Comparison Of AIMS65 And Blatchford And Rockall Scoring Systems In The Prognosis Of Patients With Acute Non-varicose Upper Gastrointestinal Bleeding

Objective: To compare the prognostic value of AIMS65,Blatchford and Rockall scoring systems in patients with acute non-variceal upper gastrointestinal bleeding(ANVUGIB).Methods:A total of 568 patients with ANVUGIB who were admitted to the Second Hospital of Hebei Medical University from January 2017 to December 2018 were selected as the study subjects.The detailed post-hospital clinical data were collected for all patients,including baseline data(age,sex,heart rate),laboratory findings(hemoglobin,plasma albumin,blood urea nitrogen,INR),and clinical features(melena,syncope),associated with underlying diseases(heart failure,liver disease,liver and kidney failure,MI,AF,coronary artery disease,cancer spread);Blood transfusion,bleeding,operation(endoscopic hemostasis,vascular intervention,surgical operation),length of hospital stay and death were recorded.The AIMS65 score,Blatchford score and Rockall score were used to evaluate the clinical characteristics of the low-risk group and the middle-high-risk Group.The ROC curve was used to compare the predictive value of three scoring systems for rebleeding,transfusion treatment,surgery and death in patients with ANVUGIB.Results: 1.According to the AIMS65 score,compared with the low-risk Group(499 cases),the heart rate,hemoglobin,albumin level and anticoagulant treatment ratio decreased in the high-risk Group(69 cases),INR,urea nitrogen,syncope rate,liver disease rate,liver and kidney failure rate,atrial fibrillation rate,blood transfusion rate,rebleeding rate were significantly increased(P<0.05).2.According to the Blatchford score,compared with the low-risk group(142 cases),the patients in the high-risk Group(426 cases)had lower levels of hemoglobin,albumin and heart failure.Heart rate,INR,urea nitrogen,melena,syncope,liver and kidney failure and blood transfusion were significantly increased(P<0.05).3.According to the Rockall score,compared with the low-risk group(286 cases),the sex,heart rate,INR,urea nitrogen,and black,syncope,the proportions of the liver disease,atrial fibrillation,operation method and bleeding ratio data comparison difference has no statistical significance in the high-risk Group(282)(P>0.05).Compared with low risk group,in the high-risk group of patients,hemoglobin,albumin levels drop,age,hospitalization duration,the proportions of the heart failure,myocardial infarction,cerebral infarction,ischemic heart disease,anticoagulant therapy,the cancer spread,liver and kidney failure rate,the cancer spread,anticoagulants and blood transfusion ratio increases,the difference was statistically significant(P<0.05).4.The results of correlation analysis showed that the AIMS65 score was positively correlated with the Blatchford score(r=0.391,P<0.01)and the Rockall score(r=0.439,P<0.01),the Blatchford score was positively correlated correlated with the Rockall score(r=0.250,P<0.01).5.The ROC curve results showed that the area under the ROC curve of hematocele under the ROC curve predicted by AIMS65,Blatchford and Rockall scoring systems was 0.666(95%CI: 0.626~0.705),0.763(95%CI: 0.726~0.798),and 0.599(95%CI: 0.557~0.640),and the correlation prediction thresholds were 2,7,and 4 respectively.The area under the ROC curve predicted rehaemorrhagia by the score was 0.686(95%CI: 0.646~0.724),0.590(95%CI: 0.548~0.630),and 0.579(95%CI: 0.537~0.620),and the correlation prediction thresholds were 2,8,and 5.The area under the ROC curve predicted Endoscopic hemostasis by AIMS65 score,Blatchford score and Rockall score was 0.625(95%CI:0.553~0.635)?0.556(95%CI:0.485~0.569)?0.780(95%CI:0.743~0.813),and the corresponding prediction thresholds were 1,9,and 3 respectively.The area under the ROC curve for surgical treatment was 0.595(95%CI: 0.553~0.635),0.527(95%CI: 0.485~0.569),and 0.682(95%CI: 0.642~0.721),and the corresponding critical values were 2,6 and 3 points respectively.The areas under the ROC curve predicted length of hospital stay by AIMS65 score,Blatchford score and Rockall score were 0.481(95%CI: 0.476~0.559),0.551(95%CI: 0.509~0.592),0.531(95%CI: 0.489~0.572),and the corresponding critical values were all 1.Conclusion:1.AIMS65,Blatchford and Rockall scores have good predictive value for clinical intervention and rebleeding in patients with acute non-varicose upper gastrointestinal bleeding.2.The predictive value of AIMS65 score for rebleeding is superior to the other two scores.In addition to simple data and convenient calculation,AIMS65 score has obvious advantages in the treatment and prognosis assessment of ANVUGIB patients.3.The optimal critical value of AIMS65 score system for blood transfusion,rebleeding and surgical treatment is 2 points.