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J. Clin. Med. 2019, 8(1), 37; https://doi.org/10.3390/jcm8010037

Early Risk Score for Predicting Hypotension in Normotensive Patients with Non-Variceal Upper Gastrointestinal Bleeding

1
Department of Emergency Medicine, College of Medicine, Hanyang University, 222 Wangsimni-ro, Seongdong-gu, Seoul 133-791, Korea
2
Department of Emergency Medicine, Asan Medical Center, College of Medicine, University of Ulsan, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea
3
Research Scholar, Department of Biomedical Informatics, School of Medicine, University of San Diego, 9500 Gilman Drive #0728, La Jolla, CA 92093, USA
4
Department of Gastroenterology, Asan Medical Center, College of Medicine, University of Ulsan, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea
These authors contributed equally to this work.
These authors contributed equally to this work.
*
Author to whom correspondence should be addressed.
Received: 11 November 2018 / Revised: 24 December 2018 / Accepted: 26 December 2018 / Published: 2 January 2019
(This article belongs to the Section Vascular Medicine)
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Abstract

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. View Full-Text
Keywords: non-variceal upper gastrointestinal bleeding; hypotension; lactate; risk model non-variceal upper gastrointestinal bleeding; hypotension; lactate; risk model
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    Description: Table S1: Outcomes of the patients in the development group Table S2: Endoscopic finding of the patients in the development group Table S3: Test of accuracy of cutoff value for predicting need of red blood cell transfusion in the validation set
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Ko, B.S.; Kim, Y.-J.; Jung, D.H.; Sohn, C.H.; Seo, D.W.; Lee, Y.-S.; Lim, K.S.; Jung, H.-Y.; Kim, W.Y. Early Risk Score for Predicting Hypotension in Normotensive Patients with Non-Variceal Upper Gastrointestinal Bleeding. J. Clin. Med. 2019, 8, 37.

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