A NOVEL PROGNOSTIC SYSTEM FOR 30-DAY MORTALITY IN PATIENTS WITH ULCER UPPER GASTROINTESTINAL BLEEDING
Keywords:
prognostic system, mortality, gastrointestinal bleeding, novel developmentAbstract
Upper gastrointestinal bleeding (UGIB) remains a serious medical issue with a high incidence rate and significant mortality. Despite modern advancements in diagnosis and treatment, mortality rates have not decreased, making accurate prognosis a crucial challenge in contemporary medicine.
Objective. To develop and validate a novel prognostic system for assessing the risk of 30-day in-hospital mortality in patients with ulcerative UGIB.
Materials and Methods. A two-center study was conducted, comprising a retrospective derivation phase and a prospective validation phase, performed using a double-blind method. Analysis was carried out using logistic regression and factor clustering. The developed prognostic system was compared with six recommended scoring systems.
Results. The novel system demonstrated an excellent AUROC score (0.853). Its sensitivity reached 76.47%, and specificity was 94.12%, allowing for a more accurate identification of patients at high risk of fatal outcomes compared to existing analogs.
Conclusion. The newly developed prognostic system exhibits high accuracy in predicting 30-day in-hospital mortality in patients with ulcerative UGIB.
References
Revishvili ASh, Sazhin VP, Olovyanniy VE, Zakharova MA. Current trends in emergency abdominal surgery in the Russian Federation. Pirogov Russian Journal of Surgery = Khirurgiya. Zurnal im. N.I. Pirogova. 2020;(7):6‑11. (In Russ.). doi: 10.17116/hirurgia20200716.
Zheng NS, Tsay C, Laine L, Shung DL. Trends in characteristics, management, and outcomes of patients presenting with gastrointestinal bleeding to emergency departments in the United States from 2006 to 2019. Aliment Pharmacol Ther. 2022 Dec;56(11-12):1543-1555. doi: 10.1111/apt.17238. Epub 2022 Sep 29. PMID: 36173090; PMCID: PMC9669230.
Liu S, Zhang X, Walline JH, Yu X, Zhu H. Comparing the Performance of the ABC, AIMS65, GBS, and pRS Scores in Predicting 90-day Mortality Or Rebleeding Among Emergency Department Patients with Acute Upper Gastrointestinal Bleeding: A Prospective Multicenter Study. J Transl Int Med. 2021 Jun 16;9(2):114-122. doi: 10.2478/jtim-2021-0026. PMID: 34497750; PMCID: PMC8386323.
Mules, TC, Stedman, C, Ding, S, et al. Comparison of Risk Scoring Systems in Hospitalised Patients who Develop Upper Gastrointestinal Bleeding. GastroHep. 2021; 3: 5– 11. https://doi.org/10.1002/ygh2.436
Sakong, H., Moon, H. S., Choi, S. W., Kang, S. H., Sung, J. K., & Jeong, H. Y. (2022). ABC score is an effective predictor of outcomes in peptic ulcer bleeding. Medicine, 101(49), e31541. https://doi.org/10.1097/MD.0000000000031541.
Jimenez-Rosales, R., Lopez-Tobaruela, J. M., Lopez-Vico, M., Ortega-Suazo, E. J., Martinez-Cara, J. G., & Redondo-Cerezo, E. (2023). Performance of the New ABC and MAP(ASH) Scores in the Prediction of Relevant Outcomes in Upper Gastrointestinal Bleeding. Journal of Clinical Medicine, 12(3), 1085. https://doi.org/10.3390/jcm12031085
Stanley A J, Laine L, Dalton H R, Ngu J H, Schultz M, Abazi R et al. Comparison of risk scoring systems for patients presenting with upper gastrointestinal bleeding: international multicentre prospective study BMJ 2017; 356 :i6432 doi:10.1136/bmj.i6432
Hyett, B., Abougergi, M., Charpentier, J., Kumar, N., Brozović, S., Claggett, B., Travis, A., & Saltzman, J. (2013). The AIMS65 score compared with the Glasgow-Blatchford score in predicting outcomes in upper GI bleeding.. Gastrointestinal endoscopy, 77 4, 551-7 . https://doi.org/10.1016/j.gie.2012.11.022.
Marmo, R., Soncini, M., Bucci, C., & Zullo, A. (2021). Comparison Of Assessment Tools in Acute Upper Gastrointestinal Bleeding: which one for Which Decision. Endoscopy, 53, S62. https://doi.org/10.1080/00365521.2021.1976268.
Martínez-Cara, J. G., Jiménez-Rosales, R., Úbeda-Muñoz, M., de Hierro, M. L., de Teresa, J., & Redondo-Cerezo, E. (2016). Comparison of AIMS65, Glasgow-Blatchford score, and Rockall score in a European series of patients with upper gastrointestinal bleeding: performance when predicting in-hospital and delayed mortality. United European gastroenterology journal, 4(3), 371–379. https://doi.org/10.1177/2050640615604779
Benedeto-Stojanov D, Bjelaković M, Stojanov D, Aleksovski B. Prediction of in-hospital mortality after acute upper gastrointestinal bleeding: cross-validation of several risk scoring systems. Journal of International Medical Research. 2022;50(3). doi:10.1177/03000605221086442
