• Исмати А.О., Аносов В.Д., Мамараджабов С.Э., Назарова М.З.
  1 - Самаркандский государственный медицинский университет, Республика Узбекистан, г. Самар-канд; 2 - Городская клиническая больница №15 им. О.М. Филатова, Российская Федерация, г. Москва

Аннотация

За последние полвека были существенно усовершенствованы подходы к лечению и диагностике пациентов с желудочно-кишечными кровотечениями из верхних отделов. Однако ряд факторов продолжают проявлять негативное влияния, сглаживая успехи десятилетий. В контексте череды высокотехнологических нововведений и безуспешных попыток получить перманентные положительные тенденции в статистических показателях свою значимость обретает стратификация пациентов по группам риска и прогнозирование неблагоприятного исхода с целью определения пациентов, наиболее нуждающихся в интенсификации лечебного процесса. Каждая из популярных интегральных шкал была разработана с собственной специфической прогностической целью. Тем не менее, это не препятствовало исследователям проводить валидацию шкал на прогнозе летальности с последующим сравнительным анализом. На данный момент, лидирующей по точности преэндоскопической шкалой прогноза летальности признана ABC, а хуже всего проявляет себя Glasgow-Blatchford Bleeding Score. Среди постэндоскопических шкал доминирует итальянская Progetto Nazionale Emorragia Digestive score. Тем не менее, каждая из широкоизвестных интегральных шкал имеет свои преимущества и недостатки, понимание которых позволяет избирательно подходить к применению в различных случаях.

Ключевые слова

желудочно-кишечное кровотечение, прогноз, шкала, летальность.

Литература

1. de Groot NL, et al Reassessment of the predictive value of the Forrest classification for peptic ulcer rebleeding and mortality: can classification be simplified? Endoscopy. 2014 Jan;46(1):46-52. doi: 10.1055/s-0033-1344884. Epub 2013 Nov 11. PMID: 24218308.

2. Jong NH, et al Prediction of clinical outcome in patients with nonvariceal gastrointestinal bleeding using Forrest classification and Rockall score. Kasr Al Ainy Med J 2018;24:83-8

3. Lai Y, et al. Development and validation of a model to predict rebleeding within three days after endoscopic hemostasis for high-risk peptic ulcer bleeding. BMC Gastroenterol. 2022 Feb 14;22(1):64.

4. Budimir I, et al Scoring systems for peptic ulcer bleeding: Which one to use? World J Gastroenterol. 2017 Nov 7;23(41):7450-7458.

5. Laursen SB, et al The Glasgow Blatchford score is the most accurate assessment of patients with upper gastrointestinal hemorrhage. Clin Gastroenterol Hepatol. 2012 Oct;10(10):1130-1135.e1.

6. Rockall TA, et al. Risk assessment after acute upper gastrointestinal haemorrhage. Gut. 1996 Mar;38(3):316-21.

7. Kim BJ, Park MK, Kim SJ, Kim ER, Min BH, Son HJ, Rhee PL, Kim JJ, Rhee JC, Lee JH. Comparison of scoring systems for the prediction of outcomes in patients with nonvariceal upper gastrointestinal bleeding: a prospective study. Dig Dis Sci. 2009 Nov;54(11):2523-9.

8. Vreeburg EM, Terwee CB, Snel P, Rauws EA, Bartelsman JF, Meulen JH, Tytgat GN. Validation of the Rockall risk scoring system in upper gastrointestinal bleeding. Gut. 1999 Mar;44(3):331-5.

9. Ebrahimi Bakhtavar H, et al. Clinical Scoring Systems in Predicting the Outcome of Acute Upper Gastrointestinal Bleeding; a Narrative Review. Emerg (Tehran). 2017;5(1):e36. Epub 2017 Jan 11. PMID: 28286843; PMCID: PMC5325906.

10. Ebrahimi Bakhtavar H, Morteza Bagi HR, Rahmani F, Shahsavari Nia K, Ettehadi A. Clinical Scoring Systems in Predicting the Outcome of Acute Upper Gastrointestinal Bleeding; a Narrative Review. Emerg (Tehran). 2017;5(1):e36. Epub 2017 Jan 11. PMID: 28286843; PMCID: PMC5325906.

11. Benedeto-Stojanov D, Bjelaković M, Stojanov D, Aleksovski B. Prediction of in-hospital mortality after acute upper gastrointestinal bleeding: cross-validation of several risk scoring systems. J Int Med Res. 2022 Mar;50(3):3000605221086442.

12. Blatchford O, Murray WR, Blatchford M. A risk score to predict need for treatment for upper-gastrointestinal haemorrhage. Lancet. 2000 Oct 14;356(9238):1318-21.

