ₈ , Takanori Kanai ₂

Affiliation

Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan; Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA.
Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan.
Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA; Division of Gastroenterology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA.
Department of Clinical Trial, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan; Teikyo Academic Research Center, Teikyo University, Tokyo, Japan.
Center for Diagnostic and Therapeutic Endoscopy, Keio University Hospital, Tokyo, Japan.
Department of Gastroenterology and Hepatology, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan.
Division of Gastroenterology, Department of Internal Medicine, National Hospital Organization Saitama National Hospital, Saitama, Japan.
Division of Gastroenterology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA.

Background and Aims

Although upper GI bleeding (UGIB) is a significant cause of inpatient admissions, no scoring method has proven to be accurate and simple as a standard for triage purposes. Therefore, we compared a previously described 3-variable score (1 point each for absence of daily proton pump inhibitor use in the week before the index presentation, shock index [heart rate/systolic blood pressure] ≥1, and blood urea nitrogen/creatinine ≥30 [urea/creatinine≥140]), the Horibe gAstRointestinal BleedING scoRe (HARBINGER), with the 8-variable Glasgow-Blatchford Score (GBS) and 5-variable AIMS65 to evaluate and validate the accuracy in predicting high-risk features that warrant admission and urgent endoscopy.

Methods

Consecutive patients presenting with suspected UGIB between 2012 and 2015 were prospectively enrolled in 3 acute care Japanese hospitals. On presentation to the emergency setting, an endoscopy was performed in a timely fashion. The primary outcome was the prediction of high-risk endoscopic stigmata.

Results

Of 1486 enrolled patients, 637 (43%) harbored high-risk endoscopic stigmata according to international consensus statements. The area under the receiver operating characteristic curve (AUC) for the HARBINGER was .76 (95% confidence interval [CI], .72-.79), which was significantly superior to both the GBS (AUC, .68; 95% CI, .64-.71; P < .001) and the AIMS65 (AUC, .54; 95% CI, .50-.58; P < .001). When the HARBINGER cutoff value was set at 1 to rule out patients who needed admission and urgent endoscopy, its sensitivity and specificity was 98.8% (95% CI, 97.9-99.6) and 15.5% (95% CI, 13.1-18.0), respectively.

Conclusions

The HARBINGER, a simple 3-variable score, provides a more accurate method for triage of patients with suspected UGIB than both the GBS and AIMS65.

中文翻译：

Horibe GI出血预测评分：可疑的上GI出血患者的分流决策的简单评分。

背景和目标

尽管上消化道出血（UGIB）是住院患者的重要原因，但没有一种评分方法被证明是准确且简单的分类标准。因此，我们比较了先前描述的3变量评分（在出现指数前一周没有使用质子泵抑制剂的情况，休克指数[心率/收缩压]≥1和血尿素氮/肌酐各1分） ≥30 [尿素/肌酐≥140]），Horibe胃肠道出血评分（HARBINGER），8变量格拉斯哥-布拉奇福德评分（GBS）和5变量AIMS65来评估和验证预测高危特征的准确性需要入院并进行紧急内镜检查。

方法

前瞻性在2012年至2015年之间连续出现UGIB的患者入选了3家日本急诊医院。在出现紧急情况时，及时进行了内镜检查。主要结果是预测高风险内镜下的柱头。

结果

根据国际共识声明，在1486名登记的患者中，有637名（43％）患有高风险的内窥镜柱头。HARBINGER的接收器工作特征曲线（AUC）下的面积为0.76（95％置信区间[CI] ，. 72-.79），显着优于两个GBS（AUC，0.68； 95％CI），.64-.71；P <.001）和AIMS65（AUC，.54； 95％CI，.50-.58；P <.001）。当将HARBINGER临界值设置为1以排除需要入院和急诊内镜检查的患者时，其敏感性和特异性分别为98.8％（95％CI，97.9-99.6）和15.5％（95％CI，13.1-18.0）。