Yonsei Med J.  2019 Apr;60(4):368-374. 10.3349/ymj.2019.60.4.368.

Performance of Three Scoring Systems in Predicting Massive Transfusion in Patients with Unstable Upper Gastrointestinal Hemorrhage

Affiliations
  • 1Department of Emergency Medicine, Chonnam National University Hospital, Gwangju, Korea. terran034@naver.com
  • 2Department of Emergency Medical Technology, Namseoul University, Cheonan, Korea.

Abstract

PURPOSE
After trauma and surgery, upper gastrointestinal bleeding (UGIB) is the most common condition that can require massive transfusion (MT). The present study aimed to analyze and compare the prognostic performance of the Glasgow-Blatchford (GB), pre-endoscopy Rockall (PER), and modified early warning (MEW) scores for predicting MT in patients with unstable UGIB.
MATERIALS AND METHODS
This retrospective observational study included patients with UGIB from March 2016 to February 2018. Receiver operating characteristics analysis was performed to examine the prognostic performance of the GB, PER, and MEW scoring systems. Logistic regression analysis was used to identify independent risk factors for MT, after adjusting for relevant covariates. The primary outcome was MT.
RESULTS
Of the 484 included patients with unstable UGIB, 19 (3.9%) received an MT. The areas under the curves (AUCs) of the GB, PER, and MEW scores for MT were 0.577 [95% confidence interval (CI), 0.531-0.621], 0.570 (95% CI, 0.525-0.615), and 0.767 (95% CI, 0.727-0.804), respectively. The AUC of the MEW score was significantly different from those of the GB and PER scores. In multivariate analysis, MEW score was independently associated with MT in patients with unstable UGIB (odds ratio, 1.495; 95% CI, 1.100-2.033; p=0.010).
CONCLUSION
In unstable UGIB patients, MEW score had the best prognostic performance for MT among three scoring systems.

Keyword

Emergency department; massive transfusion; upper gastrointestinal bleeding

MeSH Terms

Area Under Curve
Emergency Service, Hospital
Gastrointestinal Hemorrhage*
Hemorrhage
Humans
Logistic Models
Multivariate Analysis
Observational Study
Retrospective Studies
Risk Factors
ROC Curve

Figure

  • Fig. 1 Patients with acute UGIB and unstable vital signs between March 2016 and February 2018. UGIB, upper gastrointestinal bleeding; MT, massive transfusion.

  • Fig. 2 Area under the receiver operating characteristic analyses of GB, PER, and MEW scores for predicting massive transfusion. (A) AUC in all patients group. (B) AUC in patients with variceal bleeding. The AUC of the MEW score was significantly different from that of the GB or PER score in all patients with UGIB and variceal bleeding. (C) AUC in patients with non-variceal bleeding. In non-variceal bleeding, the AUC of the MEW score was not significantly different from that of the GB or PER score. AUC, area under the curve; GB, Glasgow-Blatchford; PER, pre-endoscopy Rockall; MEW, modified early warning; UGIB, upper gastrointestinal bleeding.


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