13. Liu S, et al. Comparing the Performance of the ABC, AIMS65, GBS, and pRS Scores in Predicting 90-day Mortality Or Rebleeding Among Emergency Department Patients with Acute Upper Gastrointestinal Bleeding: A Prospective Multicenter Study. J Transl Int Med. 2021 Jun 16;9(2):114-122.

14. Stanley A J, et al. Comparison of risk scoring systems for patients presenting with upper gastrointestinal bleeding: international multicentre prospective study BMJ 2017; 356 :i6432

15. Cheng DW, et al. A modified Glasgow Blatchford Score improves risk stratification in upper gastrointestinal bleed: a prospective comparison of scoring systems. Aliment Pharmacol Ther. 2012 Oct;36(8):782-9. doi: 10.1111/apt.12029. Epub 2012 Aug 28. PMID: 22928529.

16. Shahrami A, Ahmadi S, Safari S. Full and Modified Glasgow-Blatchford Bleeding Score in Predicting the Outcome of Patients with Acute Upper Gastrointestinal Bleeding; a Diagnostic Accuracy Study. Emerg (Tehran). 2018;6(1):e31. Epub 2018 May 17. PMID: 30009233; PMCID: PMC6036534.

17. Ur-Rahman, A., et al. Both Full Glasgow-Blatchford Score and Modified Glasgow-Blatchford Score Predict the Need for Intervention and Mortality in Patients with Acute Lower Gastrointestinal Bleeding. Dig Dis Sci 63, 3020–3025 (2018).

18. Stanley AJ, et al Outpatient management of patients with low-risk upper-gastrointestinal haemorrhage: multicentre validation and prospective evaluation. Lancet. 2009 Jan 3;373(9657):42-7.

19. Marmo R, et al. Predictive factors of mortality from nonvariceal upper gastrointestinal hemorrhage: a multicenter study. Am J Gastroenterol. 2008 Jul;103(7):1639-47; quiz 1648.

20. Contreras-Omaña R, et al The Progetto Nazionale Emorragia Digestiva (PNED) system vs. the Rockall score as mortality predictors in patients with nonvariceal upper gastrointestinal bleeding: A multicenter prospective study. Rev Gastroenterol Mex. 2017 Apr-Jun;82(2):123-128. English, Spanish.

21. Chandnani S, et al. Clinical utility of risk scores in variceal bleeding. Arq Gastroenterol. 2019 Sep 30;56(3):286-293.

22. Saltzman JR, et al A simple risk score accurately predicts in-hospital mortality, length of stay, and cost in acute upper GI bleeding. Gastrointest Endosc. 2011 Dec;74(6):1215-24. doi: 10.1016/j.gie.2011.06.024. Epub 2011 Sep 10. PMID: 21907980.

23. Yaka E, Yılmaz S, Doğan NÖ, Pekdemir M. Comparison of the Glasgow-Blatchford and AIMS65 scoring systems for risk stratification in upper gastrointestinal bleeding in the emergency department. Acad Emerg Med. 2015 Jan;22(1):22-30. doi: 10.1111/acem.12554. Epub 2014 Dec 31. PMID: 25556538.

24. Robertson M, Majumdar A, Boyapati R, Chung W, Worland T, Terbah R, Wei J, Lontos S, Angus P, Vaughan R. Risk stratification in acute upper GI bleeding: comparison of the AIMS65 score with the Glasgow-Blatchford and Rockall scoring systems. Gastrointest Endosc. 2016 Jun;83(6):1151-60. doi: 10.1016/j.gie.2015.10.021. Epub 2015 Oct 26. PMID: 26515955.

25. Thandassery RB, Sharma M, John AK, Al-Ejji KM, Wani H, Sultan K, Al-Mohannadi M, Yakoob R, Derbala M, Al-Dweik N, Butt MT, Al-Kaabi SR. Clinical Application of AIMS65 Scores to Predict Outcomes in Patients with Upper Gastrointestinal Hemorrhage. Clin Endosc. 2015 Sep;48(5):380-4. doi: 10.5946/ce.2015.48.5.380. Epub 2015 Sep 30. PMID: 26473120; PMCID: PMC4604275.

26. Laursen SB, Oakland K, Laine L, Bieber V, Marmo R, Redondo-Cerezo E, Dalton HR, Ngu J, Schultz M, Soncini M, Gralnek I, Jairath V, Murray IA, Stanley AJ. ABC score: a new risk score that accurately predicts mortality in acute upper and lower gastrointestinal bleeding: an international multicentre study. Gut. 2021 Apr;70(4):707-716. doi: 10.1136/gutjnl-2019-320002. Epub 2020 Jul 28. PMID: 32723845.

