COMPARAREA SCORURILOR DE RISC UTILIZATE ÎN HEMORAGIA

DIGESTIVĂ NON-VARICEALĂ CA EVALUARE A PROGNOSTICULUI

PACIENŢILOR ŞI ACURATEŢEA LOR

Daniela Lazăr1,Ioan Sporea1, Denisia Tornea1, Liliana Girboni1, Cristina Filip1, Virgil
Ardelean1, Raluca Lupuşoru1, Ioan Romoşan2, Adrian Goldiş1

1. Departamentul de Gastroenterologie şi Hepatologie, 2. Departamentul de Medicină

Internă
Universitatea de Medicină şi Farmacie “Victor Babeş” Timişoara

Introducere: Scopul studiului a constat în analiza acurateţei a trei scoruri de risc utilizate în
hemoragia digestivă superioară non-variceală (HDS-NV) ca evaluare a prognosticului
pacienţilor, estimate anterior ca fiind predictive pentru resângerare/deces după un episod de
sângerare gastrointestinală.
Material şi metodă: Am evaluat retrospectiv un lot de 1872 pacienţi internaţi în Clinica de
Gastroenterologie a Spitalului Clinic Judeţean de Urgenţă Timişoara cu HDS-NV într-o
perioadă de 12 ani, la care am calculat 3 scoruri de risc, Rockall, Cedars-Sinai şi Baylor. Am
comparat acurateţea acestora în evaluarea prognosticului pacienţilor, exprimat ca necesar de
transfuzii de sânge, număr zile spitalizare, resângerare, transfer în chirurgie şi deces.
Capacitatea discriminativă a fost evaluată utilizând aria de sub curba ROC (AUROC).
Rezultate şi concluzii: Lotul a inclus 1134 (60.6%) bărbaţi şi 738 (39.4%) femei, vârsta
medie fiind de 627.8 ani. În ceea ce priveşte necesarul de transfuzii de sânge, capacitatea
predictivă a scorurilor este după cum urmează:Rockall AUROC 0.59,
sensibilitate(Se)=81.7%, specificitate(Sp)=35.5%, valoare predictivă pozitivă (PPV)=28.4%,
valoare predictivă negativă(NPV)=86.1%;Cedars-Sinai AUROC 0.59, Se=72.4%, Sp=41.3%,
PPV=28.5%, NPV=82.3%;Baylor AUROC 0.56, Se=41.9%, Sp=75.5%, PPV=40.6%,
NPV=76.5%. Numărul zile de spitalizare:Rockall AUROC 0.66, Se=61.5%, Sp=65.2%,
PPV=90%, NPV=25%;Cedars-Sinai AUROC 0.63, Se=53.1%, Sp=73.9%, PPV=89.5%,
NPV=27.4%;Baylor AUROC 0.52, Se=47.06%, Sp=66.6%, PPV=84.2%, NPV=25%.
Resângerare:Rockall AUROC 0.69, Se=69.1%, Sp=60.4%, PPV=14.2%,
NPV=92.8%;Cedars-Sinai AUROC 0.73, Se=84.4%, Sp=49.02%, PPV=13.7%,
NPV=97%;Baylor AUROC 0.54, Se=35.1%, Sp=81.2%, PPV=16.2%, NPV=92.4%.
Transfer chirurgie:Rockall AUROC 0.67, Se=71.2%, Sp=59%, PPV=16%,
NPV=98.1%;Cedars-Sinai AUROC 0.72, Se=58%, Sp=77.4%, PPV=9.3%,
NPV=97.9%;Baylor AUROC 0.55, Se=50%, Sp=66.2%, PPV=5.1%, NPV=97.4%.
Deces:Rockall AUROC 0.85, Se=84.7%, Sp=76%, PPV=18.2%, NPV=99.5%;Cedars-Sinai
AUROC 0.71, Se=83.1%, Sp=48.1%, PPV=10.2%, NPV=97.6%;Baylor AUROC 0.75,
Se=76.09%, Sp=72.3%, PPV=19.2%, NPV=97.2%. Nu s-au evidenţiat diferenţe semnificative
statistic în prezicerea necesarului de transfuzii şi transferului în chirurgie între
scoruri(p>0.05).Scorul Baylor a fost superior vs. Rockall în estimarea duratei spitalizării
(p=0.04) şi riscului de resângerare (p=0.0009), iar Cedars-Sinai s-a dovedit superior scorului
Baylor în prezicerea resângerării (p=0.002) şi scorului Rockall în prezicerea decesului
(p=0.006). În concluzie, scorul Cedars-Sinai a fost cel mai bun în prezicerea resângerării şi a
decesului la pacienţii cu HDS-NV.
Cuvinte cheie: hemoragie digestivă non-variceală, scoruri de risc, prognostic
 COMPARISON OF THE RISK SCORING SYSTEMS USED IN NON-VARICEAL UPPER DIGESTIVE
BLEEDING FOR ASSESSING PATIENT’S PROGNOSIS AND THEIR ACCURACY

