Study On Clinical Characteristics And Prognosis Of 281 Adult Cases Of Acute Nonvariceal Gastrointestinal Bleeding

Objective:This study aims to analysis the clinical features of acute non-variceal upper gastrointestinal bleeding(ANVUGIB)and to find the independent risk factors affecting prognosis of ANVUGIB.It also aims to evaluate prognosis prediction ability of Blatchford,Rockall and AIMS65 scoring system in ANVUGIB patients' rebleeding rate,early endoscopic intervention,mortality,so that clinicians can choose the best appropriate ANVUGIB risk assessment tool,which provides the basis for improving the prognostic more accuracy.Methods : Restrospective analysis was applied by us in studying the clinical aspects of 281 hospitalized adult cases conform to the diagnostic criteria of ANVUGIB between September 2015 to September 2016 in The Zhongshan Hospital of Xiamen University.We knowing about the information with endoscopy and endoscopic treatment and operation during hospitalization,the fatality rate and rebleeding rate of the patients within 1 months.And than we collecting patients' general information,symptoms within 24 hours after admission(melena syncope),systolic blood pressure,heart rate,blood routine,biochemical and blood coagulation,the other complications of important organ.Multi-factor logistic regression was used to find the independent risk factors.The receiver operating characteristic curve(ROC curve)and the area under the curve(AUC)were used to evaluate prediction ability of Blatchford,Rockall,AIMS65 scoring system in ANVUGIB patients‘ rebleeding rate,early endoscopic intervention,mortality.Z test was used to compare the AUC of each scoring system.Results : 1.Of all 281 patients,231 cases was peptic ulcer(82.2%),as the main causes for ANVUGIB,other causes include gastrointestinal malignant tumor resection,disease after gastroduodenalectomy,acute gastric mucosal lesions,acute gastric mucosa,Mallory-Weiss syndrome,reflux esophagitis,etc.2.Of all 281 patients,51 cases undergo endoscopic hemostatic therapy,including 46 patients who underwent endoscopic hemostatic treatment,5 cases were Forrest IIa ulcer but did not underwent endoscopic treatment.Of all 8 cases of patient death,7 cases were gastrointestinal malignant tumor,the other 1 was peptic ulcer bleeding,of all 5 patient undergo rebleeding,2 cases were Duodenal ulcer and 3cases were gastric ulcer 3.Relevance analysis and multi-factors logistic regression analysis showed that HB(hemoglobin),ALB,hemoglobin(albumin),major organ dysfunction(including ischemic cardiomyopathy,COPD,diabetes,liver failure,renal failure and other vital organs lesions)were the independent risk factors of ANVUGIB.4.Drawing ROC curve for each score,for the invasive intervention treatment of ANVUGIB,AUCBlatchford > AUCAIMS65 > AUCClinical Rockall,Blatcford scoring system was the best with the biggest AUC,and the rest of the scoring system have similar predicting values(P>0.05).When Blatchford score of > 8,the possibility of requiring endoscopic hemostatic therapy is increased(P < 0.05);For the prediction of mortality,AUCClinical Rockall > AUCAIMS65 > AUCBlatchford,Clinical scoring system has the biggest AUC,but there has no difference between three scoring system(P > 0.05);For the prediction of rebleeding,AUCComplete Rockall > AUCClinical Rockall > AUCAIMS65 > AUCBlatchford,Clinical Rockall scoring system has the biggest AUC,but there has no difference between three scoring system(P > 0.05).Conclusion: The major etiology of ANVUGIB was peptic ulcer;HB,ALB,complications of important organ were independent factors affecting ANVUGIB death;HB,complications of important organ were the independent factors of rebleeding.When Blatchford score of > 8,requiring endoscopic hemostatic therapy is increased;Rockall,Blatchford,AIMS65 scoring system have the same predictive value in mortality,the rate of rebleeding.