Early Risk Score for Predicting Hypotension in Normotensive Patients with Non-Variceal Upper Gastrointestinal Bleedin
Risk assessment for upper gastrointestinal bleeding (UGIB) is important; however, current scoring systems are insufficient. We aimed to develop and validate a prediction model for rapidly determining the occurrence of hypotension in non-variceal UGIB patients with normotension (systolic blood pressu...
Main Authors: | , , , , , , , , |
---|---|
Format: | Article |
Language: | English |
Published: |
MDPI AG
2019-01-01
|
Series: | Journal of Clinical Medicine |
Subjects: | |
Online Access: | http://www.mdpi.com/2077-0383/8/1/37 |
id |
doaj-9b50990c2e204c66bf21958d601dab44 |
---|---|
record_format |
Article |
spelling |
doaj-9b50990c2e204c66bf21958d601dab442020-11-24T22:18:00ZengMDPI AGJournal of Clinical Medicine2077-03832019-01-01813710.3390/jcm8010037jcm8010037Early Risk Score for Predicting Hypotension in Normotensive Patients with Non-Variceal Upper Gastrointestinal BleedinByuk Sung Ko0Youn-Jung Kim1Dae Ho Jung2Chang Hwan Sohn3Dong Woo Seo4Yoon-Seon Lee5Kyoung Soo Lim6Hwoon-yong Jung7Won Young Kim8Department of Emergency Medicine, College of Medicine, Hanyang University, 222 Wangsimni-ro, Seongdong-gu, Seoul 133-791, KoreaDepartment of Emergency Medicine, Asan Medical Center, College of Medicine, University of Ulsan, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, KoreaDepartment of Emergency Medicine, Asan Medical Center, College of Medicine, University of Ulsan, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, KoreaDepartment of Emergency Medicine, Asan Medical Center, College of Medicine, University of Ulsan, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, KoreaDepartment of Emergency Medicine, Asan Medical Center, College of Medicine, University of Ulsan, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, KoreaDepartment of Emergency Medicine, Asan Medical Center, College of Medicine, University of Ulsan, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, KoreaDepartment of Emergency Medicine, Asan Medical Center, College of Medicine, University of Ulsan, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, KoreaDepartment of Gastroenterology, Asan Medical Center, College of Medicine, University of Ulsan, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, KoreaDepartment of Emergency Medicine, Asan Medical Center, College of Medicine, University of Ulsan, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, KoreaRisk assessment for upper gastrointestinal bleeding (UGIB) is important; however, current scoring systems are insufficient. We aimed to develop and validate a prediction model for rapidly determining the occurrence of hypotension in non-variceal UGIB patients with normotension (systolic blood pressure ≥90 mmHg) at emergency department presentation. In this prospective observational cohort study, consecutive non-variceal UGIB patients between January 2012 and April 2017 were enrolled. We developed and validated a new prediction model through logistic regression, with the occurrence of hypotension <24 h as the primary outcome. Among 3363 UGIB patients, 1439 non-variceal UGIB patients were included. The risk factors for the occurrence of hypotension were lactate level, blood in nasogastric tube, and systolic blood pressure. The area under the curve (AUC) of the new scoring model (LBS—Lactate, Blood in nasogastric tube, Systolic blood pressure) in the development cohort was 0.74, higher than the value of 0.64 of the Glasgow–Blatchford score for predicting the occurrence of hypotension. The AUC of the LBS score in the validation cohort was 0.83. An LBS score of ≤2 had a negative predictive value of 99.5% and an LBS score of ≥7 had a specificity of 97.5% in the validation cohort. The new LBS score stratifies normotensive patients with non-variceal UGIB at risk for developing hypotension.http://www.mdpi.com/2077-0383/8/1/37non-variceal upper gastrointestinal bleedinghypotensionlactaterisk model |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Byuk Sung Ko Youn-Jung Kim Dae Ho Jung Chang Hwan Sohn Dong Woo Seo Yoon-Seon Lee Kyoung Soo Lim Hwoon-yong Jung Won Young Kim |
