Background and Aims

Limited data exist on prediction of adverse outcomes in patients with acute lower GI bleeding (LGIB). The purpose of our study was to compare the ability of existing validated clinical risk scores to predict relevant outcomes in LGIB.

Methods

We performed a prospective observational study of patients admitted with LGIB who underwent colonoscopy at a single center between April 2016 and September 2017. Seven risk scores were calculated at admission (Strate, NOBLADS, Sengupta, Oakland, Blatchford, AIMS65, and Charlson Comorbidity Index). The risk of severe LGIB was determined via univariable and multivariable logistic regression. Area under the receiver operating characteristic curve (AUC) analysis was used to compare the scores.

Results

We included 170 patients admitted with LGIB requiring colonoscopy. Fifty-two percent (n = 89) fit criteria for severe bleeding. Patients with severe bleeding had lower admission hemoglobin levels (8.6 g/dL vs 11.1 g/dL; P = .0001), were more likely to have blood transfusions (85% vs 36%; P < .0001), intensive care unit stays (49% vs 19%; P < .0001), and had a longer length of stay (6 days vs 4 days; P = .0009). The Oakland score was best for prediction of severe bleeding (AUC, .74), Blatchford score for blood transfusion (AUC, .87), and Strate score for in-hospital recurrent bleeding (AUC, .66) and endoscopic intervention (AUC, .62). The strongest individual predictors of severe bleeding were low admission hemoglobin (odds ratio, 1.28 per 1-g/dL decrease; P = .0015; 95% confidence interval, 1.10-1.49) and low albumin (odds ratio, 2.56 per 1-g/dL decrease; P = .02; 95% confidence interval, 1.16-5.56).

Conclusion

Admission albumin and hemoglobin levels were the strongest predictors of severe bleeding. No singular clinical risk tool had the best predictive ability across all outcomes.

中文翻译：

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急性下消化道出血的临床预测工具比较和不良结局危险因素识别

背景和目标

关于急性下消化道出血（LGIB）患者不良结局的预测数据有限。我们研究的目的是比较现有已验证的临床风险评分预测LGIB相关结果的能力。

方法

我们对2016年4月至2017年9月在同一中心接受结肠镜检查的LGIB入院患者进行了一项前瞻性观察研究。入院时计算了七个风险评分（Strate，NOBLADS，Sengupta，Oakland，Blatchford，AIMS65和Charlson合并症指数） 。严重LGIB的风险是通过单变量和多变量logistic回归确定的。接收器工作特性曲线（AUC）分析下的面积用于比较得分。

结果

我们纳入了170例需要结肠镜检查的LGIB入院患者。52％（n = 89）符合严重出血的标准。严重出血患者的入院血红蛋白水平较低（8.6 g / dL vs 11.1 g / dL；P  = .0001），输血的可能性更高（85％vs 36％；P  <.0001），重症监护病房停留（49％比19％；P  <.0001），并且住院时间更长（6天比4天；P = .0009）。Oakland评分最适合预测严重出血（AUC，.74），Blatchford输血评分（AUC，.87）和院内复发性出血的Strate评分（AUC，.66）和内镜干预（AUC， .62）。严重出血的最强个体预测因素是低入院血红蛋白（比值，每1-g / dL降低1.28；P  = 0.0015； 95％置信区间，1.10-1.49）和白蛋白低（比值，每1-g 2.56） / dL降低；P  = .02； 95％置信区间，1.16-5.56）。

结论

入院白蛋白和血红蛋白水平是严重出血的最强预测指标。在所有结局中，没有任何一种独特的临床风险工具具有最佳的预测能力。