Analysis Of Risk Factors For Mortality In Patients With Acute Non-variceal Upper Gastrointestinal Bleeding And The Predictive Value Of DGSG Score For That

Objectives To analyze the independent predictors of mortality in patients with acute non-variceal upper gastrointestinal bleeding(ANVUGIB),and evaluate the discrimination capability of DGSG sore in predicting the risk of death in patients with ANVUGIB.Methods This retrospective study was undertaken by collecting a total of 479 consecutive cases with ANVUGIB in the Second Affiliated Hospital of Fujian Medical University,from June 2014 to June 2016.Patients were divided into death group and survival group according to their outcome.Univariate analysis and a further logistic regression analysis were performed to identify the independent predictors of mortality.Then we calculate the DGSG score and the Rockall score respectively,and used the area under the curve to compare the discrimination ability between the two scoring systems.Results A total of 479 patients with ANVUGIB were enrolled in the study,22 in death group and 457 in survival group.Mortality was 4.59%.The common etiologys of ANVUGIB contained peptic ulcer(62.63%),Mallory-Weiss syndrome(7.72%),exfoliative esophagitis(6.05%)andacute gastric mucosal lesion(1.88%).Univariate analysis showed that age,sex,one or more comorbidities,hemodynamic instability,active bleeding at endoscopy,packed red blood cell transfusions,rebleeding,blood urea nitrogen(BUN)levels,and Prothrombin Time(PT)were all significantly.In logistic regression analysis,the independent predictors of mortality included age > 65 years(OR=4.836),hemodynamic instability(OR=17.758),active bleeding at endoscopy(OR=11.848),transfusions(OR=11.343),rebleeding(5.053),serum BUN>14.24mmol/L(OR=4.614).The AUC under the DGSG score was 0.932 [95 % CI0.906-0.953],and that of Rockall score was 0.879 [95%CI 0.846-0.907]?Conclusions 1.Age > 65 years,hemodynamic instability,active bleeding at endoscopy,transfusions,rebleeding and serum BUN > 14.24mmol/L were the independent predictors of mortality in ANVUGIB patients.2.DGSG score and Rockall score both shows a excellent discrimination capability in predicting death in ANVUGIB patients.3.DGSG score was as accurate as Rockall score in predicting death in ANVUGIB patients.But the new predictive score offered a comprehensice,objective evaluation based on clinical manifestations,endoscopic data and treatment factors,and easy for counting.So it was worth for popularizing.