27. Mules, TC, Stedman, C, Ding, S, et al. Comparison of Risk Scoring Systems in Hospitalised Patients who Develop Upper Gastrointestinal Bleeding. GastroHep. 2021; 3: 5– 11. https://doi.org/10.1002/ygh2.436

28. Jimenez-Rosales, R.;   Lopez-Tobaruela, J.M.; Lopez-Vico, M.; Ortega-Suazo, E.J.; Martinez-Cara, J.G.; Redondo-Cerezo, E. Performance of the New ABC and MAP(ASH) Scores in the Prediction of Relevant Outcomes in Upper Gastrointestinal Bleeding. J. Clin. Med. 2023, 12, 1085. https://doi.org/10.3390/jcm12031085

29. Saade, M.C., Kerbage, A., Jabak, S. et al. Validation of the new ABC score for predicting 30-day mortality in gastrointestinal bleeding. BMC Gastroenterol 22, 301 (2022). https://doi.org/10.1186/s12876-022-02374-y

30. Kim MS, Moon HS, Kwon IS, Park JH, Kim JS, Kang SH, Sung JK, Lee ES, Kim SH, Lee BS, Jeong HY. Validation of a new risk score system for non-variceal upper gastrointestinal bleeding. BMC Gastroenterol. 2020 Jun 17;20(1):193. doi: 10.1186/s12876-020-01346-4. PMID: 32552662; PMCID: PMC7301517.

31. Sakong, Heon MDa; Moon, Hee Seok MD, PhDa,*; Choi, Seong Woo MDa; Kang, Sun Hyung MD, PhDa; Sung, Jae Kyu MD, PhDa; Jeong, Hyun Yong MD, PhDa. ABC score is an effective predictor of outcomes in peptic ulcer bleeding. Medicine 101(49):p e31541, December 9, 2022. | DOI: 10.1097/MD.0000000000031541

32. Park SM, Yeum SC, Kim BW, Kim JS, Kim JH, Sim EH, Ji JS, Choi H. Comparison of AIMS65 Score and Other Scoring Systems for Predicting Clinical Outcomes in Koreans with Nonvariceal Upper Gastrointestinal Bleeding. Gut Liver. 2016 Jul 15;10(4):526-31. doi: 10.5009/gnl15153. PMID: 27377742; PMCID: PMC4933411.

33. Gu L, Xu F, Yuan J. Comparison of AIMS65, Glasgow-Blatchford and Rockall scoring approaches in predicting the risk of in-hospital death among emergency hospitalized patients with upper gastrointestinal bleeding: a retrospective observational study in Nanjing, China. BMC Gastroenterol. 2018 Jun 28;18(1):98. doi: 10.1186/s12876-018-0828-5. PMID: 29954332; PMCID: PMC6022417.

34. Tuncer H, Yardan T, Akdemir HU, Ayyildiz T. Comparison of four scoring systems for risk stratification of upper gastrointestinal bleeding. Pak J Med Sci. 2018 May-Jun;34(3):649-654. doi: 10.12669/pjms.343.14956. PMID: 30034432; PMCID: PMC6041537.

35. Lu M, Sun G, Huang H, Zhang X, Xu Y, Chen S, Song Y, Li X, Lv B, Ren J, Chen X, Zhang H, Mo C, Wang Y, Yang Y. Comparison of the Glasgow-Blatchford and Rockall Scores for prediction of nonvariceal upper gastrointestinal bleeding outcomes in Chinese patients. Medicine (Baltimore). 2019 May;98(21):e15716. doi: 10.1097/MD.0000000000015716. PMID: 31124950; PMCID: PMC6571241.

36. Li Y, Lu Q, Wu K, Ou X. Evaluation of Six Preendoscopy Scoring Systems to Predict Outcomes for Older Adults with Upper Gastrointestinal Bleeding. Gastroenterol Res Pract. 2022 Jan 30;2022:9334866. doi: 10.1155/2022/9334866. PMID: 35136407; PMCID: PMC8818397.

37. Redondo-Cerezo E, Vadillo-Calles F, Stanley AJ, Laursen S, Laine L, Dalton HR, Ngu JH, Schultz M, Jiménez-Rosales R. MAP(ASH): A new scoring system for the prediction of intervention and mortality in upper gastrointestinal bleeding. J Gastroenterol Hepatol. 2020 Jan;35(1):82-89. doi: 10.1111/jgh.14811. Epub 2019 Aug 19. PMID: 31359521.

