Rockall score is the most widely used prognostic scale for assessing risk of complications from non-varicose upper gastrointestinal bleeding (UGIB). Several studies have been conducted in adult ...populations with non-varicose UGIB in different parts of the world, with conflicting findings regarding the extent of association between the score and some morbidity and mortality outcomes. Also, there is controversy regarding the best cut-off point for the score. Moreover, no studies validating this score in Colombia have been carried out.
To assess the diagnostic performance of the Rockall score in predicting rebleeding and mortality in patients with non-varicose UGIB.
A prospective cohort study was conducted in patients requiring upper gastrointestinal endoscopy (UGIE) for non-varicose bleeding. The pre-and post-endoscopy Rockall scores were calculated and outcomes, including mortality, UGIB-associated mortality and in hospital rebleeding were determined at the 1 and 3-month time points. The association between the scores and these outcomes was assessed using the chi2 or the Fisher test, whereas the discrimination ability of the score was determined using the areas under the ROC curve (AUC). High discrimination ability was considered to exist in cases in which an AUC ≤0.7 with α=0.05 could be rejected.
Overall, 177 patients were analyzed. In-hospital outcomes at 1 and 3 months were 12%, 17% and 23% for general mortality, 6%, 12% and 15% for UGIB mortality, and 19%, 30% and 37% for rebleeding. The post-endoscopy Rockall score was associated with the three outcomes at the three time points assessed, while the pre-endoscopy score was only associated with general mortality at the three time points, and rebleeding at 1 and 3 months. Regarding discrimination ability, although the AUC was greater than expected by randomness (0.5) in all cases, only one AUC ≤0.7 was rejected in the post-endoscopy score for in-hospital UGIB mortality (AUC=0.901; 95%CI: 0.845-0.958), at 1 month (AUC=0.836; 95%CI: 0.717-0.954) and at 3 months (AUC=0.869; 95%CI: 0.771-0.967), and for rebleeding at 1 month (AUC=0.793; 95%CI: 0.725-0.861) and at 3 months (AUC=0.806; 95%CI: 0.741-0.871).
An association was found between the Rockall score and rebleeding and mortality in patients with non-varicose UGIB. Only the post-endoscopy score had a high predictive ability for rebleeding and UGIB mortality.
Introducción: desde el 6 de marzo 2020 se confirmó el primer contagiado de la enfermedad coronavirus 2019 (COVID-19) en Colombia, se extendió por todo su territorio con un compromiso clínico ...variable. Es de vital importancia conocer las características de los pacientes afectados letalmente. Objetivos: describir las características clínicas y sociodemográficas de pacientes fallecidos por COVID-19 en Colombia hasta el 15 de mayo 2020. Materiales y métodos: estudio de corte transversal. Se tomaron datos de los pacientes fallecidos por COVID-19 en todo el territorio colombiano, registradas en las bases de datos reportadas por el Instituto Nacional de Salud desde el 6 de marzo a 15 de mayo 2020. Resultados: hasta el 15 de mayo 2020 se reportaron un total de 546 muertes, 60.8% de los fallecidos eran hombres. La edad mediana fue 69 años (RIC: 59-79) siendo 73.3% pacientes con 60 años o más, 86.8% tenían factores de riesgo conocidos, los más comunes fueron hipertensión arterial (37.9%), diabetes mellitus (18.7%), enfermedad pulmonar obstructiva crónica (17.3%) y antecedente de cardiopatía (15.2%), 3.3% eran casos provenientes del extranjero. Las principales zonas afectadas a nivel nacional fueron Bogotá (29.8%), Cali (12.2%), Cartagena (11.1%) y Leticia (6.2%). Conclusiones: la letalidad en Colombia por COVID-19 es de 3.8%. La mayoría de los pacientes tuvo una condición clínica asociada siendo la hipertensión arterial la más frecuente, pero enfermedad pulmonar obstructiva crónica e hipotiroidismo son relevantes en nuestra población.
El sangrado gastrointestinal es una emergencia médica y es la causa más frecuente de hospitalizaciones asociado con otras enfermedades a nivel mundial. Representa una entidad con tasa de mortalidad ...considerable, y se vincula con una morbilidad significativa (30 días) y costos para los sistemas de salud. La hemorragia de vías digestivas altas no varicosa se ha relacionado con factores de riesgo prevenibles, principalmente consumo de alcohol, infección por Helicobacter pylori y consumo de antiinflamatorios no esteroideos, entre otros. El diagnóstico se confirma con la endoscopia, que también sirve para proporcionar una intervención terapéutica. Esta entidad presenta complicaciones asociadas principalmente al resangrado y la muerte. El puntaje de Rockall es la escala pronostica más usada para evaluar el riesgo de complicaciones por hemorragia de vías altas no varicosa. Esta escala ha sido evaluada a nivel mundial en distintos contextos. Mediante el siguiente artículo se plantea revisar el estado del arte enfocado a pronóstico para esta entidad en particular. Palabras clave: tracto gastrointestinal superior; hemorragia gastrointestinal; epidemiología; pronóstico; endoscopia; mortalidad. Gastrointestinal bleeding is a medical emergency and is the most common cause of hospitalizations associated with other diseases worldwide. It represents an entity with a considerable mortality rate, and is associated with significant morbidity, 30- day mortality, and costs for health systems. Non-variceal upper gastrointestinal bleeding has been related to preventable risk factors, mainly alcohol consumption, Helicobacter pylori infection, and non-steroidal anti-inflammatory drugs, among others. The diagnosis is confirmed by endoscopy, which also serves to provide therapeutic intervention. This entity presents complications mainly represented by rebleeding and death. The Rockall score is the most widely used prognostic scale to assess the risk of complications from non-varicose upper airway bleeding. This scale has been evaluated worldwide in different contexts. Through the following article, it is proposed to review the state of the art focused on forecasting for this particular entity. Key words: Upper gastrointestinal tract; gastrointestinal hemorrhage; epidemiology; prognosis; endoscopy; mortality (MeSH).
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