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Lancet Gastroenterology & Hepatology:低风险消化道出血患者识别方法

2017-06-24 zhangfan MedSci原创

研究人员开发了一种新的临床预测模型用于下消化道出血患者风险评估,该系统对患者的合理化治疗以及医疗资源节约具有重要意义

急性下消化道出血是急救住院的常见原因。如何识别低风险的患者降低住院率是临床研究的重点。近日研究人员开发了一套简易的识别下消化道出血低风险患者的评估方法。研究人员对2015年英国143家医院的下消化道出血患者数据进行分析建立相应的模型,采用多变量逻辑回归模型确定安全指标,考察因素包括无再出血,输血治疗,28天再入院或死亡率。该模型被转换成一个简化的风险评分系统并在288例下消化道出血患者中进行外部验证。在系统开发阶段收纳了2336名患者数据,其中1599人(68%)为低风险无需住院患者,研究人员考察了年龄、性别、下消化道出血史、直肠检查、心率、收缩压、血红蛋白等指标对患者疾病风险的影响 (C 统计 0.84,95% CI 0.82–0.86)。校准曲线显示风险评分在验证队列中有良好的准确度。多项指标(Rockall, Blatchford, Strate, BLEED, AIMS65,  NOBLADS)考察证实该预测模型有较高的准确性。评分不超过8分的患者其消化道出血不严重,门诊离院后的安全性超过95%。研究人员开发了一种新的临床预测模型用于下消化道出血患者风险评估,该系统对

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  1. 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ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=214836, encodeId=488c2148364c, content=合理评估,适宜治疗,好方法。, beContent=null, objectType=article, channel=null, level=null, likeNumber=97, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=60791943465, createdName=1e0f8808m18(暂无匿称), createdTime=Sat Jun 24 14:39:42 CST 2017, time=2017-06-24, status=1, ipAttribution=)]
    2017-10-13 许安
  2. 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ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=214836, encodeId=488c2148364c, content=合理评估,适宜治疗,好方法。, beContent=null, objectType=article, channel=null, level=null, likeNumber=97, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=60791943465, createdName=1e0f8808m18(暂无匿称), createdTime=Sat Jun 24 14:39:42 CST 2017, time=2017-06-24, status=1, ipAttribution=)]
  3. 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target=_blank style='color:#2F92EE;'>#Gastroenterology#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=7854, encryptionId=7730e85412, topicName=Gastroenterology)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=5fc29706655, createdName=chaojitidian, createdTime=Mon Jun 26 00:46:00 CST 2017, time=2017-06-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=214843, encodeId=dc222148434c, content=非常好的文章,学习了,很受益, beContent=null, objectType=article, channel=null, level=null, likeNumber=75, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo7LIiaRZTzJ3SEfiauCzTMPW7YvPPYLNJBXG9oh6Al1icq2VQQkIHWxqXehcicTS62YKJVBhxeth3wggw/0, createdBy=7ce01621306, createdName=天涯183, createdTime=Sat Jun 24 15:23:44 CST 2017, time=2017-06-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=214836, encodeId=488c2148364c, content=合理评估,适宜治疗,好方法。, beContent=null, objectType=article, channel=null, level=null, likeNumber=97, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=60791943465, createdName=1e0f8808m18(暂无匿称), createdTime=Sat Jun 24 14:39:42 CST 2017, time=2017-06-24, status=1, ipAttribution=)]
    2017-11-08 howi
  4. 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encryptionId=94ffe853a7, topicName=Gastroenterol)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=0bed488, createdName=jktdtl, createdTime=Sat Nov 11 17:46:00 CST 2017, time=2017-11-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=219686, encodeId=348021968687, content=这个可以啊,不错, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mONcle9pic3zMoyicyo6ia9f4IuLQAwZoxD6Hx4ibd5CMcOCYhStY6oDibbKK6O2X8iaicldO5ib8j1iapOIobIKCGiczU2A/0, createdBy=56251941490, createdName=虈亣靌, createdTime=Fri Jul 07 23:27:18 CST 2017, time=2017-07-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1426757, encodeId=83dc1426e571e, content=<a href='/topic/show?id=221d685172' target=_blank style='color:#2F92EE;'>#EPA#</a>, beContent=null, objectType=article, channel=null, level=null, 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target=_blank style='color:#2F92EE;'>#Gastroenterology#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=7854, encryptionId=7730e85412, topicName=Gastroenterology)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=5fc29706655, createdName=chaojitidian, createdTime=Mon Jun 26 00:46:00 CST 2017, time=2017-06-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=214843, encodeId=dc222148434c, content=非常好的文章,学习了,很受益, beContent=null, objectType=article, channel=null, level=null, likeNumber=75, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo7LIiaRZTzJ3SEfiauCzTMPW7YvPPYLNJBXG9oh6Al1icq2VQQkIHWxqXehcicTS62YKJVBhxeth3wggw/0, createdBy=7ce01621306, createdName=天涯183, createdTime=Sat Jun 24 15:23:44 CST 2017, time=2017-06-24, status=1, 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  5. 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target=_blank style='color:#2F92EE;'>#Gastroenterology#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=7854, encryptionId=7730e85412, topicName=Gastroenterology)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=5fc29706655, createdName=chaojitidian, createdTime=Mon Jun 26 00:46:00 CST 2017, time=2017-06-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=214843, encodeId=dc222148434c, content=非常好的文章,学习了,很受益, beContent=null, objectType=article, channel=null, level=null, likeNumber=75, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo7LIiaRZTzJ3SEfiauCzTMPW7YvPPYLNJBXG9oh6Al1icq2VQQkIHWxqXehcicTS62YKJVBhxeth3wggw/0, createdBy=7ce01621306, createdName=天涯183, createdTime=Sat Jun 24 15:23:44 CST 2017, time=2017-06-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=214836, encodeId=488c2148364c, content=合理评估,适宜治疗,好方法。, beContent=null, objectType=article, channel=null, level=null, likeNumber=97, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=60791943465, createdName=1e0f8808m18(暂无匿称), createdTime=Sat Jun 24 14:39:42 CST 2017, time=2017-06-24, status=1, ipAttribution=)]
    2017-07-07 虈亣靌