38. Stanley AJ, Dalton HR, Blatchford O, Ashley D, Mowat C, Cahill A, Gaya DR, Thompson E, Warshow U, Hare N, Groome M, Benson G, Murray W. Multicentre comparison of the Glasgow Blatchford and Rockall Scores in the prediction of clinical end-points after upper gastrointestinal haemorrhage. Aliment Pharmacol Ther. 2011 Aug;34(4):470-5. doi: 10.1111/j.1365-2036.2011.04747.x. Epub 2011 Jun 26. PMID: 21707681.

39. Bryant RV, Kuo P, Williamson K, Yam C, Schoeman MN, Holloway RH, Nguyen NQ. Performance of the Glasgow-Blatchford score in predicting clinical outcomes and intervention in hospitalized patients with upper GI bleeding. Gastrointest Endosc. 2013 Oct;78(4):576-83. doi: 10.1016/j.gie.2013.05.003. Epub 2013 Jun 18. PMID: 23790755.

40. Marmo, Riccardo MD; Koch, Maurizio MD; Cipolletta, Livio MD; Capurso, Lucio MD; Grossi, Enzo MD; Cestari, Renzo MD; Bianco, Maria A MD; Pandolfo, Nicola MD; Dezi, Angelo MD; Casetti, Tino MD; Lorenzini, Ivano MD; Germani, Ugo MD; Imperiali, Giorgio MD; Stroppa, Italo MD; Barberani, Fausto MD; Boschetto, Sandro MD; Gigliozzi, Alessandro MD; Gatto, Giovanni MD; Peri, Vittorio MD; Buzzi, Andrea MD; Casa, Domenico Della MD; Di Cicco, Marino MD; Proietti, Massimo MD; Aragona, Giovanni MD; Giangregorio, Francesco MD; Allegretta, Luciano MD; Tronci, Salvatore MD; Michetti, Paolo MD; Romagnoli, Paola MD; Piubello, Walter MD; Ferri, Barbara MD; Fornari, Fabio MD; Del Piano, Mario MD; Pagliarulo, Michela MD; Di Mitri, Roberto MD; Trallori, Giacomo MD; Bagnoli, Sirio MD; Frosini, Giorgio MD; Macchiarelli, Raffaele MD; Sorrentini, Italo MD; Pietrini, Lorena MD; De Stefano, Salvatore MD; Ceglia, Tommaso MD; Chiozzini, Giorgio MD; Salvagnini, Mario MD; Di Muzio, Daniela MD; Rotondano, Gianluca MD, FACG3 for the Italian registry on upper gastrointestinal bleeding (Progetto Nazionale Emorragie Digestive—PNED 2). Predicting Mortality in Non-Variceal Upper Gastrointestinal Bleeders: Validation of the Italian PNED Score and Prospective Comparison With the Rockall Score. American Journal of Gastroenterology 105(6):p 1284-1291, June 2010. | DOI: 10.1038/ajg.2009.687

41. Tang Y, Shen J, Zhang F, Zhou X, Tang Z, You T. Scoring systems used to predict mortality in patients with acute upper gastrointestinal bleeding in the ED. Am J Emerg Med. 2018 Jan;36(1):27-32. doi: 10.1016/j.ajem.2017.06.053. Epub 2017 Jun 27. PMID: 28673695.

42. Cazacu SM, Alexandru DO, Statie RC, Iordache S, Ungureanu BS, Iovănescu VF, Popa P, Sacerdoțianu VM, Neagoe CD, Florescu MM. The Accuracy of Pre-Endoscopic Scores for Mortality Prediction in Patients with Upper GI Bleeding and No Endoscopy Performed. Diagnostics (Basel). 2023 Mar 21;13(6):1188. doi: 10.3390/diagnostics13061188. PMID: 36980496; PMCID: PMC10047350.

43. Hyett BH, Abougergi MS, Charpentier JP, Kumar NL, Brozovic S, Claggett BL, Travis AC, Saltzman JR. The AIMS65 score compared with the Glasgow-Blatchford score in predicting outcomes in upper GI bleeding. Gastrointest Endosc. 2013 Apr;77(4):551-7. doi: 10.1016/j.gie.2012.11.022. Epub 2013 Jan 26. PMID: 23357496.

44. Uysal Y, Babus SB, Kose A, Ates F, Biricik S, Erdogan S, Cevik I, Toker I, Ayrik C. The prognostic significance of the risk scores at upper gastrointestinal bleeding. Niger J Clin Pract. 2019 Aug;22(8):1099-1108. doi: 10.4103/njcp.njcp_193_18. PMID: 31417053.

45. Saade MC, Kerbage A, Jabak S, Makki M, Barada K, Shaib Y. Validation of the new ABC score for predicting 30-day mortality in gastrointestinal bleeding. BMC Gastroenterol. 2022 Jun 21;22(1):301. doi: 10.1186/s12876-022-02374-y. PMID: 35729498; PMCID: PMC9209314.