Daniela Lazăr1,Ioan Sporea1, Denisia Tornea1, Liliana Girboni1, Cristina Filip1, Virgil Ardelean1, Raluca
Lupuşoru1, Ioan Romoşan2, Adrian Goldiş1

1. Department of Gastroenterology and Hepatology, 2. Department of Internal Medicine

University of Medicine and Pharmacy “Victor Babeş” Timişoara

Introduction: The aim of the study consisted in the analysis of the accuracy of three risk scoring
systems used in non-variceal upper digestive bleeding (NV-UDB) for assessing patient’s prognosis,
previously estimated to be predictive for re-bleeding/death after gastrointestinal bleeding.

Material and method: We assessed prospectively a batch of 1872 patients admitted in the
Gastroenterology department of Emergency County Hospital Timisoara in a 12 years period, in which
we calculated 3 risk scoring systems, Rockall, Cedars-Sinai and Baylor. We compared their accuracy
for assessing patient’s prognosis, expressed as the need of blood transfusions, number of
hospitalization days, re-bleeding, surgery and death. Discriminative ability was assessed using the
area under the receiver operating characteristic curve (AUROC).

Results and conclusion: The batch included 1134 (60.6%) male and 738 (39.4%) female, mean age
627.8 years. Regarding the need of blood transfusions, the predictive ability of the scores is as
follows:Rockall AUROC 0.59, sensitivity(Se)=81.7%, specificity(Sp)=35.5%, positive predictive
value(PPV)=28.4%, negative predictive value(NPV)=86.1%;Cedars-Sinai AUROC 0.59, Se=72.4%,
Sp=41.3%, PPV=28.5%, NPV=82.3%;Baylor AUROC 0.56, Se=41.9%, Sp=75.5%, PPV=40.6%,
NPV=76.5%. Number of hospitalization days:Rockall AUROC 0.66, Se=61.5%, Sp=65.2%, PPV=90%,
NPV=25%;Cedars-Sinai AUROC 0.63, Se=53.1%, Sp=73.9%, PPV=89.5%, NPV=27.4%;Baylor AUROC
0.52, Se=47.06%, Sp=66.6%, PPV=84.2%, NPV=25%. Re-bleeding:Rockall AUROC 0.69, Se=69.1%,
Sp=60.4%, PPV=14.2%, NPV=92.8%;Cedars-Sinai AUROC 0.73, Se=84.4%, Sp=49.02%, PPV=13.7%,
NPV=97%;Baylor AUROC 0.54, Se=35.1%, Sp=81.2%, PPV=16.2%, NPV=92.4%. Surgery:Rockall AUROC
0.67, Se=71.2%, Sp=59%, PPV=16%, NPV=98.1%;Cedars-Sinai AUROC 0.72, Se=58%, Sp=77.4%,
PPV=9.3%, NPV=97.9%;Baylor AUROC 0.55, Se=50%, Sp=66.2%, PPV=5.1%, NPV=97.4%.
Death:Rockall AUROC 0.85, Se=84.7%, Sp=76%, PPV=18.2%, NPV=99.5%;Cedars-Sinai AUROC 0.71,
Se=83.1%, Sp=48.1%, PPV=10.2%, NPV=97.6%;Baylor AUROC 0.75, Se=76.09%, Sp=72.3%,
PPV=19.2%, NPV=97.2%. There were no statistically significant differences encountered in predicting
the need of blood transfusions and surgery between the scores(p>0.05). Baylor score was superior vs
Rockall in estimating the hospitalization period (p=0.04) and the risk of re-bleeding (p=0.0009), and
Cedars-Sinai proved to be superior to Baylor score in predicting re-bleeding (p=0.002) and to Rockall
score in predicting death (p=0.006). In conclusion, Cedars-Sinai score was the best in predicting the
re-bleeding and death in patients with NV-UDB.

Keywords : non-variceal upper digestive bleeding, risk scoring systems, prognosis