The effect of the shock index and scoring systems for predicting mortality among geriatric patients with upper gastrointestinal bleeding: a prospective cohort study

ABSTRACT BACKGROUND: Gastrointestinal (GI) bleeding is an important cause of mortality and morbidity among geriatric patients. OBJECTIVE: To investigate whether the shock index and other scoring systems are effective predictors of mortality and prognosis among geriatric patients presenting to the emergency department with complaints of upper GI bleeding. DESIGN AND SETTING: Prospective cohort study in an emergency department in Bursa, Turkey. METHODS: Patients over 65 years admitted to a single-center, tertiary emergency service between May 8, 2019, and April 30, 2020, and diagnosed with upper GI bleeding were analyzed. 30, 180 and 360-day mortality prediction performances of the shock index and the Rockall, Glasgow-Blatchford and AIMS-65 scores were evaluated. RESULTS: A total of 111 patients who met the criteria were included in the study. The shock index (P < 0.001) and AIMS-65 score (P < 0.05) of the patients who died within the 30-day period were found to be significantly different, while the shock index (P < 0.001), Rockall score (P < 0.001) and AIMS-65 score (P < 0.05) of patients who died within the 180-day and 360-day periods were statistically different. In the receiver operating characteristic (ROC) analysis for predicting 360-day mortality, the area under the curve (AUC) value was found to be 0.988 (95% confidence interval, CI, 0.971-1.000; P < 0.001). CONCLUSION: The shock index measured among geriatric patients with upper GI bleeding at admission seems to be a more effective predictor of prognosis than other scoring systems.

摘要 背景：胃肠道（GI）出血是老年患者致死与致残的重要病因。
研究目的：探讨休克指数（shock index）及其他评分系统能否作为因上消化道出血（upper GI bleeding）就诊于急诊科的老年患者的死亡与预后有效预测因子。
设计与研究地点：土耳其布尔萨某急诊科开展的前瞻性队列研究（prospective cohort study）。
研究方法：纳入2019年5月8日至2020年4月30日期间于单中心三级急诊科室收治的65岁以上、确诊为上消化道出血的患者进行分析。评估休克指数以及Rockall评分（Rockall score）、Glasgow-Blatchford评分（Glasgow-Blatchford score）、AIMS-65评分（AIMS-65 score）对患者30天、180天及360天死亡率的预测效能。
研究结果：本研究最终纳入111名符合纳入标准的患者。30天内死亡的患者，其休克指数（P < 0.001）与AIMS-65评分（P < 0.05）存在显著差异；而180天及360天内死亡的患者，其休克指数（P < 0.001）、Rockall评分（P < 0.001）及AIMS-65评分（P < 0.05）均存在统计学差异。针对360天死亡率预测的受试者工作特征（Receiver Operating Characteristic，ROC）分析显示，曲线下面积（Area Under the Curve，AUC）为0.988（95%置信区间（Confidence Interval，CI）：0.971~1.000；P < 0.001）。
研究结论：老年上消化道出血患者入院时检测的休克指数，相较其他评分系统，似乎是更为有效的预后预测因子。