Resumen

GOMEZ, Martín Alonso et al. "UNAL" of prediction climbs to identify patient with digestive high hemorrhage that urgent endoscopia needs. Rev Col Gastroenterol [online]. 2006, vol.21, n.4, pp.244-258. ISSN 0120-9957.

The determination of clinical variables that you/they allow to predict how patient with digestive high (HVDA) hemorrhage, they have bled active, it is very important since they would identify those that need digestive urgent (in the first 12 hours of entrance) endoscopy or if the procedure you can differ to make it in the first 24 hours. Besides the above-mentioned, a scale predictive, would be very useful for the services of urgencies of hospitals and centers of health since facilitates to optimize the resources and stiller in Colombia where these they are insufficient and very few hospitals they lend an endoscopy service the 24 hours of the day. The purpose of this work was to evaluate, in our means, the utility of the clinical discoveries and of laboratory to identify those patients with HVDA that are presenting to the moment of the entrance bled active, to build with them an original scale, the one which later on was validated in a prospective way in a group different from patient. Objective: To define the clinical variables and of laboratory, in patient with digestive high hemorrhage that you/they can be used to carry out a scale that allows to identify those with having bled active to the moment of the entrance and that they need urgent endoscopy. Patients and Methods: It is an observational analytic study, of traverse type in the one that took the information of patients that you/they entered to the service of urgencies of a hospital of third level. The clinical discoveries to the entrance of the patients were taken as prediction variables and the presence or absence of having bled active during the endoscopy carried out in the first 12 hours they were taken as outcome variables. The sample constitutes it two prospective cohorts of patients that were selected in serial form. The first cohort was recruited from January of the 2004 until August of the 2005 for the internal validation of the scale and the second cohort, another independent group, recruited from September from the 2005 to June of the 2006. The inclusion approaches were patient bigger than 18 years with clinical diagnosis of HVDA. Using the variables that were identified as predictives of having bled active in the multivariate analysis, the scale was built. Results: In the first court, we include 109 patients with HVDA (age X=59 .3 + /- 19.1, men 69.7%). The main presentation symptom was manes in 73.4% and the main discovery endoscópico was it ulcerates peptic (58.7%). Six variables (Lipotimia, hemodynamic Uncertainty, Hemoglobin smaller than 8, Leukocytes bigger than 12000, Bleed in SNG, and Age > 65 years), they were identified as independent predictors of having bled active in urgent EVDA and they were used to carry out the following scale: It climbs of having bled = 5 x (Bleed in SNG) + 4 x (Hemoglobin < 8) +4 x (Lipotimia) +2x (leukocytes > 12.000) +2x (Age > 65 years) +1x (hemodynamic Uncertainty) The values of the scale varied between 0 and 18 and you I use the curve of characteristic operative (ROC) in the determination of the court point where it becomes maximum the sensibility and specificity and the capacity of prediction of the scale was evaluated, finding that that point was 7 in such a way that if the patient has less than 7 points you/he/she means absence of having bled active and therefore urgent EVDA doesn’t need. If he/she has 7 or but points are bled active and urgent EVDA needs. This scale was validated externally in the independent other group constituted finally by 98 patients (age X = 56.2 + /- 16, men 62.2%), of which 15.6% had bled active. When applying the scale with the point of established court he/she was a sensibility 100%; specificity of 83.1%; Value Predictive of 64.3%; Negative VP 100%. Conclusions: the discoveries suggest that a simple scale, of easy memorization, built with clinical parameters and of available laboratories in any hospital of our country, it can identify patient with HVDA who an urgent EVDA needs of those that don’t need it. This scale carried out on solid bases mathematics can be used in hospitals that don’t have a gastroenterology service the 24 hours of the day or I eat tool to prioritize the remission of the patients from the centers that don’t have readiness of EVDA. The results of this study allow us to recommend the clinical application of this original scale since in the external validation he/she had an excellent yield mainly to discard bled active and it demonstrated to be consistent and of high value discriminative when it was evaluated in two independent groups of patient.

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