Blatchford评分在预测460例急诊上消化道出血病因中的价值研究

目的:探讨Blatchford评分在预测急诊上消化道出血病因中的价值。方法:选取2017-01-2019-12期间我院急诊科收治的急性上消化道出血患者460例,根据出血病因分为肝硬化静脉曲张破裂出血组193例和非静脉曲张性出血组267例,分析两组患者临床特征,绘制受试者工作曲线(ROC),评价Blatchford评分预测肝硬化静脉曲张破裂出血的能力。结果:两组患者中男性居多,肝硬化静脉曲张破裂出血组平均动脉压(MAP)、白细胞计数(WBC)、血红蛋白浓度(Hb)、血小板计数(PLT)、凝血酶原活动度(PTA)、纤维蛋白原(FIB)、白蛋白(ALB)及白/球比值(A/G)显著降低,部分凝血活酶时间(APTT)、总胆红素(TBIL)、谷丙转氨酶(ALT)、谷草转氨酶(AST)、球蛋白(GLB)增高,差异均有统计学意义(P0.05)。肝硬化静脉曲张破裂出血组Blatchford评分较高,Blatchford评分预测肝硬化静脉曲张破裂出血的ROC曲线下面积为0.66。结论:Blatchford评分在预测急诊上消化道出血病因方面仍需进一步研究来证实。     

Rockall评分法在老年人上消化道大出血应用研究

老年上消化道大出血是临床常见的急症，病死率明显高于中、青年患者[1]，对入院就诊患者正确估计其预后，以指导治疗有较大意义。近年Rockall等对数千例急性消化道出血患者的多项临床变量进行多因素分析，结果发现年龄、伴发病、休克、出血原因和新近出血痕迹五项，对病死率有可重复性预测价值，从而据此制订了一个评分法[2]。本文应用这一评分法对135例老年人上消化道大量出血进行预后估计，以观该评分法的实际应用价值。材料与方法1．收集1990～1995年上消化道大出血老年住院患者135例，其中男90例，女45例，年龄60～92岁，平均71．63±7…     

急性上消化道出血患者血清LDH、D-LA水平与预后的相关性研究

目的:通过检测急性上消化道出血患者血清乳酸脱氢酶(lactate dehydrogenase, LDH)、D-乳酸(D-lactic acid, D-LA)水平,探究二者与患者预后的关系。方法:选择2018年12月-2023年1月在邯郸市人民医院住院治疗的急性上消化道出血患者216例作为试验组,体检健康人员132例作为对照组。收集急性上消化道出血患者临床资料、AIMS65评分和生化指标,检测试验组和对照组血清LDH、D-LA水平。根据入院后30 d内存活情况,将急性上消化道出血患者分为存活组194例,死亡组22例。分析急性上消化道出血患者血清LDH与D-LA水平的相关性,影响急性上消化道出血患者入院后30 d内死亡的因素,血清LDH和D-LA水平对急性上消化道出血患者入院后30 d内死亡的预测价值。结果:与对照组比较,试验组血清LDH、D-LA水平显著升高,差异有统计学意义(P<0.05);与存活组比较,死亡组AIMS65评分、血清LDH、D-LA水平显著升高,血红蛋白(Hb)水平显著降低,差异有统计学意义(P<0.05);急性上消化道出血患者血清LDH与D-LA水平呈正相...     

急性脑梗死并发上消化道出血患者预后的影响因素

目的:分析急性脑梗死并发上消化道出血患者预后的影响因素。方法:选取2015年3月-2022年10月在徐州医科大学附属医院住院且符合纳入及排除标准的住院期间并发上消化道出血的急性脑梗死患者94例为研究对象。采用改良Rankin量表(mRS)评分通过电话随访以评价发病90 d预后情况，按照发病90 d mRS评分是否≤2分，分为预后良好组(44例)和预后不良组(50例)。收集患者的临床资料和实验室检查资料，并计算患者的老年人营养风险指数(geriatric nutritional risk index, GNRI)评分。采用多因素logistic回归分析影响急性脑梗死并发上消化道出血患者预后的影响因素；采用受试者工作特征(ROC)曲线分析GNRI对急性脑梗死并发上消化道出血患者的预测价值。结果:预后不良组既往饮酒、丘脑或脑干梗死、大面积脑梗死、出血量≥800 mL、入住ICU等占比、入院美国国立卫生研究院卒中量表(National Institute of Health stroke scale, NIHSS)评分、出院NIHSS评分明显高于预后良好组，血红蛋白、白蛋白、GNRI明显低于预...     

