ПБиМ 2023 №4 (146)

Subject of the article

СРАВНИТЕЛЬНЫЙ АНАЛИЗ ПРОГНОСТИЧЕСКИХ СИСТЕМ ОЦЕНКИ РИСКА НЕБЛАГОПРИЯТНОГО ИСХОДА ПРИ КРОВОТЕЧЕНИЯХ ИЗ ВЕРХНИХ ОТДЕЛОВ ЖЕЛУДОЧНО-КИШЕЧНОГО ТРАКТА: ОЦЕНКА ТОЧНОСТИ И ПРАКТИЧНОСТИ (271-279)

Authors

Исмати Амир Олимович1, Аносов Виктор Давидович2, Мамараджабов Собиржон Эргашевич1, Назарова Маъмура Зариповна1

Institution

1 - Самаркандский государственный медицинский университет, Республика Узбекистан, г. Самар-канд; 2 - Городская клиническая больница №15 им. О.М. Филатова, Российская Федерация, г. Москва

Abstract

За последние полвека были существенно усовершен-ствованы подходы к лечению и диагностике пациен-тов с желудочно-кишечными кровотечениями из верх-них отделов. Однако ряд факторов продолжают про-являть негативное влияния, сглаживая успехи десяти-летий. В контексте череды высокотехнологических нововведений и безуспешных попыток получить пер-манентные положительные тенденции в статистиче-ских показателях свою значимость обретает стра-тификация пациентов по группам риска и прогнозиро-вание неблагоприятного исхода с целью определения пациентов, наиболее нуждающихся в интенсификации лечебного процесса. Каждая из популярных инте-гральных шкал была разработана с собственной спе-цифической прогностической целью. Тем не менее, это не препятствовало исследователям проводить вали-дацию шкал на прогнозе летальности с последующим сравнительным анализом. На данный момент, лидиру-ющей по точности преэндоскопической шкалой про-гноза летальности признана ABC, а хуже всего прояв-ляет себя Glasgow-Blatchford Bleeding Score. Среди постэндоскопических шкал доминирует итальянская Progetto Nazionale Emorragia Digestive score. Тем не менее, каждая из широкоизвестных интегральных шкал имеет свои преимущества и недостатки, пони-мание которых позволяет избирательно подходить к применению в различных случаях.

Key words

желудочно-кишечное кровотечение, прогноз, шкала, летальность.

