Novel risk score for acute upper gastrointestinal bleeding in elderly patients: a single-centre retrospective study
Objectives Acute upper gastrointestinal bleeding (UGIB) is a common reason for emergency hospital admission. Identifying low-risk patients suitable for outpatient management is a clinical and research priority. This study aimed to develop a simple risk score to identify elderly patients with UGIB fo...
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| Format: | Article |
| Language: | English |
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BMJ Publishing Group
2023-06-01
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| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/13/6/e072602.full |
| _version_ | 1797748843540905984 |
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| author | Mingyang Song Qin Lu Yajie Li Kexuan Wu Xilong Ou |
| author_facet | Mingyang Song Qin Lu Yajie Li Kexuan Wu Xilong Ou |
| author_sort | Mingyang Song |
| collection | DOAJ |
| description | Objectives Acute upper gastrointestinal bleeding (UGIB) is a common reason for emergency hospital admission. Identifying low-risk patients suitable for outpatient management is a clinical and research priority. This study aimed to develop a simple risk score to identify elderly patients with UGIB for whom hospital admission is not required.Design This was a single-centre retrospective study.Setting This study was conducted at Zhongda Hospital affiliated with Southeast University in China.Participants Patients from January 2015 to December 2020 for the derivation cohort and from January 2021 to June 2022 for the validation cohort were enrolled in this study. A total of 822 patients (derivation cohort=606 and validation cohorts=216) were included in this study. Patients aged ≥65 years with coffee-grounds vomiting, melena or/and haematemesis were included in the analysis. Patients admitted but had UGIB or transferred between hospitals were excluded.Methods Baseline demographic characteristics and clinical parameters were recorded at the first visit. Data were collected from electronic records and databases. Multivariable logistic regression modelling was performed to identify predictors of safe discharge.Results 304/606 (50.2%) and 132/216 (61.1%) patients were not safely discharged in the derivation and validation cohorts, respectively. A clinical risk score of five variables was entered into UGIB risk stratification: Charlson Comorbidity Index >2, systolic blood pressure <100 mm Hg, haemoglobin <100 g/L, blood urea nitrogen ≥6.5 mmol/L, albumin <30 g/L. The optimal cut-off value was ≥1, the sensitivity was 97.37% and the specificity was 19.21% for predicting the inability to discharge safely. The area under the receiver operating characteristic curve was 0.806.Conclusions A novel clinical risk score with good discriminative performance was developed to identify elderly patients with UGIB who were suitable for safe outpatient management. This score can reduce unnecessary hospitalisations. |
| first_indexed | 2024-03-12T16:10:41Z |
| format | Article |
| id | doaj.art-a27b84e7b77a4151ae0581e4d1620b26 |
| institution | Directory Open Access Journal |
| issn | 2044-6055 |
| language | English |
| last_indexed | 2024-03-12T16:10:41Z |
| publishDate | 2023-06-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open |
| spelling | doaj.art-a27b84e7b77a4151ae0581e4d1620b262023-08-09T13:50:07ZengBMJ Publishing GroupBMJ Open2044-60552023-06-0113610.1136/bmjopen-2023-072602Novel risk score for acute upper gastrointestinal bleeding in elderly patients: a single-centre retrospective studyMingyang Song0Qin Lu1Yajie Li2Kexuan Wu3Xilong Ou4School of Medicine, Southeast University, Nanjing, ChinaDepartment of Gastroenterology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, ChinaDepartment of Gerontology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, ChinaSchool of Medicine, Southeast University, Nanjing, ChinaDepartment of Gastroenterology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, ChinaObjectives Acute upper gastrointestinal bleeding (UGIB) is a common reason for emergency hospital admission. Identifying low-risk patients suitable for outpatient management is a clinical and research priority. This study aimed to develop a simple risk score to identify elderly patients with UGIB for whom hospital admission is not required.Design This was a single-centre retrospective study.Setting This study was conducted at Zhongda Hospital affiliated with Southeast University in China.Participants Patients from January 2015 to December 2020 for the derivation cohort and from January 2021 to June 2022 for the validation cohort were enrolled in this study. A total of 822 patients (derivation cohort=606 and validation cohorts=216) were included in this study. Patients aged ≥65 years with coffee-grounds vomiting, melena or/and haematemesis were included in the analysis. Patients admitted but had UGIB or transferred between hospitals were excluded.Methods Baseline demographic characteristics and clinical parameters were recorded at the first visit. Data were collected from electronic records and databases. Multivariable logistic regression modelling was performed to identify predictors of safe discharge.Results 304/606 (50.2%) and 132/216 (61.1%) patients were not safely discharged in the derivation and validation cohorts, respectively. A clinical risk score of five variables was entered into UGIB risk stratification: Charlson Comorbidity Index >2, systolic blood pressure <100 mm Hg, haemoglobin <100 g/L, blood urea nitrogen ≥6.5 mmol/L, albumin <30 g/L. The optimal cut-off value was ≥1, the sensitivity was 97.37% and the specificity was 19.21% for predicting the inability to discharge safely. The area under the receiver operating characteristic curve was 0.806.Conclusions A novel clinical risk score with good discriminative performance was developed to identify elderly patients with UGIB who were suitable for safe outpatient management. This score can reduce unnecessary hospitalisations.https://bmjopen.bmj.com/content/13/6/e072602.full |
| spellingShingle | Mingyang Song Qin Lu Yajie Li Kexuan Wu Xilong Ou Novel risk score for acute upper gastrointestinal bleeding in elderly patients: a single-centre retrospective study BMJ Open |
| title | Novel risk score for acute upper gastrointestinal bleeding in elderly patients: a single-centre retrospective study |
| title_full | Novel risk score for acute upper gastrointestinal bleeding in elderly patients: a single-centre retrospective study |
| title_fullStr | Novel risk score for acute upper gastrointestinal bleeding in elderly patients: a single-centre retrospective study |
| title_full_unstemmed | Novel risk score for acute upper gastrointestinal bleeding in elderly patients: a single-centre retrospective study |
| title_short | Novel risk score for acute upper gastrointestinal bleeding in elderly patients: a single-centre retrospective study |
| title_sort | novel risk score for acute upper gastrointestinal bleeding in elderly patients a single centre retrospective study |
| url | https://bmjopen.bmj.com/content/13/6/e072602.full |
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