肝硬化上消化道出血合并细菌感染影响因素及其血清miRNA-122与预后关系

目的探讨肝硬化上消化道出血合并细菌感染影响因素及其血清miRNA-122与预后关系。方法选取2018年6月—2021年3月收治的肝硬化上消化道出血合并细菌感染80例作为感染组,同期收治未合并细菌感染肝硬化上消化道出血80例作为非感染组。根据住院28 d治疗结果将肝硬化上消化道出血合并细菌感染患者分为好转组(57例)和恶化组(23例)两组。采用单因素和多因素Logistic回归分析探讨肝硬化上消化道出血合并细菌感染影响因素,分析肝硬化上消化道出血合并细菌感染患者血清miRNA-122与Child肝功能分级、急性生理与慢性健康状况评分系统Ⅱ(APACHEⅡ)评分相关性,比较好转组和恶化组血清miRNA-122,探讨血清miRNA-122对肝硬化上消化道出血合并细菌感染患者预后预测价值。结果肝硬化失代偿期、中重度出血、APACHEⅡ评分≥25分和血清miRNA-122≥2.4是肝硬化上消化道出血合并细菌感染的独立危险因素,入院时白蛋白≥22 g/L是肝硬化上消化道出血合并细菌感染的保护因素(P0.05或P0.01)。肝硬化上消化道出血合并细菌感染患者血清miRNA-122与Child肝功能分级、APACHEⅡ评分均呈正相关(P0.05或P0.01)。血清miRNA-122好转组低于恶化组(P0.01)。血清miRNA-122对肝硬化上消化道出血合并细菌感染患者预后预测价值的曲线下面积为0.814,最佳截断值为2.85。结论血清miRNA-122是肝硬化上消化道出血合并细菌感染的影响因素,与其肝功能、病情严重程度呈正相关,对其预后有一定预测价值。     

英国早期预警评分结合休克指数在急性上消化道出血病人中的应用

[目的]探讨英国早期预警评分(NEWS)结合休克指数(SI)在急性上消化道出血病人中的应用效果。[方法]对急诊抢救室收治的108例急性上消化道出血病人进行NEWS评分结合SI分层联合把控,根据评分结果对病人进行相应的早期干预。[结果]108例急性上消化道出血病人预警前(2.11±2.17)分,预警后(1.58±1.83)分,预警前后比较差异有统计学意义(P<0.05);预警前SI评分(0.85±0.28)分,预警后(0.81±0.26)分,预警前后比较差异无统计学意义(P>0.05)。[结论]NEWS评分结合SI有利于及早识别急性上消化道出血病人的潜在风险,使病人能及时获得有效的临床干预。     