Literature

de Groot NL, et al Reassessment of the predictive value of the Forrest classification for peptic ulcer rebleeding and mortality: can classification be simplified? Endoscopy. 2014 Jan;46(1):46-52. doi: 10.1055/s-0033-1344884. Epub 2013 Nov 11. PMID: 24218308. 2. Jong NH, et al Prediction of clinical outcome in patients with nonvariceal gastrointestinal bleeding using Forrest classification and Rockall score. Kasr Al Ainy Med J 2018;24:83-8 3. Lai Y, et al. Development and validation of a model to predict rebleeding within three days after endoscopic hemostasis for high-risk peptic ulcer bleeding. BMC Gastroenterol. 2022 Feb 14;22(1):64. 4. Budimir I, et al Scoring systems for peptic ulcer bleeding: Which one to use? World J Gastroenter-ol. 2017 Nov 7;23(41):7450-7458. 5. Laursen SB, et al The Glasgow Blatchford score is the most accurate assessment of patients with upper gastrointestinal hemorrhage. Clin Gastroen-terol Hepatol. 2012 Oct;10(10):1130-1135.e1. 6. Rockall TA, et al. Risk assessment after acute upper gastrointestinal haemorrhage. Gut. 1996 Mar;38(3):316-21. 7. Kim BJ, Park MK, Kim SJ, Kim ER, Min BH, Son HJ, Rhee PL, Kim JJ, Rhee JC, Lee JH. Com-parison of scoring systems for the prediction of outcomes in patients with nonvariceal upper gas-trointestinal bleeding: a prospective study. Dig Dis Sci. 2009 Nov;54(11):2523-9. 8. Vreeburg EM, Terwee CB, Snel P, Rauws EA, Bartelsman JF, Meulen JH, Tytgat GN. Validation of the Rockall risk scoring system in upper gastro-intestinal bleeding. Gut. 1999 Mar;44(3):331-5. 9. Ebrahimi Bakhtavar H, et al. Clinical Scoring Systems in Predicting the Outcome of Acute Up-per Gastrointestinal Bleeding; a Narrative Review. Emerg (Tehran). 2017;5(1):e36. Epub 2017 Jan 11. PMID: 28286843; PMCID: PMC5325906. 10. Ebrahimi Bakhtavar H, Morteza Bagi HR, Rahmani F, Shahsavari Nia K, Ettehadi A. Clinical Scoring Systems in Predicting the Outcome of Acute Upper Gastrointestinal Bleeding; a Narrative Review. Emerg (Tehran). 2017;5(1):e36. Epub 2017 Jan 11. PMID: 28286843; PMCID: PMC5325906. 11. Benedeto-Stojanov D, Bjelaković M, Stojanov D, Aleksovski B. Prediction of in-hospital mortali-ty after acute upper gastrointestinal bleeding: cross-validation of several risk scoring systems. J Int Med Res. 2022 Mar;50(3):3000605221086442. 12. Blatchford O, Murray WR, Blatchford M. A risk score to predict need for treatment for upper-gastrointestinal haemorrhage. Lancet. 2000 Oct 14;356(9238):1318-21. 13. Liu S, et al. Comparing the Performance of the ABC, AIMS65, GBS, and pRS Scores in Predicting 90-day Mortality Or Rebleeding Among Emergen-cy Department Patients with Acute Upper Gastro-intestinal Bleeding: A Prospective Multicenter Study. J Transl Int Med. 2021 Jun 16;9(2):114-122. 14. Stanley A J, et al. Comparison of risk scoring systems for patients presenting with upper gastro-intestinal bleeding: international multicentre pro-spective study BMJ 2017; 356 :i6432 15. Cheng DW, et al. A modified Glasgow Blatch-ford Score improves risk stratification in upper gastrointestinal bleed: a prospective comparison of scoring systems. Aliment Pharmacol Ther. 2012 Oct;36(8):782-9. doi: 10.1111/apt.12029. Epub 2012 Aug 28. PMID: 22928529. 