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KMID : 1100620180050040219
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Clinical and Experimental Emergency Medicine
2018 Volume.5 No. 4 p.219 ~ p.229
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Comparison of the National Early Warning Score+Lactate score with the pre-endoscopic Rockall, Glasgow-Blatchford, and AIMS65 scores in patients with upper gastrointestinal bleeding
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Kim Dae-Jin
Jo Si-On
Lee Jae-Baek
Jin Young-Ho
Jeong Tae-Oh
Yoon Jae-Chol
Park Bo-Young
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Abstract
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Objective: We compared the predictive value of the National Early Warning Score+Lactate (NEWS+L) score with those of other parameters such as the pre-endoscopic Rockall score (PERS), Glasgow-Blatchford score (GBS), and albumin, international normalized ratio, altered mental status, systolic blood pressure, age older than 65 years score (AIMS65) among patients with upper gastrointestinal bleeding (UGIB).
Methods: We conducted a retrospective study of patients with UGIB during 2 consecutive years. The primary outcome was the composite of in-hospital death, intensive care unit admission, and the need for ≥5 packs of red blood cell transfusion within 24 hours.
Results: Among 530 included patients, the composite outcome occurred in 59 patients (19 in-hospital deaths, 13 intensive care unit admissions, and 40 transfusions of ≥5 packs of red blood cells within 24 hours). The area under the receiver operating characteristic curve of the NEWS+L score for the composite outcome was 0.76 (95% confidence interval, 0.70 to 0.82), which demonstrated a significant difference compared to PERS (0.66, 0.59?0.73, P=0.004), but not to GBS (0.70, 0.64?0.77, P=0.141) and AIMS65 (0.76, 0.70?0.83, P=0.999). The sensitivities of NEWS+L scores of 3 (n=34, 6.4%), 4 (n=92, 17.4%), and 5 (n=171, 32.3%) were 100%, 98.3%, and 96.6%, respectively, while the sensitivity of an AIMS65 score of 0 (n=159, 30.0%) was 91.5%.
Conclusion: The NEWS+L score showed better discriminative performance than the PERS and comparable discriminative performance to the GBS and AIMS65. The NEWS+L score may be used to identify low-risk patients among patients with UGIB.
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KEYWORD
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Risk, Lactate, Mortality, Gastrointestinal, Bleeding
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