肝硬化伴食管胃底静脉曲张出血的影响因素及3种模型对再出血的预测价值

目的探讨肝硬化伴食管胃底静脉曲张出血的影响因素,评估终末期肝病血清钠模型(MELD-Na)、终末期肝病模型(MELD)、Child-Turcotte-Pugh评分(CTP评分)对再出血的预测价值。方法将196例肝硬化伴食管胃底静脉曲张患者分为出血组和非出血组,对其临床指标进行单因素及多因素分析。对出血组患者进行随访,评估3种模型对内镜治疗后半年和1年内再出血的预测价值。结果单因素分析发现,出血组与未出血组的MELD-Na评分、MELD评分、CTP评分、肝性脑病、曲张静脉血管有红色征、血红蛋白、总胆红素、肌酐、血清钠、年龄比较,差异有统计学意义(P0.05)。多因素Logistic回归分析显示,红色征、总胆红素、合并肝性脑病、MELD评分、CTP评分是食管胃底静脉曲张患者上消化道出血的独立影响因素。受试者工作特征(ROC)曲线分析结果显示,MELD-Na、MELD评分预测半年内再出血的价值高于CTP评分,差异有统计学意义(Z=2.162、3.368,P=0.015、0.001); MELD-Na评分预测1年内再出血的价值高于CTP评分,差异有统计学意义(Z=2.407,P=0.008)。结论 CTP评分、MELD评分、胃镜下出现红色征、血红蛋白、总胆红素、肌酐、血清钠、年龄是肝硬化伴食管胃底静脉曲张出血的危险因素,而胃镜下发现红色征、MELD评分、CTP评分、肝性脑病、总胆红素是肝硬化上消化道出血的独立危险因素。3种评分系统中,MELD-Na评分对半年内或1年内再出血的预测价值最高。     

血清白蛋白及EPIC评分在中至重症急性胰腺炎中的应用价值

目的:旨在采用修订版急性胰腺炎Altanta分类标准,重新评价各临床生化指标、临床评分及影像学评分对急性胰腺炎严重程度的预测价值。方法:回顾性收集2015-03—2018-03期间于我院急诊内科住院的中重症急性胰腺炎(MSAP)及重症急性胰腺炎(SAP)患者资料;通过单因素分析比较MSAP及SAP患者组间差异;采用多因素Logistic回归分析评价各指标对SAP患者的预测价值,对有统计学意义的临床指标及评分应用ROC曲线分析敏感度及特异度。结果:本研究共纳入患者124例,其中MSAP组患者100例(80.65%),SAP组患者24例(19.35%)。SAP组患者CRP、Scr、BUN、AST、LDH、BG、Ranson评分、BISAP评分、EPIC评分及入院时合并SIRS的比例均高于MSAP组,而ALB、血Ca、FT3水平均低于MSAP组(P<0.05)。单因素Logistic回归分析结果显示,CRP、Scr、ALB、FT3、Ranson评分、BISAP评分、EPIC评分和入院时合并SIRS对SAP患者均有一定预测价值;多因素Logistic回归分析结果表明,ALB、Ranson评分及BISAP评分可作为预测SAP患者的独立因素(P <0.05),AUC(95%CI)分别为0.906(0.848~0.964)、0.919(0.863~0.975)和0.908(0.850~0.966)。结论:在修订版急性胰腺炎Altanta分类下,ALB可作为预测中至重症急性胰腺炎患者疾病严重程度的重要指标,其对SAP患者的预测作用与Ranson评分及BISAP评分相当。     

3种评分方法对急诊室全身炎症反应综合征患者28 d死亡预测能力的比较

目的 比较急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ)、简化急性生理学评分Ⅱ(SAPSⅡ)、急诊脓毒症死亡风险评分(MEDS)对急诊抢救室全身炎症反应综合征(SIRS)患者28 d死亡的预测能力.方法 选取2006年12月-2007年9月在首都医科大学附属北京朝阳医院急诊抢救室救治的621例SIRS患者,分别进行APACHEⅡ、SAPSⅡ和MEDS评分,记录28 d转归情况.通过logistic回归分析评价各评分系统分值与预后的关系,确定SIRS患者28 d死亡的独立预测因素,通过受试者工作特征曲线(ROC曲线)对各独立预测因素的预后能力进行比较.结果 621例患者28 d死亡222例.死亡组患者年龄及3种评分系统的分值均显著高于存活组(年龄:73岁比70岁,APACHEⅡ评分:18分比14分,SAPSⅡ评分:36分比24分,MEDS评分:14分比7分,P<0.05或P<0.01).28 d死亡的独立预测因素有APACHEⅡ、SAPSⅡ、MEDS评分,ROC曲线下面积(AUC)分别为0.715、0.774、0.965.与APACHEⅡ评分比较,MEDS评分的预后能力更佳(Z=35.435,P<0.01).结论 对于急诊抢救室SIRS患者,MEDS具有较好的预后价值.     