16. Shahrami A, Ahmadi S, Safari S. Full and Modified Glasgow-Blatchford Bleeding Score in Predicting the Outcome of Patients with Acute Upper Gastrointestinal Bleeding; a Diagnostic Ac-curacy Study. Emerg (Tehran). 2018;6(1):e31. Epub 2018 May 17. PMID: 30009233; PMCID: PMC6036534. 17. Ur-Rahman, A., et al. Both Full Glasgow-Blatchford Score and Modified Glasgow-Blatchford Score Predict the Need for Intervention and Mortality in Patients with Acute Lower Gas-trointestinal Bleeding. Dig Dis Sci 63, 3020–3025 (2018). 18. Stanley AJ, et al Outpatient management of patients with low-risk upper-gastrointestinal haemorrhage: multicentre validation and prospec-tive evaluation. Lancet. 2009 Jan 3;373(9657):42-7. 19. Marmo R, et al. Predictive factors of mortality from nonvariceal upper gastrointestinal hemor-rhage: a multicenter study. Am J Gastroenterol. 2008 Jul;103(7):1639-47; quiz 1648. 20. Contreras-Omaña R, et al The Progetto Na-zionale Emorragia Digestiva (PNED) system vs. the Rockall score as mortality predictors in pa-tients with nonvariceal upper gastrointestinal bleeding: A multicenter prospective study. Rev Gastroenterol Mex. 2017 Apr-Jun;82(2):123-128. English, Spanish. 21. Chandnani S, et al. Clinical utility of risk scores in variceal bleeding. Arq Gastroenterol. 2019 Sep 30;56(3):286-293. 22. Saltzman JR, et al A simple risk score accu-rately predicts in-hospital mortality, length of stay, and cost in acute upper GI bleeding. Gastrointest Endosc. 2011 Dec;74(6):1215-24. doi: 10.1016/j.gie.2011.06.024. Epub 2011 Sep 10. PMID: 21907980. 23. Yaka E, Yılmaz S, Doğan NÖ, Pekdemir M. Comparison of the Glasgow-Blatchford and AIMS65 scoring systems for risk stratification in upper gastrointestinal bleeding in the emergency department. Acad Emerg Med. 2015 Jan;22(1):22-30. doi: 10.1111/acem.12554. Epub 2014 Dec 31. PMID: 25556538. 24. Robertson M, Majumdar A, Boyapati R, Chung W, Worland T, Terbah R, Wei J, Lontos S, Angus P, Vaughan R. Risk stratification in acute upper GI bleeding: comparison of the AIMS65 score with the Glasgow-Blatchford and Rockall scoring systems. Gastrointest Endosc. 2016 Jun;83(6):1151-60. doi: 10.1016/j.gie.2015.10.021. Epub 2015 Oct 26. PMID: 26515955. 25. Thandassery RB, Sharma M, John AK, Al-Ejji KM, Wani H, Sultan K, Al-Mohannadi M, Yakoob R, Derbala M, Al-Dweik N, Butt MT, Al-Kaabi SR. Clinical Application of AIMS65 Scores to Predict Outcomes in Patients with Upper Gastroin-testinal Hemorrhage. Clin Endosc. 2015 Sep;48(5):380-4. doi: 10.5946/ce.2015.48.5.380. Epub 2015 Sep 30. PMID: 26473120; PMCID: PMC4604275. 26. Laursen SB, Oakland K, Laine L, Bieber V, Marmo R, Redondo-Cerezo E, Dalton HR, Ngu J, Schultz M, Soncini M, Gralnek I, Jairath V, Mur-ray IA, Stanley AJ. ABC score: a new risk score that accurately predicts mortality in acute upper and lower gastrointestinal bleeding: an internation-al multicentre study. Gut. 2021 Apr;70(4):707-716. doi: 10.1136/gutjnl-2019-320002. Epub 2020 Jul 28. PMID: 32723845. 27. Mules, TC, Stedman, C, Ding, S, et al. Com-parison of Risk Scoring Systems in Hospitalised Patients who Develop Upper Gastrointestinal Bleeding. GastroHep. 