- 作者：Pedro Almela ; Adolfo Benages ; Salvador Peiró ; Ramó ; n Añ ; ó ; n ; Miguel Minguez Pé ; rez ; André ; s Peñ ; a ; Isabel Pascual ; Francisco Mora
- 刊名：Gastrointestinal Endoscopy
- 出版年：2004
- 出版时间：June 2004
- 年：2004
- 卷：59
- 期：7
- 页码：772-781
- 全文大小：182 K
Methods
From a prospective cohort of 983 consecutive patients with upper-GI hemorrhage not associated with portal hypertension, 581 cases that did not meet pre-established criteria for admission were selected, and a logistic regression analysis was performed to identify factors associated with two adverse outcomes: recurrent bleeding and/or the need for emergency surgery. The risk score system was developed by using the beta coefficients of the logistic model, and its performance was evaluated. The results of this model were combined with pre-established criteria for admission to build a simplified scoring system for identification of patients who can be managed safely on an outpatient basis.
Results
Chronic alcoholism, active malignancy, prior upper digestive tract surgery, wasting syndrome, hemodynamic compromise, duodenal ulcer as the cause of upper-GI hemorrhage, and hemorrhage of unknown cause were independently associated with a greater risk of unfavorable outcomes in the group that did not meet pre-established criteria for admission. The logistic model showed a high capacity for discrimination (C statistic: 0.87) and good calibration (p value for Hosmer-Lemeshow goodness-of-fit test, 0.62), with a sensitivity of 100 % and specificity of 64 % . The simplified score had a sensitivity of 100 % and specificity of 29 % for adverse outcomes, and sensitivity of 78 % and specificity of 38 % for mortality.
Conclusions
The score system developed in this study may be helpful in deciding between hospitalization and outpatient management for patients with upper-GI hemorrhage, but it remains to be validated in patient groups other than those used for its development.