改良早期预警评分对重症急性胰腺炎并发急性肺损伤患者病情评估和预后的预测价值

目的:探讨改良早期预警评分(MEWS)对重症胰腺炎并发急性肺损伤患者病情评估和预后的预测价值。方法:选取我院147例重症急性胰腺炎患者进行回顾性研究,患者入院后详细记录第一次生命体征数据和急性生理学等指标,根据其结果计算MEWS评分及APACHEⅡ评分,根据是否发生ALI将患者分成发生肺损伤组(APALI组)和未发生肺损伤组(Non-APALI组),比较两组MEWS评分和APACHEⅡ评分的差异。采用Spearman检验进行两种评分相关性的分析。绘制受试者工作曲线(ROC)评价MEWS评分对患者APALI发生、入住ICU、死亡的预测价值。结果:APALI组及Non-APALI组的MEWS评分及APACHEⅡ评分比较差异具有统计学意义(P0.05)。MEWS评分与APACHEⅡ评分呈一元线性相关:Y(MEWS)=0.220+0.317X(APACHEⅡ),相关系数r=0.716,Pearson检验P0.01。MEWS评分与氧合指数(PO2/FiO2)的关系同样发现呈一元线性相关:Y(MEWS)=11.17+(-0.026)X(PO2/FiO2),相关系数r=-0.674,Pearson检验P0.01。MEWS预测APALI发生、ICU住院、死亡事件的曲线下面积分别为:0.912(95%CI:0.862～0.963)、0.932(95%CI:0.890～0.975)、0.967(95%CI:0.929～1.005),截断点分别为3.5分、4.5分及6.5分,具有良好预测价值。结论:MEWS评分与APACHEⅡ均适合重症胰腺炎并发急性肺损伤患者病情评估和预后的预测,但MEWS更易操作、节省时间,便于对此类患者中应用,甚至可推广应用于急诊室急危重症患者。     

Comparison of the quick SOFA score with Glasgow-Blatchford and Rockall scores in predicting severity in patients with upper gastrointestinal bleeding

IntroductionUpper gastrointestinal bleeding is one of the common causes of mortality and morbidity. The Rockall score (RS) and Glasgow-Blatchford score (GBS) are frequently used in determining the prognosis and predicting in-hospital adverse events, such as mortality, re-bleeding, hospital stay, and blood transfusion requirements. The quick Sepsis Related Organ Failure Assessment (qSOFA) score is easy and swift to calculate. The commonly used scores and the qSOFA score were compared and why and when these scores are most useful was investigated.Method133 patients admitted to the emergency department with upper gastrointestinal bleeding over the period of a year, were evaluated in this retrospective study. The RS, GBS and qSOFA score were calculated for each patient, and their relationship with in-hospital adverse events, such as length of hospitalization, rebleeding, endoscopic treatment, blood transfusion requirements, and mortality, was investigated.ResultsThe mean overall GBS was 9.72 ± 3.72 (0–19), while that of patients who did not survive was 14.0 ± 1.1 (13–16), with an area under the curve (AUC) of 0.901, a cutoff value of 12.5, and specificity (Spe) and sensitivity (Sen) of 1 and 0.82, respectively. The median value of the GBS, in terms of transfusion need, was 7.12 ± 4.01 (0–15).(AUC = 0.752, cut-off = 9.5, Spe = 0.79, Sen = 0.69). The median value of the qSOFA score, in terms of intensive care need, was 1.73 ± 0.7 (0–3) (AUC = 0.921, cut-off = 0.5, Spe = 0.93, Sen = 0.79). The RS median, in terms of re-bleeding, was 8.22 ± 0.97 (6–9).ConclusionEarly use of risk stratification scores in upper gastrointestinal bleeding is important due to the high risk of morbidity and mortality. All scoring systems were effective in predicting mortality, the need for intensive care, and re-bleeding. The GBS had a greater predictive power in terms of mortality and transfusion need, the qSOFA score for intensive care need, and the RS for re-bleeding. The simpler, more efficient, and more easily calculated qSOFA score can be used to estimate the severity of patients with upper gastrointestinal bleeding.     

