Analysis Of Prognostic Factors Influencing Non-varicose Upper Gastrointestinal Bleeding And Application Of AIMS 65 Score

Objective: To explore the prognostic factors affecting clinical intervention and death of patients with non-varicose upper gastrointestinal bleeding,and to verify the clinical value of AIMS 65 score in non-varicose upper gastrointestinal bleeding.Methods:1.A total of 215 patients with NVUGIB from the First Affiliated Hospital of Wannan Medical College from August 1,2018 to July 31,2019 were selected,and all of them are adult patients who met the diagnostic criteria for non-varicose upper gastrointestinal bleeding(2018edition)formulated by the Chinese Medical Association Digestive Endoscopy Branch were retrospectively analyzed.Design case information registration form andcollect clinical data of patients,including gender,age,history of tobacco and alcohol,family history,long-term and recent medication history,admission symptoms,systolic blood pressure,pulse,blood routine,blood urea nitrogen,plasma albumin,INR,endoscopic examination results,Data of basic diseases,clinical interventions(blood transfusion,endoscopic or surgical hemostasis,etc.),active bleeding after admission,death and death,and length of hospital stay were combined.The scores were calculated according to the AIMS 65 scoring system and the GBS scoring system to compare the clinical intervention and death of patients in different groups.2.Data processing was performed by SPSS 20.0 software.Count data is expressed by the number of cases(n)and percentage(%),and measurement data is expressed by the mean±standard deviation;Comparisons between groups were performed by one-factor analysis using t-test or chi-square test.Variables with statistical differences(P <0.5)were selected and multi-factor logistic regression analysis was performed to study the prognostic factors of clinical intervention and death.By drawing the receiver operating characteristic curve(ROC),the area under the curve(AUC)was used to evaluate the accuracy,assessment ability,and application value of the AIMS 65 score for clinical intervention and death prediction of patients.Results:1.A total of 215 subjects were studied,13 patients died,and the mortality rate was46.05%.There were 67 clinical interventions.The main causes of NVUGIB are peptic ulcers,which account for 60.46%,and malignant tumors,11.16%.The male to female ratio was2.98:1,and the average patient age was 57.14 ± 17.32 years.The previous history of upper gastrointestinal bleeding accounted for 9.77%.The main symptom upon admission was melena(75.35%).2.Univariate analysis showed: age,previous bleeding history,active bleeding after admission,systolic blood pressure,hematocrit,blood urea nitrogen,INR,albumin,hemoglobin,and non-varicose upper digestion between the clinical intervention group and the non-clinical intervention group Whether tract bleeding requires clinical intervention,(P <0.05);Multivariate logistic regression analysis showed that: previous history of bleeding,active bleeding after admission,systolic blood pressure(mmHg),blood urea nitrogen(mmol / L),hemoglobin(g /L)is an independent influencing factor of clinical intervention in patients with non-varicose upper gastrointestinal bleeding.Results of univariate comparison between survival group and death group: age,systolic blood pressure,hematocrit,INR,albumin were related to risk of death(P <0.05);Multivariate Logistic Regression Analysis Results: INR and systolic blood pressure were independent influencing factors for the risk of death in NVUGIB patients.3.The risk prediction of AIMS 65 scoring system for clinical interventions is AUROC0.800,which is lower than the GBS scoring system AUROC 0.859(p <0.05).In terms of predicting the risk of death,the areas under the curve of the AIMS 65 and GBS scoring systems were 0.867(95% CI,0.723-1.000)and 0.716(95% CI,0.561-0.872),respectively.There was no statistical difference between the two.4.The prediction for clinical intervention is AUCGBS> AUCAIMS 65,and the prediction for death is AUCAIMS 65> AUCGBS.Both AUCs were> 0.7.There was no significant difference in the predictive ability of the two scores on clinical intervention of patients(P = 0.171),and there was no significant difference in the predictive ability of the two scores on the death of patients(P = 0.165).Conclusion: Past bleeding history,active bleeding after admission,systolic blood pressure,blood urea nitrogen,and hemoglobin are independent risk factors that affect clinical intervention in patients with non-varicose upper gastrointestinal bleeding.INR and systolic blood pressure are independent risk factors affecting the death of patients with non-varicose upper gastrointestinal bleeding.The area under the curve(AUC)of the clinical intervention and death risk prediction of AIMS 65 score and GBS score in patients with non-varicose upper gastrointestinal hemorrhage are all greater than 0.7,which is used to predict clinica intervention and death.Equivalent to GBS.However,the AIMS 65 score is simple and easy tocalculate and convenient for clinical application.It may be a good tool for predicting clinical intervention and risk of death in patients with non-varicose upper gastrointestinal bleeding.