Acil serviste üst gastrointestinal kanama ile baþvuran 80 yaþ üstü hastalarda invaziv olmayan skorlama sistemleri kullanýlarak olumsuz sonuçlarýn tahmini

AMAÇ: Varis dýþý üst gastrointestinal (GÝS) kanamasý olan yaþlý hastalar için acil servis baþvurularý artmaktadýr. AIMS65 ve Glasgow-Blatchford skoru (GBS), bu hastalarda hastane içi ve taburculuk sonrasý mortaliteyi, kalýþ süresini ve saðlýkla ilgili maliyetleri tahmin etmek için önerilen iki ayrý skorlama sistemidir. Bu çalýþmanýn amacý, 80 yaþýnda veya daha büyük olan UGIB hastalarýnda 30 günlük mortalite ve kalýþ süresini tahmin etmek için, Charlson komorbidite indeksi (CCI) ile birlikte bu skorlama sistemlerinin etkinliðini deðerlendirmektir.
GEREÇ VE YÖNTEM: Çanakkale Onsekiz Mart Üniversitesi Hastanesi Acil Servisi’ne baþvuran varis dýþý üst GÝS kanamalý 182 hasta geriye dönük olarak incelendi. AIMS65, GBS ve CCI skorlarý hesaplandý ve olumsuz hasta sonuçlarý deðerlendirildi.
BULGULAR: Hastalarýn ortalama yaþý 85.59±4.33 yýl idi ve hastalarýn 90’ý (%49.5) erkekti. AIMS65, 30 günlük mortaliteyi tahmin etmede GBS’den (sýrasýyla, AUROC 0.695 vs 0.877) ve CCI’dan (sýrasýyla, AUROC 0.526 vs 0.877) üstündür. Her üç skor da hastanede kalýþ süresini tahmin etmede yetersiz performans gösterdi. AIMS65 skoru için mortalite tahmininde, duyarlýlýk ve özgüllük en üst düzeye çýkaran kesme deðeri 3 (duyarlýlýk, 0.87; özgüllük, 0.80; NPD, 0.977; PPD, 0.392), GBS için 14 (duyarlýlýk, 0.83; özgüllük, 0.51; NPD, CC23 için 0.923; PPD, 0.367) ve CCI için 5 (duyarlýlýk, 0.91; özgüllük, 0.22; NPD, 0.946; PPD, 0.145) olarak tespit edilmiþtir.
TARTIÞMA: AIMS65, acil servis ayarlarýnda kolayca yapýlabilen basit, doðru ve endoskopik olmayan bir skorlama sistemidir. UGIB’li yaþlý hastalarda 30 günlük mortaliteyi tahmin etmede GBS ve CCI’den daha üstündür.

Prediction of adverse outcomes using non-endoscopic scoring systems in patients over 80 years of age who present with the upper gastrointestinal bleeding in the emergency department

BACKGROUND: The emergency department (ED) admission rate for elderly patients with non-variceal upper gastrointestinal bleeding (UGIB) is increasing. The AIMS65 and Glasgow-Blatchford score (GBS) are two distinct scoring systems proposed to predict in-hospital and post-discharge mortality, length of stay (LOS), and health-related costs in these patients. The objective of the present study is to evaluate the accuracy of these scoring systems, in conjunction with the Charlson comorbidity index (CCI), to predict 30-day mortality and LOS in UGIB patients who are 80 years of age or older
METHODS: A retrospective analysis was undertaken of 182 patients with non-variceal UGIB who were admitted to the ED of Canakkale Onsekiz Mart University Hospital. The AIMS65, GBS, and CCI scores were calculated and adverse patient outcomes were assessed.
RESULTS: The mean age of patients was 85.59±4.33 years, and 90 (49.5%) of the patients were males. The AIMS65 was superior to the GBS (area under the receiver operating characteristic curve [AUROC] 0.877 vs. 0.695, respectively) and CCI (AUROC 0.877 vs. 0.526, respectively) in predicting the 30-day mortality. All three scores performed poorly in predicting the LOS in hospital. The cutoff threshold that maximized sensitivity and specificity for mortality was three for the AIMS65 score (sensitivity, 0.87; specificity, 0.80; negative predictive values [NPV], 0.977; positive predictive values [PPV], 0.392), 14 for GBS (sensitivity, 0.83; specificity, 0.51; NPV, 0.923; PPV, 0.367), and 5 for CCI (sensitivity, 0.91; specificity, 0.22; NPV, 0.946; PPV, 0.145).
CONCLUSION: The AIMS65 is a simple, accurate, and non-endoscopic scoring system that can be performed easily in ED settings. It is superior to GBS and CCI in predicting 30-day mortality in elderly patients with UGIB.