NEWS-3PL评分对急诊脓毒症患者的早期识别价值

目的评价NEWS-3PL评分对急诊脓毒症患者的早期识别价值。方法选择2019年7月至2020年7月来我院就诊的急性感染需住院治疗的120例患者为研究对象,获取其入院6 h内的相关生理生化指标进行NEWS-3PL评分、英国国家早期预警评分(NEWS)、快速序贯器官功能衰竭评分(qSOFA)。依据患者出院或死亡诊断分为脓毒症组和非脓毒症组,比较两组上述评分,绘制受试者工作特征曲线(ROC曲线),比较各评分ROC曲线下面积(AUC)。结果脓毒症组的NEWS-3PL、NEWS、qSOFA评分均高于非脓毒症组,差异有统计学意义(P<0.05)。NEWS-3PL、NEWS、qSOFA评分的AUC分别为0.918(95%CI:0.843~0.961)、0.866(95%CI:0.792~0.921)、0.788(95%CI:0.704~0.857)。NEWS-3PL评分的AUC值大于NEWS评分及qSOFA评分,NEWS评分的AUC值大于qSOFA评分,差异有统计学意义(P<0.05);NEWS-3PL评分预测值为>5分(灵敏度:88.19%、特异度:84.79%)。结论NEWS-3PL评分可用于脓毒症的早期识别,其识别效能优于NEWS评分和qSOFA评分,但部分评分项目的获取不如后两者方便,存在一定不足。     

The combined score of quick SOFA and the charlson comorbidity index could be a poor prognostic indicator for in-hospital mortality among patients with necrotizing fasciitis

IntroductionWhile necrotizing fasciitis (NF) is a rare but rapidly progressive devastating soft tissue infectious disease showing a high in-hospital mortality rate of 20–30%, there are no evidence-based predictive tools.Patients and methodsFor the purpose of examining which predictive tools could correctly reflect the severity and prognosis of NF, we retrospectively reviewed all patients who were diagnosed with NF at our institute. The disease severity was evaluated by quick SOFA (qSOFA), SOFA score, SIRS score, APACHE II score, LRINEC score and the combined score of qSOFA and CCI.ResultsA total of 27 patients were enrolled in this study. The median age was 68 years (range 39–96 years). With respect to the predictive values for in-hospital mortality among NF patients, the area under the ROC curve for qSOFA, SOFA score, APACHE II score, the combined score of qSOFA and CCI were 0.653 (p = 0.192), 0.588 (p = 0.12), 0.709 (p = 0.075) and 0.782 (p = 0.016) respectively.A univariate analysis showed that the combined score of qSOFA and CCI≥5 and the initial treatment failure were poor prognostic indicators for the in-hospital death among NF patients. The appropriate cut-offs of qSOFA and CCI were based on the Youden Index.ConclusionWe concluded that the combined score of qSOFA and CCI could reflect the severity and prognosis of NF for in-hospital death.     

NEWS评分、qSOFA评分、SIRS评分对急诊感染性疾病患者预后评估价值的对比研究

目的 比较早期预警评分（NEWS）、快速脓毒症相关器官功能障碍评分(qSOFA)和全身炎症反应综合征（SIRS）评分对感染性疾病患者预后的评估价值。方法 选择2016年6月至2017年6月就诊于我院急诊的412例感染性疾病患者作为研究对象。收集患者的一般临床资料,记录就诊后生命体征,进行NEWS评分、qSOFA评分和SIRS评分,根据患者28天预后情况分为死亡组和存活组,分析3种评分与患者预后的相关性,应用受试者工作特征曲线（ROC）评估3种评分对预后的评估价值,并进行比较。结果 NEWS评分、qSOFA评分和SIRS评分分值越高,死亡危险越高;NEWS评分、qSOFA评分和SIRS评分的ROC曲下面积分别为0.750、0.792和0.723。结论 NEWS评分、qSOFA评分和SIRS评分对急诊感染性疾病预后评估存在临床价值,且3种评分中qSOFA评分的评估价值最高。     