    这个可以啊,不错

    0

  6. 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target=_blank style='color:#2F92EE;'>#Gastroenterology#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=7854, encryptionId=7730e85412, topicName=Gastroenterology)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=5fc29706655, createdName=chaojitidian, createdTime=Mon Jun 26 00:46:00 CST 2017, time=2017-06-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=214843, encodeId=dc222148434c, content=非常好的文章,学习了,很受益, beContent=null, objectType=article, channel=null, level=null, likeNumber=75, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo7LIiaRZTzJ3SEfiauCzTMPW7YvPPYLNJBXG9oh6Al1icq2VQQkIHWxqXehcicTS62YKJVBhxeth3wggw/0, createdBy=7ce01621306, createdName=天涯183, createdTime=Sat Jun 24 15:23:44 CST 2017, time=2017-06-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=214836, encodeId=488c2148364c, content=合理评估,适宜治疗,好方法。, beContent=null, objectType=article, channel=null, level=null, likeNumber=97, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=60791943465, createdName=1e0f8808m18(暂无匿称), createdTime=Sat Jun 24 14:39:42 CST 2017, time=2017-06-24, status=1, ipAttribution=)]
    2017-06-26 gwc384
  7. 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ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=214836, encodeId=488c2148364c, content=合理评估,适宜治疗,好方法。, beContent=null, objectType=article, channel=null, level=null, likeNumber=97, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=60791943465, createdName=1e0f8808m18(暂无匿称), createdTime=Sat Jun 24 14:39:42 CST 2017, time=2017-06-24, status=1, ipAttribution=)]
  8. 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target=_blank style='color:#2F92EE;'>#Gastroenterology#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=7854, encryptionId=7730e85412, topicName=Gastroenterology)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=5fc29706655, createdName=chaojitidian, createdTime=Mon Jun 26 00:46:00 CST 2017, time=2017-06-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=214843, encodeId=dc222148434c, content=非常好的文章,学习了,很受益, beContent=null, objectType=article, channel=null, level=null, likeNumber=75, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo7LIiaRZTzJ3SEfiauCzTMPW7YvPPYLNJBXG9oh6Al1icq2VQQkIHWxqXehcicTS62YKJVBhxeth3wggw/0, createdBy=7ce01621306, createdName=天涯183, createdTime=Sat Jun 24 15:23:44 CST 2017, time=2017-06-24, status=1, 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  9. [GetPortalCommentsPageByObjectIdResponse(id=2071819, encodeId=a3ef20e1819f3, content=<a href='/topic/show?id=9d4ee84647' target=_blank style='color:#2F92EE;'>#GAS#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=50, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=7846, encryptionId=9d4ee84647, topicName=GAS)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=e2dd327, createdName=许安, createdTime=Fri Oct 13 01:46:00 CST 2017, time=2017-10-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1711097, encodeId=39a21e110971a, content=<a href='/topic/show?id=9a1c289680' target=_blank style='color:#2F92EE;'>#AST#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=61, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=2896, encryptionId=9a1c289680, topicName=AST)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=8b9831894722, 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target=_blank style='color:#2F92EE;'>#Gastroenterology#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=7854, encryptionId=7730e85412, topicName=Gastroenterology)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=5fc29706655, createdName=chaojitidian, createdTime=Mon Jun 26 00:46:00 CST 2017, time=2017-06-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=214843, encodeId=dc222148434c, content=非常好的文章,学习了,很受益, beContent=null, objectType=article, channel=null, level=null, likeNumber=75, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo7LIiaRZTzJ3SEfiauCzTMPW7YvPPYLNJBXG9oh6Al1icq2VQQkIHWxqXehcicTS62YKJVBhxeth3wggw/0, createdBy=7ce01621306, createdName=天涯183, createdTime=Sat Jun 24 15:23:44 CST 2017, time=2017-06-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=214836, encodeId=488c2148364c, content=合理评估,适宜治疗,好方法。, beContent=null, objectType=article, channel=null, level=null, likeNumber=97, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=60791943465, createdName=1e0f8808m18(暂无匿称), createdTime=Sat Jun 24 14:39:42 CST 2017, time=2017-06-24, status=1, ipAttribution=)]
    2017-06-24 天涯183

