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首页> 外文期刊>Medicine. >A Novel Easy-to-Use Prediction Scheme for Upper Gastrointestinal Bleeding: Cologne-WATCH (C-WATCH) Risk Score
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A Novel Easy-to-Use Prediction Scheme for Upper Gastrointestinal Bleeding: Cologne-WATCH (C-WATCH) Risk Score

机译:一种新颖的易于使用的上消化道出血预测方案:科隆-WATCH(C-WATCH)风险评分

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摘要

Acute upper gastrointestinal bleeding (UGIB) is the leading indication for emergency endoscopy. Scoring schemes have been developed for immediate risk stratification. However, most of these scores include endoscopic findings and are based on data from patients with nonvariceal bleeding. The aim of our study was to design a pre-endoscopic score for acute UGIB—including variceal bleeding—in order to identify high-risk patients requiring urgent clinical management. The scoring system was developed using a data set consisting of 586 patients with acute UGIB. These patients were identified from the emergency department as well as all inpatient services at the University Hospital of Cologne within a 2-year period (01/2007–12/2008). Further data from a cohort of 322 patients who presented to our endoscopy unit with acute UGIB in 2009 served for external/temporal validation. Clinical, laboratory, and endoscopic parameters, as well as further data on medical history and medication were retrospectively collected from the electronic clinical documentation system. A multivariable logistic regression was fitted to the development set to obtain a risk score using recurrent bleeding, need for intervention (angiography, surgery), or death within 30 days as a composite endpoint. Finally, the obtained risk score was evaluated on the validation set. Only C -reactive protein, w hite blood cells, a lanine-aminotransferase, t hrombocytes, c reatinine, and h emoglobin were identified as significant predictors for the composite endpoint. Based on the regression coefficients of these variables, an easy-to-use point scoring scheme (C-WATCH) was derived to estimate the risk of complications from 3% to 86% with an area under the curve (AUC) of 0.723 in the development set and 0.704 in the validation set. In the validation set, no patient in the identified low-risk group (0–1 points), but 38.7% of patients in the high-risk group (≥ 2 points) reached the composite endpoint. Our easy-to-use scoring scheme is able to distinguish high-risk patients requiring urgent endoscopy, from low-risk cases who are suitable candidates for outpatient management or in whom endoscopy may be postponed. Based on our findings, a prospective validation of the C-WATCH score in different patient populations outside the university hospital setting seems warranted.
机译:急性上消化道出血(UGIB)是紧急内镜检查的主要指征。已经开发了计分方案以立即进行风险分层。但是,这些评分大多数都包括内窥镜检查结果,并且是基于非静脉曲张破裂出血患者的数据。我们研究的目的是为急性UGIB(包括静脉曲张破裂出血)设计内镜前评分,以识别需要紧急临床治疗的高危患者。评分系统是使用586名急性UGIB患者组成的数据集开发的。这些患者是在两年内(01 / 2007-12 / 2008)从科隆大学急诊科以及所有住院服务中识别出来的。来自2009年向我们的内镜部门接受急性UGIB治疗的322名患者的进一步数据用于外部/时间验证。临床,实验室和内窥镜参数以及病史和用药的进一步数据均从电子临床文档系统中回顾性收集。将多变量logistic回归拟合到开发集,以使用复发性出血,需要干预(血管造影,手术)或30天内死亡作为复合终点的风险评分。最后,在验证集上评估获得的风险评分。只有C反应蛋白,白血球细胞,丙氨酸转氨酶,T淋巴细胞,C肌酐和H血红蛋白被确定为复合终点的重要预测因子。根据这些变量的回归系数,得出了一种易于使用的点评分方案(C-WATCH),可以将并发症风险从3%降低到86%,而曲线下面积(AUC)为0.723。开发集和验证集中的0.704。在验证集中,确定的低风险组中没有患者(0-1分),但高风险组中的患者(≥2分)中有38.7%达到了复合终点。我们易于使用的评分方案能够区分需要紧急内镜检查的高危患者和适合门诊治疗或可能推迟内镜检查的低危患者。根据我们的发现,似乎有必要对大学医院范围以外的不同患者人群的C-WATCH分数进行前瞻性验证。

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