OASIS评分联合血小板-白蛋白-胆红素指数与急性上消化道出血病情的相关性及对预后评估价值

doi:10.3969/j.issn.1006-6233.2024.03.016

摘要
图/表
参考文献
相关文章 (15)

全文: PDF (1381 KB) HTML (1 KB)
输出: BibTeX | EndNote (RIS)

摘要 目的:探究牛津急性疾病严重程度(OASIS)评分联合血小板-白蛋白-胆红素(PALBI)指数与急性上消化道出血(AUGB)患者病情的相关性及对预后的评估价值。方法:回顾性分析我院165例AUGB患者资料,根据《急性上消化道出血急诊诊治流程专家共识 2020》危险分级将患者分为高危组(n=44)、中危组(n=63)和低危组(n=58),比较三组入院OASIS评分和PALBI指数,采用Spearman相关分析OASIS评分和PALBI指数与AUGB疾病危险程度的关系,所有患者均进行临床治疗,根据治疗后是否发生再出血、重症监护、死亡将患者分为预后良好组(n=114)和预后不良组(n=51),比较两组一般临床资料和实验室指标,采用Logistic回归模型分析影响AUGB患者预后的相关因素,采用受试者工作特征(ROC)曲线分析OASIS评分和PALBI指数对AUGB患者预后的评估价值。结果:高危组OASIS评分、PALBI指数均显著高于中危组、低危组(P<0.05),中危组OASIS评分、PALBI指数均显著高于低危组(P<0.05);Spearman相关分析显示,OASIS评分和PALBI指数与AUGB疾病危险程度均呈正相关(P<0.05);预后不良组AUGB次数、呕血、幽门螺杆菌感染占比、心率、呼吸频率、OASIS评分、PALBI指数值高于预后良好组(P<0.05),HBG、ALB、PLT值低于预后良好组(P<0.05),两组性别、年龄、BMI、既往史、晕厥、黑便、心力衰竭占比、病因、血清TBIL、ALT、AST、Ser、UA、BUN水平、PT、TT、APTT值比较,差异无统计学意义(P>0.05);多因素Logistic回归分析显示,AUGB次数、呕血、OASIS评分、PALBI指数是影响AUGB患者预后的危险因素(P<0.05);ROC曲线分析显示,OASIS评分、PALBI指数单独及联合预测AUGB患者预后的敏感度为88.24%、70.59%、90.20%,特异度为80.70%、78.95%、84.21%,AUC为0.897、0.806、0.929,联合诊断预测价值更高。结论:OASIS评分、PALBI指数与AUGB患者病情相关,且对患者预后具有较高的预测价值。

	服务

	把本文推荐给朋友
	加入我的书架
	加入引用管理器
	E-mail Alert
	RSS
	作者相关文章

关键词 ：急性上消化道出血, 牛津急性疾病严重程度评分, 血小板-白蛋白-胆红素指数, 预后

Abstract：Objective: To investigate the correlation of oxford acute severity of illness score (OASIS) combined with platelet-albumin-bilirubin index (PALBI) with the severity of acute upper gastrointestinal bleeding (AUGB) and its evaluated value on prognosis.Methods: The data of 165 patients with AUGB in our hospital were retrospectively analyzed, and the patients were divided into high-risk group (n=44), medium-risk group(n=63) and low-risk group(n=58) according to the risk classification of Expert Consensus 2020 on the Emergency Diagnosis and Treatment of Acute Upper Gastrointestinal Bleeding. OASIS score and PALBI index were compared among the three groups. Spearman correlation analysis was used to analyze the relationship between OASIS score and PALBI index and risk degree of AUGB. All patients underwent clinical treatment, and then they were divided into good prognosis group (n=114) and poor prognosis group (n=51) according to whether rebleeding, intensive care and death occurred after treatment. The general clinical data and laboratory indicators were compared between the two groups, Logistic regression model was applied to analyze the related factors affecting the prognosis of patients with AUGB, and receiver operating characteristics (ROC) curve was used to analyze the value of OASIS score and PALBI index on the prognosis of patients with AUGB. Results: OASIS score and PALBI index in high-risk group were significantly higher than those in middle-risk group and low-risk group (P<0.05), and OASIS score and PALBI index in middle-risk group were significantly higher than those in low-risk group (P<0.05). Spearman correlation analysis analysis showed that OASIS score and PALBI index were significantly positively correlated with AUGB risk degree (P<0.05). AUGB frequency, proportions of hematemesis and Helicobacter pylori infection, heart rate, respiratory rate, OASIS score and PALBI index in poor prognosis group were significantly higher than those in good prognosis group (P<0.05) while HBG, ALB and PLT were significantly lower than those in good prognosis group (P<0.05). There were no statistically significant differences in gender, age, BMI, past history, proportions of syncope, melena and heart failure, etiology, serum TBIL, ALT, AST, Ser, UA, BUN, PT, TT and APTT between the two groups (P>0.05). Multivariate Logistic regression analysis showed that AUGB frequency, hematemesis, OASIS score and PALBI index were the risk factors affecting the prognosis of patients with AUGB (P<0.05). ROC curve analysis showed that the sensitivities of OASIS score and PALBI index alone and in combination in predicting prognosis of patients with AUGB were 88.24%, 70.59% and 90.20%, and the specificities were 80.70%, 78.95% and 84.21%, and the AUCs were 0.897, 0.806 and 0.929 respectively. Combined diagnosis had higher predictive value. Conclusion: OASIS score and PALBI index are significantly correlated with disease condition of patients with AUGB, and have high predictive value on prognosis of patients.