    非常好的文章,学习了,很受益

    0

  10. 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target=_blank style='color:#2F92EE;'>#Gastroenterology#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=7854, encryptionId=7730e85412, topicName=Gastroenterology)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=5fc29706655, createdName=chaojitidian, createdTime=Mon Jun 26 00:46:00 CST 2017, time=2017-06-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=214843, encodeId=dc222148434c, content=非常好的文章,学习了,很受益, beContent=null, objectType=article, channel=null, level=null, likeNumber=75, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo7LIiaRZTzJ3SEfiauCzTMPW7YvPPYLNJBXG9oh6Al1icq2VQQkIHWxqXehcicTS62YKJVBhxeth3wggw/0, createdBy=7ce01621306, createdName=天涯183, createdTime=Sat Jun 24 15:23:44 CST 2017, time=2017-06-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=214836, encodeId=488c2148364c, content=合理评估,适宜治疗,好方法。, beContent=null, objectType=article, channel=null, level=null, likeNumber=97, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=60791943465, createdName=1e0f8808m18(暂无匿称), createdTime=Sat Jun 24 14:39:42 CST 2017, time=2017-06-24, status=1, ipAttribution=)]
    2017-06-24 1e0f8808m18(暂无匿称)

    合理评估,适宜治疗,好方法。

    0

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质子泵抑制剂(PPIs)对心肌梗死后患者服用抗血栓形成剂并使用的非甾体类抗炎药(NSAIDs)治疗后消化道出血的风险的影响是怎样的呢?这是一个全国性的队列研究,是以1997年和2011年之间链接丹麦所有医院的行政登记资料为基础的。这些研究参与者均为30岁及以上,并被确诊为第一次发生心肌梗死,且出院后存活至少30天。研究人员使用调整时间相关的Cox回归模型评估了根据NSAIDs加抗血栓治疗,PPIs

Aliment Pharmacol Ther:胃肠出血相关因素研究进展

众所周知,阿司匹林有导致胃肠出血的风险。那么,减少阿司匹林用量能否改善胃肠出血的情况呢?最近发表在Aliment Pharmacol Ther杂志上的一篇文章针对胃肠出血相关因素进行了研究。该研究筛选了服用低剂量阿司匹林的患者(75-325mg /日),并对其年龄、性别、纳入时间等条件进行控制。在台湾国家健康保险研究数据库中,按照1:5的比例随机抽取研究对象。Cox比例风险回归模型用于评估下消化道

BMJ:≥75岁应慎用新型口服抗凝药

近期Abraham NS等人通过Optum Labs Data数据库进行了一项基于人群的回顾性、倾向匹配的队列研究,探究新型口服抗凝药物达比加群(dabigatran)、利伐沙班(rivaroxaban)与华法林(Warfarin)相比其胃肠道出血风险。参与者从2010年11月1日至2013年9月30日使用达比加群(dabigatran)、利伐沙班(rivaroxaban)与华法林(Warfari

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