spellingShingle |
Byuk Sung Ko Youn-Jung Kim Dae Ho Jung Chang Hwan Sohn Dong Woo Seo Yoon-Seon Lee Kyoung Soo Lim Hwoon-yong Jung Won Young Kim Early Risk Score for Predicting Hypotension in Normotensive Patients with Non-Variceal Upper Gastrointestinal Bleedin Journal of Clinical Medicine non-variceal upper gastrointestinal bleeding hypotension lactate risk model |
author_facet |
Byuk Sung Ko Youn-Jung Kim Dae Ho Jung Chang Hwan Sohn Dong Woo Seo Yoon-Seon Lee Kyoung Soo Lim Hwoon-yong Jung Won Young Kim |
author_sort |
Byuk Sung Ko |
title |
Early Risk Score for Predicting Hypotension in Normotensive Patients with Non-Variceal Upper Gastrointestinal Bleedin |
title_short |
Early Risk Score for Predicting Hypotension in Normotensive Patients with Non-Variceal Upper Gastrointestinal Bleedin |
title_full |
Early Risk Score for Predicting Hypotension in Normotensive Patients with Non-Variceal Upper Gastrointestinal Bleedin |
title_fullStr |
Early Risk Score for Predicting Hypotension in Normotensive Patients with Non-Variceal Upper Gastrointestinal Bleedin |
title_full_unstemmed |
Early Risk Score for Predicting Hypotension in Normotensive Patients with Non-Variceal Upper Gastrointestinal Bleedin |
title_sort |
early risk score for predicting hypotension in normotensive patients with non-variceal upper gastrointestinal bleedin |
publisher |
MDPI AG |
series |
Journal of Clinical Medicine |
issn |
2077-0383 |
publishDate |
2019-01-01 |
description |
Risk assessment for upper gastrointestinal bleeding (UGIB) is important; however, current scoring systems are insufficient. We aimed to develop and validate a prediction model for rapidly determining the occurrence of hypotension in non-variceal UGIB patients with normotension (systolic blood pressure ≥90 mmHg) at emergency department presentation. In this prospective observational cohort study, consecutive non-variceal UGIB patients between January 2012 and April 2017 were enrolled. We developed and validated a new prediction model through logistic regression, with the occurrence of hypotension <24 h as the primary outcome. Among 3363 UGIB patients, 1439 non-variceal UGIB patients were included. The risk factors for the occurrence of hypotension were lactate level, blood in nasogastric tube, and systolic blood pressure. The area under the curve (AUC) of the new scoring model (LBS—Lactate, Blood in nasogastric tube, Systolic blood pressure) in the development cohort was 0.74, higher than the value of 0.64 of the Glasgow–Blatchford score for predicting the occurrence of hypotension. The AUC of the LBS score in the validation cohort was 0.83. An LBS score of ≤2 had a negative predictive value of 99.5% and an LBS score of ≥7 had a specificity of 97.5% in the validation cohort. The new LBS score stratifies normotensive patients with non-variceal UGIB at risk for developing hypotension. |
topic |
non-variceal upper gastrointestinal bleeding hypotension lactate risk model |
url |
http://www.mdpi.com/2077-0383/8/1/37 |
work_keys_str_mv |
AT byuksungko earlyriskscoreforpredictinghypotensioninnormotensivepatientswithnonvaricealuppergastrointestinalbleedin AT younjungkim earlyriskscoreforpredictinghypotensioninnormotensivepatientswithnonvaricealuppergastrointestinalbleedin AT daehojung earlyriskscoreforpredictinghypotensioninnormotensivepatientswithnonvaricealuppergastrointestinalbleedin AT changhwansohn earlyriskscoreforpredictinghypotensioninnormotensivepatientswithnonvaricealuppergastrointestinalbleedin AT dongwooseo earlyriskscoreforpredictinghypotensioninnormotensivepatientswithnonvaricealuppergastrointestinalbleedin AT yoonseonlee earlyriskscoreforpredictinghypotensioninnormotensivepatientswithnonvaricealuppergastrointestinalbleedin AT kyoungsoolim earlyriskscoreforpredictinghypotensioninnormotensivepatientswithnonvaricealuppergastrointestinalbleedin AT hwoonyongjung earlyriskscoreforpredictinghypotensioninnormotensivepatientswithnonvaricealuppergastrointestinalbleedin AT wonyoungkim earlyriskscoreforpredictinghypotensioninnormotensivepatientswithnonvaricealuppergastrointestinalbleedin |
_version_ |
1725783474688753664 |