不同评分系统对ICU中肺部感染患者预后评估的意义

目的不同评分工具对ICU中肺部感染患者预后评估的意义。方法本研究收集了2018-01-01—06-30于天津市第四中心医院综合ICU住院的所有肺部感染患者,计算CR B-65、CUR B-65、快速SOFA评分(qSOFA)、序贯器官衰竭评估(SOFA)评分,采用受试者工作曲线(R OC曲线)及趋势2检验比较不同评分对ICU中肺部感染患者预后的评估价值。结果279例感染患者中诊断为脓毒症49例,未诊断脓毒症230例,脓毒症组年龄、性别构成与未诊断脓毒症组差异无统计学意义(P>0.05)。脓毒症组CRB-65、CURB-65、qSOFA、SOFA评分高于未诊断脓毒症组(P<0.05),且两两相关。ROC曲线结果显示SOFA对患者死亡有较好预测价值(AUC面积为0.638),而CRB-65、CURB-65和qSOFA不能预测患者死亡(AUC面积为0.529,0.573,0.514)。趋势2检验结果显示SOFA和CURB-65随着分值的增加,病死率呈增高趋势(P<0.05)。结论对于ICU中的肺部感染患者,q SOFA、CRB-65、CURB-65评分不能用于预测患者死亡率。SOFA对ICU中肺部感染患者结局有预测价值,应重视对ICU中肺部感染患者SOFA评分的评估。     

qSOFA评分联合中性粒细胞CD64指数对恶性血液病患者血流感染的早期诊断价值

目的探讨快速序贯器官衰竭评估(qSOFA)评分联合中性粒细胞CD64指数(简称CD64指数)对恶性血液病患者血流感染的早期诊断价值。方法选择该院2019年6月至2020年6月收治的45例恶性血液病血流感染患者为研究对象(感染组),另选择同期恶性血液病无感染患者45例(非感染组)作为对照。测定CD64指数及肿瘤坏死因子(TNF)-α、白细胞介素(IL)-6、降钙素原(PCT)水平,评估患者的qSOFA评分。分析qSOFA评分、CD64指数与TNF-α、IL-6的相关性。采用受试者工作特征(ROC)曲线分析各指标的诊断价值;采用Logistic回归分析血流感染发生的危险因素。结果感染组患者qSOFA评分、CD64指数、TNF-α、IL-6水平明显高于非感染组(P<0.05),感染组中死亡患者qSOFA评分、CD64指数、TNF-α、IL-6水平明显高于非死亡患者(P<0.05);血流感染患者qSOFA评分、CD64指数与TNF-α、IL-6呈正相关(P<0.05)。qSOFA评分诊断恶性血液病患者血流感染的曲线下面积为0.637(95%CI:0.582~0.755),CD64指数诊断恶性血液病患者血流感染的曲线下面积为0.705(95%CI:0.695~0.813);qSOFA评分联合CD64指数诊断恶性血液病患者血流感染的曲线下面积为0.878(95%CI:0.831~0.926)。qSOFA评分、CD64指数、TNF-α、IL-6是恶性血液病患者发生血流感染的危险因素(P<0.05)。结论qSOFA评分、CD64指数联合应用对恶性血液病患者血流感染的早期诊断具有一定价值。     

消化道出血行内镜治疗后发生早期再出血的危险因素分析

目的分析影响消化道出血行内镜治疗后发生早期再出血的危险因素。方法选取2016年1月-2018年12月在该院接受内镜治疗的消化道出血患者167例,按内镜治疗后是否发生早期再出血分为再出血组(n=33)及对照组(n=134),查阅病历资料统计相关影响因素,多因素Logtisic回归分析影响消化道出血行内镜治疗后发生早期再出血的危险因素。结果Glasgow-Blatchford危险评分(GBS)、Rockall危险评分(RS)、急性上消化道出血AMIS65评分、入院时血红蛋白值及血小板指数是消化道出血行内镜治疗后发生早期再出血的独立影响因素(P<0.05)。结论消化道出血行内镜治疗的患者,应重视术前GBS、RS、AMIS65评分、入院时血红蛋白和血小板指数水平,严密监测,积极预防早期再出血。     