2021; 3: 5– 11. https://doi.org/10.1002/ygh2.436 28. Jimenez-Rosales, R.; Lopez-Tobaruela, J.M.; Lopez-Vico, M.; Ortega-Suazo, E.J.; Martinez-Cara, J.G.; Redondo-Cerezo, E. Performance of the New ABC and MAP(ASH) Scores in the Pre-diction of Relevant Outcomes in Upper Gastroin-testinal Bleeding. J. Clin. Med. 2023, 12, 1085. https://doi.org/10.3390/jcm12031085 29. Saade, M.C., Kerbage, A., Jabak, S. et al. Val-idation of the new ABC score for predicting 30-day mortality in gastrointestinal bleeding. BMC Gastroenterol 22, 301 (2022). https://doi.org/10.1186/s12876-022-02374-y 30. Kim MS, Moon HS, Kwon IS, Park JH, Kim JS, Kang SH, Sung JK, Lee ES, Kim SH, Lee BS, Jeong HY. Validation of a new risk score system for non-variceal upper gastrointestinal bleeding. BMC Gastroenterol. 2020 Jun 17;20(1):193. doi: 10.1186/s12876-020-01346-4. PMID: 32552662; PMCID: PMC7301517. 31. Sakong, Heon MDa; Moon, Hee Seok MD, PhDa,*; Choi, Seong Woo MDa; Kang, Sun Hyung MD, PhDa; Sung, Jae Kyu MD, PhDa; Jeong, Hyun Yong MD, PhDa. ABC score is an effective predictor of outcomes in peptic ulcer bleeding. Medicine 101(49):p e31541, December 9, 2022. | DOI: 10.1097/MD.0000000000031541 32. Park SM, Yeum SC, Kim BW, Kim JS, Kim JH, Sim EH, Ji JS, Choi H. Comparison of AIMS65 Score and Other Scoring Systems for Predicting Clinical Outcomes in Koreans with Nonvariceal Upper Gastrointestinal Bleeding. Gut Liver. 2016 Jul 15;10(4):526-31. doi: 10.5009/gnl15153. PMID: 27377742; PMCID: PMC4933411. 33. Gu L, Xu F, Yuan J. Comparison of AIMS65, Glasgow-Blatchford and Rockall scoring ap-proaches in predicting the risk of in-hospital death among emergency hospitalized patients with upper gastrointestinal bleeding: a retrospective observa-tional study in Nanjing, China. BMC Gastroenter-ol. 2018 Jun 28;18(1):98. doi: 10.1186/s12876-018-0828-5. PMID: 29954332; PMCID: PMC6022417. 34. Tuncer H, Yardan T, Akdemir HU, Ayyildiz T. Comparison of four scoring systems for risk stratification of upper gastrointestinal bleeding. Pak J Med Sci. 2018 May-Jun;34(3):649-654. doi: 10.12669/pjms.343.14956. PMID: 30034432; PMCID: PMC6041537. 35. Lu M, Sun G, Huang H, Zhang X, Xu Y, Chen S, Song Y, Li X, Lv B, Ren J, Chen X, Zhang H, Mo C, Wang Y, Yang Y. Comparison of the Glas-gow-Blatchford and Rockall Scores for prediction of nonvariceal upper gastrointestinal bleeding out-comes in Chinese patients. Medicine (Baltimore). 2019 May;98(21):e15716. doi: 10.1097/MD.0000000000015716. PMID: 31124950; PMCID: PMC6571241. 36. Li Y, Lu Q, Wu K, Ou X. Evaluation of Six Preendoscopy Scoring Systems to Predict Out-comes for Older Adults with Upper Gastrointesti-nal Bleeding. Gastroenterol Res Pract. 2022 Jan 30;2022:9334866. doi: 10.1155/2022/9334866. PMID: 35136407; PMCID: PMC8818397. 37. Redondo-Cerezo E, Vadillo-Calles F, Stanley AJ, Laursen S, Laine L, Dalton HR, Ngu JH, Schultz M, Jiménez-Rosales R. MAP(ASH): A new scoring system for the prediction of interven-tion and mortality in upper gastrointestinal bleed-ing. J Gastroenterol Hepatol. 2020 Jan;35(1):82-89. doi: 10.1111/jgh.14811. Epub 2019 Aug 19. PMID: 31359521. 38. Stanley AJ, Dalton HR, Blatchford O, Ashley D, Mowat C, Cahill A, Gaya DR, Thompson E, Warshow U, Hare N, Groome M, Benson G, Mur-ray W. Multicentre comparison of the Glasgow Blatchford and Rockall Scores in the prediction of clinical end-points after upper gastrointestinal haemorrhage. Aliment Pharmacol Ther. 2011 Aug;34(4):470-5. doi: 10.1111/j.1365-2036.2011.04747.x. Epub 2011 Jun 26. PMID: 21707681. 