Background
Methods
Study design
Glasgow-Blatchford score | |
---|---|
Admission risk marker | Score component value |
Blood urea nitrogen (mg/dL) | |
≥ 18.2 <22.4 mg/dL | 2 |
≥ 22.4 <28 mg/dL | 3 |
≥ 28 <70 mg/dL | 4 |
≥ 70 mg/dL | 6 |
Hemoglobin for men (g/dL) | |
≥ 12 <13 g/dL | 1 |
≥ 10 <12 g/dL | 3 |
<10 g/dL | 6 |
Hemoglobin for women (g/dL) | |
≥ 10 <12 g/dL | 1 |
<10 g/dL | 6 |
Systolic blood pressure | |
≥ 100 <109 mm Hg | 1 |
≥ 90 <99 mm H | 2 |
<90 mm Hg | 3 |
Other markers | |
Pulse ≥100/min | 1 |
Presentation with melena | 1 |
Presentation with syncope | 2 |
Hepatic disease | 2 |
Heart failure | 2 |
Pre-endoscopic rockall score | |
Admission risk factor | Score component value |
Age, y | |
<60 | 0 |
60–79 | 1 |
≥ 80 | 2 |
Shock | |
No shock: SBP ≥100, pulse <100 | 0 |
Tachycardia: SBP ≥100, pulse ≥100 | 1 |
Hypotension: SBP <100 | 2 |
Comorbidity | |
No major comorbidity | 0 |
Cardiac failure, ischemic heart disease, any major comorbidity | 2 |
Renal failure, liver failure, disseminated malignancy | 3 |
Modified early warning score | |||||||
---|---|---|---|---|---|---|---|
Score | 3 | 2 | 1 | 0 | 1 | 2 | 3 |
SBP mmHg | <70 | 71–80 | 81–100 | 101–199 | – | >200 | – |
Heart rate, bpm | – | <40 | 41–50 | 51–100 | 101–110 | 111–129 | >130 |
Respiratory rate, rpm | – | <9 | – | 9–14 | 15–20 | 21–29 | >30 |
Temperature, 1C | – | <35 | – | 35.0–38.4 | – | >38.5 | – |
AVPU | – | – | – | A | V | P | U |
Statistical analysis
Results
Demographic and clinical data
Data | Number | Percent | |
---|---|---|---|
Gender | Female | 84 | 41.6 |
Male | 118 | 58.4 | |
Complaint | Melena | 91 | 45.0 |
Hematemesis | 96 | 47.5 | |
Hematochezia | 5 | 2.5 | |
Syncope | 1 | 0.5 | |
Dizziness | 2 | 1.0 | |
Stomachache | 1 | 0.5 | |
Active bleedinga
| 6 | 3.0 | |
RT finding | Melena | 125 | 61.9 |
No Melena | 57 | 28.2 | |
Rectum empty | 12 | 5.9 | |
Hematochezia | 8 | 4.0 | |
Endoscopic treatment | Sclerotherapy | 29 | 52.7 |
Adrenalin injection | 2 | 3.6 | |
Band ligation | 20 | 36.4 | |
Other | 4 | 7.3 | |
Bleeding type | Varicous | 59 | 29.2 |
Non varicous | 143 | 70.8 | |
Hospital outcome | Discharge | 40 | 19.8 |
Hospitalization | 151 | 74.8 | |
Death | 11 | 5.4 | |
One month later result | Normal | 158 | 82.7 |
Rebleeding | 24 | 12.6 | |
Death | 9 | 4.7 | |
Hospitalization place | Service | 112 | 69.1 |
Intensive care unit | 50 | 30.9 | |
Blood transfusion | Applied | 146 | 72.3 |
Not applied | 56 | 27.7 | |
Bleeding at follow-up | Bleeding | 34 | 16.8 |
Not bleeding | 168 | 83.2 |
Scores and patient outcomes
GBS | MEWS | PER | |||||
---|---|---|---|---|---|---|---|
Min-Max | Median [25–75 percentile] | Min-Max | Median [25–75 percentile] | Min-Max | Median [25–75 percentile] | ||
Hospitalization place | Service (n = 112) | 1–18 | 12 [10–14] | 1–8 | 2 [1–3] | 0–7 | 3 [2–4] |