改良的早期预警评分动态变化在急性胰腺炎中的应用

目的探讨改良的早期预警评分(MEWS)及其动态变化在急性胰腺炎轻重方面的作用。方法对103例急性胰腺炎患者分为轻症和重症2组,入院后第1、2天记录患者的MEWS评分及动态变化(△MEWS)、Ranson评分和急性生理与慢性健康评分(APACHEⅡ评分),通过ROC曲线及截断值进行比较分析。结果 2组患者MEWS评分及动态变化(△MEWS)、Ranson评分和APACHEⅡ评分均有显著差异(P<0.01),MEWS评分及动态变化(△MEWS)与Ranson评分、APACHEⅡ评分预测重症胰腺炎的ROC曲线下面积分别为0.733、0.745、0.767、0.792比较差异无统计学意义。结论 MEWS评分及动态变化(△MEWS)可以用来评估急性胰腺炎患者的轻重。MEWS评分简便易行,适合早期筛选危重急性胰腺炎患者。     

The Glasgow Blatchford scoring system enables accurate risk stratification of patients with upper gastrointestinal haemorrhage

Background: Upper gastrointestinal (UGI) haemorrhage is a frequent cause of hospital admission. Scoring systems have been devised to identify those at risk of adverse outcomes. We evaluated the Glasgow Blatchford score’s (GBS) ability to identify the need for clinical and endoscopic intervention in patients with UGI haemorrhage. Methods: A retrospective observational study was performed in all patients who attended the A&E department with UGI haemorrhage during a 12‐month period. Patients were separated into low and high risk categories. High risk encompassed patients who required blood transfusions, operative or endoscopic interventions, management on high dependency or intensive care units, and those who re‐bled, represented with further bleeding, or who died. Results: A total of 174 patients were seen with UGI bleeding. Eight of them self‐discharged and were excluded. Of the remaining 166, 94 had a ‘low risk’ bleed, and 72 ‘high risk’. The GBS was significantly higher in the high risk (median = 10) than in the low risk group (median 1, p < 0.001). To assess the validity of the GBS at separating low and high risk groups, receiver‐operator characteristic (ROC) curves were plotted. The GBS had an area under ROC curve of 0.96 (95% CI 0.95–1.00). When a cut‐off value of ≥ 3 was used, sensitivity and specificity of GBS for identifying high risk bleeds was 100% and 68%. Thus at a cut‐off value of ≤ 2 the GBS is useful for distinguishing those patients with a low risk UGI bleed. Conclusions: The GBS accurately identifies low risk patients who could be managed safely as outpatients.     

Predictive performance of SOFA and qSOFA for in-hospital mortality in severe novel coronavirus disease

ObjectivesThe assessment of illness severity at admission can contribute to decreased mortality in patients with the coronavirus disease (COVID-19). This study was conducted to evaluate the effectiveness of the Sequential Organ Failure Assessment (SOFA) and Quick Sequential Organ Failure Assessment (qSOFA) scoring systems at admission for the prediction of mortality risk in COVID-19 patients.MethodsWe included 140 critically ill COVID-19 patients. Data on demographics, clinical characteristics, and laboratory findings at admission were used to calculate SOFA and qSOFA against the in-hospital outcomes (survival or death) that were ascertained from the medical records. The predictive accuracy of both scoring systems was evaluated by the receiver operating characteristic (ROC) curve analysis.ResultsThe area under the ROC curve for SOFA in predicting mortality was 0.890 (95% CI: 0.826–0.955), which was higher than that of qSOFA (0.742, 95% CI 0.657–0.816). An optimal cutoff of ≥3 for SOFA had sensitivity, specificity, positive predictive value, and negative predictive value of 90.00%, 83.18%, 50.00%, and 97.80%, respectively.ConclusionsThis novel report indicates that SOFA could function as an effective adjunctive risk-stratification tool at admission for critical COVID-19 patients. The performance of qSOFA is accepted but inferior to that of SOFA.