摘要
目的上消化道出血是急诊科常见的消化道疾病,识别适合门诊治疗的低危患者,是临床和研究的重点。我们的目的是建立一个简单的预测模型来识别可以避免住院的上消化道出血患者,从而为急诊医生的分诊提供一个可行的依据。方法回顾性分析2015年1月至2020年12月在东南大学附属中大医院治疗的上消化道出血患者。记录患者的一般资料和首次就诊时的临床参数,采用多因素logistic回归模型确定安全出院的预测因素。结果612/1334例(45.9%)患者非安全出院。安全出院组和非安全出院组在年龄、察尔逊氏共病指数、收缩压、脉率、血红蛋白、白蛋白、血尿素氮、肌酐、国际标准化比值等方面差异有统计学意义(P<0.05)。应用多因素logistic回归分析,7个变量被纳入上消化道出血危险分层的临床预测模型:察尔逊氏共病指数>2、收缩压<90 mmHg、血红蛋白<10 g/dL、尿素氮≥6.5mmol/L、白蛋白<30 g/L、脉搏≥100次/min和国际标准化比值≥1.5。其最佳cutoff值≥1预测非安全出院的敏感性为98.37%,特异度为24.10%,阳性预测值为52.3%,阴性预测值为94.6%;受试者工作特征曲线下面积AUCROC(the area under the receiver operating characteristic curve)为0.822,显著高于Glasgow Blatchford score(GBS)0.786(95%CI 0.752~0.820,P<0.01)和AIMS650.676(95%CI 0.638~0.714,P<0.01)。结论预测评估模型具有可靠的预测价值,可为急诊医务人员分诊治疗上消化道出血患者提供参考依据,从而减少医疗开支,具有一定的社会经济效益。
Objective Upper gastrointestinal bleeding(UGIB)is a common gastrointestinal disease in the emergency department.Identifying low-risk patients suitable for outpatient treatment is the focus of clinical and research.A simple predictive model was developed to identify patients with UGIB who could safely avoid hospitalization,thus providing a feasible basis for triage by emergency physicians.Methods A retrospective cohort study was conducted on patients with UGIB treated at Zhongda Hospital Southeast University from January 2015 to December 2020.Baseline demographic data and clinical parameters at the initial presentation were recorded.Multivariate logistic regression model was performed to identify predictors of safe discharge.Results Six hundred and twelve patients(45.9%)were not safely discharged.There were signifi cant differences in age,Charlson comorbidity index,systolic blood pressure,pulse rate,hemoglobin,albumin,blood urea nitrogen,creatinine and international normalized ratio between the safe discharge group and the non-safe discharge group(P<0.05).Using multivariate logistic regression analysis,a total of 7 variables were included in the clinical prediction model of UGIB risk stratifi cation:Charlson comorbidity index>2,systolic blood pressure<90 mmHg,hemoglobin<10 g/dL,blood urea nitrogen≥6.5 mmol/L,albumin<30 g/L,pulse≥100 beats/min and international normalized ratio≥1.5.The sensitivity,specifi city,positive predictive value,and negative predictive value for predicting unsafe discharge were 98.37%,24.10%,52.3%,and 94.6%,respectively,with the best cutoff value≥1.The area under the receiver operating characteristic(AUROC)curve was 0.822,which was significantly higher than Glasgow Blatchford score(GBS)0.786(95%CI:0.752-0.820,P<0.01)and AIMS650.676(95%CI:0.638-0.714,P<0.01).Conclusions The predictive model has a reliable predictive value,which can provide references for emergency medical staff to triage patients with UGIB,thereby reducing medical expenses and having certain social and economic benefi
作者
李雅洁
赵雅闻
宋明洋
吴克玄
Li Yajie;Zhao Yawen;Song Mingyang;Wu Kexuan(Department of Gerontology,Zhongda Hospital,School of Medicine,Southeast University,Nanjing,210009,China;Department of Gastroenterology,Zhongda Hospital,School of Medicine,Southeast University,Nanjing,210009,China)
出处
《中华急诊医学杂志》
CAS
CSCD
北大核心
2022年第12期1680-1684,共5页
Chinese Journal of Emergency Medicine
基金
江苏省老年医学会项目(JGS2019ZXYY013)
南京市卫生科技发展项目(YKK20235)。
关键词
急诊
上消化道出血
安全出院
预测模型
Emergency
Upper gastrointestinal bleeding(UGIB)
Predictive model
Safe discharge