Intensive care unit (n = 50) | 6–17 | 13 [10.75–15.00] | 1–9 | 2.5 [2–4] | 0–6 | 5 [3–5] | |
p
| 0.004 | 0.004 | <0.001 | ||||
Hospital outcome | Dischargea (n = 40) | 2–18 | 9 [5–12] | 1–5 | 2 [1–3] | 0–6 | 2 [0.25–4.00] |
Hospitalization (n = 151) | 1–18 | 12b [10–14] | 1–8 | 2 [1–3] | 0–7 | 3b [2–5] | |
Death (n = 11) | 9–17 | 14b [11–15] | 2–9 | 4b,c [2–5] | 3–6 | 5b,c [4–5] | |
p
| 0.004 | <0.001 | <0.001 |
ROC curve analyses of the scores and the parameters
Cut off | AUC (p value) | Sensitivity [95 % CI] | Specifity [95 % CI] | PPV [95 % CI] | NPV [95 % CI] | LR+ [95 % CI] | LR- [95 % CI] | ||
---|---|---|---|---|---|---|---|---|---|
Bleeding at follow-up | GBS | >11 | 0.613 (0.0237)
| 70.59 [52.5–84.9] | 51.19 [43.4–59.0] | 22.64 [15.1–31.8] | 89.58 [81.7–94.9] | 1.45 [1.1–1.9] | 0.57 [0.3–1.0] |
MEWS | >4 | 0.500 (1.000) | 14.71 [5.0–31.1] | 94.05 [89.3–97.1] | 33.33 [11.8–61.6] | 84.49 [78.5–89.4] | 2.47 [0.9–6.8] | 0.91 [0.8–1.0] | |
PER | >4 | 0.600 (0.0550) | 44.12 [27.2–61.1] | 76.19 [69.0–82.4] | 27.27 [16.1–41.0] | 87.07 [80.6–92.0] | 1.85 [1.2–3.0] | 0.73 [0.5–1.0] | |
Endoscopic therapy | GBS | >5 | 0.514 (0.7501) | 94.64 [85.1–98.9] | 10.49 [6–16.7] | 29.28 [22.8–36.5] | 83.33 [58.6–96.4] | 1.06 [1–1.1] | 0.51 [0.2–1.7] |
MEWS | >1 | 0.508 (0.8623) | 33.93 [21.8–47.8] | 71.33 [63.2–78.6] | 31.67 [20.3–45.0] | 73.38 [65.2–80.5] | 1.18 [0.8–1.9] | 0.93 [0.7–1.1] | |
PER | >3 | 0.577 (0.0769) | 57.14 [43.2–70.3] | 54.55 [46.0–62.9] | 32.99 [23.8–43.3] | 76.47 [67.0–84.3] | 1.26 [0.9–1.7] | 0.79 [0.6–1.1] | |
Need for blood transfusion | GBS | >10 | 0.829 (<0.0001)
| 79.45 [72.0–85.7] | 76.79 [63.6–87.0] | 89.92 [83.4–94.5] | 58.90 [46.8–70.39 | 3.42 [2.1–5.6] | 0.27 [0.2–0.4] |
MEWS | >1 | 0.584 (0.0470)
| 73.29 [65.3–80.3] | 39.29 [26.5–53.2] | 75.89 [68.0–82.7] | 36.07 [24.2–49.4] | 1.21 [1.0–1.5] | 0.68 [0.4–1.0] | |
PER | >3 | 0.642 (0.0014)
| 55.48 [47.0–63.7] | 67.86 [54.0–79.7] | 81.82 [72.8–88.9] | 36.89 [27.6–47.0] | 1.73 [1.1–2.6] | 0.66 [0.5–0.8] | |
Death | GBS | >13 | 0.679 (0.0222)
| 63.64 [30.8–89.1] | 72.77 [65.9–79.0] | 11.86 [4.9–22.9] | 97.20 [93.0–99.2] | 2.34 [1.4–3.9] | 0.50 [0.2–1.1] |
MEWS | >2 | 0.772 (<0.0001)
| 72.73 [39.0–94.0] | 65.45 [58.2–72.2] | 10.81 [4.8–20.2] | 97.66 [93.3–99.5] | 2.10 [1.4–3.2] | 0.42 [0.2–1.1] | |
PER | >3 | 0.767 (<0.0001)
| 90.91 [58.7–99.8] | 53.40 [46.1–60.6] | 10.10 [5.0–17.8] | 99.03 [94.7–100.0] | 1.95 [1.5–2.5] | 0.17 [0.03–1.1] | |
Rebleeding | GBS | >12 | 0.663 (0.0073)
| 70.83 [48.9–87.4] | 65.27 [57.5–72.5] | 22.67 [13.8–33.8] | 93.97 [88.0–97.5] | 2.04 [1.5–2.8] | 0.45 [0.2–0.8] |
MEWS | >2 | 0.617 (0.0638) | 50.0 [29.1–70.9] | 67.66 [60.0–74.7] | 18.18 [9.8–29.6] | 90.40 [83.8–94.9] | 1.55 [1.0–2.4] | 0.74 [0.5–1.1] | |
PER | >3 | 0.832 (<0.0001)
| 95.83 [78.9–99.9] | 60.48 [52.6–67.9] | 25.84 [17.1–36.2] | 99.02 [94.7–100.0] | 2.42 [2.0–3.0] | 0.07 [0.01–0.5] |