39. Bryant RV, Kuo P, Williamson K, Yam C, Schoeman MN, Holloway RH, Nguyen NQ. Per-formance of the Glasgow-Blatchford score in pre-dicting clinical outcomes and intervention in hos-pitalized patients with upper GI bleeding. Gastro-intest Endosc. 2013 Oct;78(4):576-83. doi: 10.1016/j.gie.2013.05.003. Epub 2013 Jun 18. PMID: 23790755. 40. Marmo, Riccardo MD; Koch, Maurizio MD; Cipolletta, Livio MD; Capurso, Lucio MD; Grossi, Enzo MD; Cestari, Renzo MD; Bianco, Maria A MD; Pandolfo, Nicola MD; Dezi, Angelo MD; Ca-setti, Tino MD; Lorenzini, Ivano MD; Germani, Ugo MD; Imperiali, Giorgio MD; Stroppa, Italo MD; Barberani, Fausto MD; Boschetto, Sandro MD; Gigliozzi, Alessandro MD; Gatto, Giovanni MD; Peri, Vittorio MD; Buzzi, Andrea MD; Casa, Domenico Della MD; Di Cicco, Marino MD; Proietti, Massimo MD; Aragona, Giovanni MD; Giangregorio, Francesco MD; Allegretta, Luciano MD; Tronci, Salvatore MD; Michetti, Paolo MD; Romagnoli, Paola MD; Piubello, Walter MD; Ferri, Barbara MD; Fornari, Fabio MD; Del Piano, Mario MD; Pagliarulo, Michela MD; Di Mitri, Roberto MD; Trallori, Giacomo MD; Bagnoli, Sirio MD; Frosini, Giorgio MD; Macchiarelli, Raffaele MD; Sorrentini, Italo MD; Pietrini, Lorena MD; De Stefano, Salvatore MD; Ceglia, Tommaso MD; Chiozzini, Giorgio MD; Salvagnini, Mario MD; Di Muzio, Daniela MD; Rotondano, Gianluca MD, FACG3 for the Italian registry on upper gastroin-testinal bleeding (Progetto Nazionale Emorragie Digestive—PNED 2). Predicting Mortality in Non-Variceal Upper Gastrointestinal Bleeders: Valida-tion of the Italian PNED Score and Prospective Comparison With the Rockall Score. American Journal of Gastroenterology 105(6):p 1284-1291, June 2010. | DOI: 10.1038/ajg.2009.687 41. Tang Y, Shen J, Zhang F, Zhou X, Tang Z, You T. Scoring systems used to predict mortality in patients with acute upper gastrointestinal bleed-ing in the ED. Am J Emerg Med. 2018 Jan;36(1):27-32. doi: 10.1016/j.ajem.2017.06.053. Epub 2017 Jun 27. PMID: 28673695. 42. Cazacu SM, Alexandru DO, Statie RC, Iordache S, Ungureanu BS, Iovănescu VF, Popa P, Sacerdoțianu VM, Neagoe CD, Florescu MM. The Accuracy of Pre-Endoscopic Scores for Mortality Prediction in Patients with Upper GI Bleeding and No Endoscopy Performed. Diagnostics (Basel). 2023 Mar 21;13(6):1188. doi: 10.3390/diagnostics13061188. PMID: 36980496; PMCID: PMC10047350. 43. Hyett BH, Abougergi MS, Charpentier JP, Kumar NL, Brozovic S, Claggett BL, Travis AC, Saltzman JR. The AIMS65 score compared with the Glasgow-Blatchford score in predicting out-comes in upper GI bleeding. Gastrointest Endosc. 2013 Apr;77(4):551-7. doi: 10.1016/j.gie.2012.11.022. Epub 2013 Jan 26. PMID: 23357496. 44. Uysal Y, Babus SB, Kose A, Ates F, Biricik S, Erdogan S, Cevik I, Toker I, Ayrik C. The prog-nostic significance of the risk scores at upper gas-trointestinal bleeding. Niger J Clin Pract. 2019 Aug;22(8):1099-1108. doi: 10.4103/njcp.njcp_193_18. PMID: 31417053. 45. Saade MC, Kerbage A, Jabak S, Makki M, Barada K, Shaib Y. Validation of the new ABC score for predicting 30-day mortality in gastroin-testinal bleeding. BMC Gastroenterol. 2022 Jun 21;22(1):301. doi: 10.1186/s12876-022-02374-y. PMID: 35729498; PMCID: PMC9209314.