Key words： Acute upper gastrointestinal bleeding Oxford acute severity of illness score Platelet-albumin-bilirubin index Prognosis

基金资助:2022年度安徽省中医药传承创新科研项目,(编号:2022CCZC31)

引用本文:

常琳琳, 代子艳, 周亚柏, 王桂周, 陆启峰, 王双平. OASIS评分联合血小板-白蛋白-胆红素指数与急性上消化道出血病情的相关性及对预后评估价值[J]. 河北医学, 2024, 30(3): 441-447.
CHANG Linlin, DAI Ziyan, ZHOU Yabai, et al. Correlation of OASIS Score Combined with Platelet-Albumin-Bilirubin Index with the Severity of Acute Upper Gastrointestinal Bleeding and Its Value in Prognostic Assessment. HeBei Med, 2024, 30(3): 441-447.

链接本文:

http://www.hbyxzzs.cn/CN/10.3969/j.issn.1006-6233.2024.03.016 或 http://www.hbyxzzs.cn/CN/Y2024/V30/I3/441

[1] Pezzotti W.Understanding acute upper gastrointestinal bleeding in adults[J].Nursing,2020,50(5):24-29.
[2] 刘霜,张小明,杨美霞,等.急性上消化道出血患者既往出血次数与90d全因死亡和再出血的关系:一项真实世界研究[J].中华急诊医学杂志,2021,30(5):593-601.
[3] Wang N,Wang M,Jiang L,et al.The predictive value of the oxford acute severity of Illness score for clinical outcomes in patients with acute kidney injury[J].Ren Fail,2022,44(1):320-328.
[4] Xu Y,Hu X,Li J,et al.An improved scoring system based on platelet-albumin-bilirubin in predicting posthepatectomy liver failure outcomes[J].Dig Dis,2021,39(3):258-265.
[5] 中国医师协会急诊医师分会,中华医学会急诊医学分会,全军急救医学专业委员会,等.急性上消化道出血急诊诊治流程专家共识(2020版)[J].中华急诊医学杂志,2021,30(1):15-24.
[6] 沈鹏程,朱甜.老年及中青年ICU患者死亡率及OASIS评分的预测价值[J].中国急救复苏与灾害医学杂志,2023,18(2):232-235.
[7] Hou D,Wang C,Luo Y,et al.Systemic immune-inflammation index (SⅡ) but not platelet-albumin-bilirubin (PALBI) grade is associated with severity of acute ischemic stroke (AIS)[J].Int Neurosci,2021,131(12):1203-1208.
[8] 王志为,许文娟,舒品源,等.OASIS评分对ICU老年患者病情的评估和预后判断的价值[J].河北医学,2023,29(3):436-441.
[9] 陈晓燕,李元海,汪正光,等.牛津急性疾病严重程度评分对老年重症患者病情评估的价值[J].重庆医学,2019,48(13):2220-2223.
[10] 程金霞,方思维,李翔,等.牛津急性疾病严重程度评分和生理评分系统对ICU患者病情评估的价值[J].安徽医学,2018,39(9):1082-1084.
[11] Faisal MS,Singh T,Amin H,et al.Role of platelet-albumin-bilirubin score in predicting re-bleeding after band ligation for acute variceal hemorrhage[J].World Hepatol,2020,2(10):880-882.
[12] 徐陈,蒋淼.PALBI评分对肝硬化合并急性上消化道出血患者短期预后的预测价值[J].临床肝胆病杂志,2021,37(7):1578-1581.
[13] 李萍,袁春辉,朱长明,等.肝硬化合并上消化道出血患者预后的影响因素及mNUTRIC评分、PALBI评分和预后营养指数的预测价值分析[J].现代生物医学进展,2023,23(3):545-550.