Validation And Comparison Of Red Cell Distribution Width,Glasgow-Blatchford Hemorrhage Score And AIMS65 Score System In Predicting High-Risk Acute Gastrointestinal Bleeding

Objective Upper gastro-intestinal bleeding(UGIB)refers to acute hemorrhage caused by upper digestive tract lesions above Treitz’s ligament,which is one of the important reasons for hospitalization of patients.However,the prognosis of different patients with acute UGIB is also different.Some patients with small amount of bleeding can recover completely without clinical treatment,while other patients with poor general condition and serious clinical symptoms need to receive effective treatment in time.Therefore,for patients with acute UGIB,it is important to distinguish between high-risk patients with high morbidity and mortality due to uncontrolled bleeding,and low-risk patients who can be safely discharged with close and early follow-up to effectively reduce patient hospitalization and mortality.In recent years,many studies have shown that red cell distribution width(RDW)is associated with the prognosis of acute UGIB,and GBS and Al MS65-scores are the most common clinical risk scores for acute UGIB.The objective of this study was to compare the value of RDW with the Glasgow-Blatchford Hemorrhage score(GBS)and Al MS65 score system in the prediction of high-risk acute UGIB,and to provide guidance for risk stratification and treatment of patients with first-diagnosed acute UGIB.Methods A total of 350 patients diagnosed with acute UGIB admitted to the Department ofGastroenterology of the First People’s Hospital of Hefei City from June 2020 to May2022 were selected as subjects.First of all,a total of 324 patients with acute upper UGIB were collected according to the inclusion and exclusion standard.On the first day after admission,general data such as gender,age,blood pressure at admission,heart rate,syncope and black stool,past medication history and past medical history were registered for all patients.Laboratory data including hemoglobin,albumin,liver and kidney function and RDW were collected.The information of recurrent bleeding,severe complications of shock or even death during hospitalization was recorded.After that,the patients were divided into high-risk group(148 cases)and low-risk group(176cases).multivariate Logistic regression analysis was carried out for the relevant variables with statistically significant differences between the high-risk group and the low-risk group.Receiver operating characteristic(ROC)curve was constructed,and the area under the curve(AUC)and 95% confidence interval(CI)were calculated to compare the ability of GBS,AIMS65 and RDW to predict UGIB high-risk patients Results 1.Compared with the low-risk group,patients with acute UGIB in the highrisk group were older,had higher utilization rate of active drugs and had higher incidence of other complications.The incidence of low systolic blood pressure(less than 90 mm Hg)and fast heart rate(more than 100 beats/min)was higher,the level of hemoglobin was lower,the level of urea nitrogen and red blood cell distribution width were higher.The median GBS scores of high-risk group and low-risk group were11.0(9-11)and 7.5(5-9),respectively,and the median Al MS65 scores were 1.0(1-2)and 1.0(0-1)(P<0.001),and the differences were statistically significant.2.The risk factors of high-risk acute UGIB were associated with the following factors(P<0.05):hemoglobin<100g/l,albumin<30g/l,urea nitrogen>25mmol/l,the use of active drugs and high RDW value.However,low systolic blood pressure(<90mm Hg),fast heart rate(>100 beats/min),and black stool were not significantly associated with the risk stratification of acute UGIB.3.ROC curve results suggested that RDW,GBS and AIMS65 all showed the ability to predict high-risk acute UGIB,among which GBS had the strongest prediction ability(AUC0.813,95%CI 0.768-0.858).4.ROC curve was used again to analyze RDW combined with GBS or AIMS65 score to predict high-risk acute UGIB,and the results showed that RDW combined with GBS had the strongest prediction ability(AUC0.885,95%CI 0.848-0.922).Conclusion High RDW(>14.5%),GBS and AIMS65 score have the ability to predict high-risk acute UGIB,and GBS has the strongest ability to predict high-risk acute UGIB.In addition,high RDW in combination with GBS or AIMS65 scoring systems further improves the accuracy of identifying high-risk patients with acute UGIB,thereby enhancing the ability to discriminate high-risk patients with acute upper gastrointestinal bleeding.And the RDW value’s acquisition is quick,convenient,inexpensive and reproducible,it is expected to be a new indicator for risk stratification of acute UGIB.