SCALE FOR PREDICTING THE RISK OF RECURRENT ULCERATIVE BLEEDING
The lack of prognostic reliability of the known scales is known to be one of the reasons for the frequent recurrence of acute ulcerative bleeding. Some recommendations suggest to use a combination of different scales. It can be considered quite efficient. The different scales are not united by a multifaceted approach for predicting. The suggested combinations are a random combination of factors.
The aim of the work was to develop a scale for predicting the risk of recurrent acute ulcerative bleeding and to evaluate its reliability.
Materials and methods. 109 patients with acute ulcerative bleeding, 29 of whom had a recurrence of bleeding. During our previous researches, there have been many differences in clinical and laboratory criteria in patients with ulcerative bleeding both with and without recurrence. Some of these differences have been significantly associated with the development of recurrent bleeding. The following criteria have been chosen to create a scale for prediction: the class of comorbid pathology, anamnesis, body temperature, application of hemostatic therapy before hospitalization, pulse rate, pulse pressure, bleeding class by Forrest, the total number of leukocytes, total protein, creatinine, restored glutathione, fibrinase, the ratio of diene conjugates and ketodienes and conjugated trienes in plasma, prothrombin index, recalcification plasma time, antithrombin III, test indicators for the fibrinogen B presence, the ratio of non-enzymatic and enzymatic fibrinolytic activity of plasma, proteolytic activity of plasma by asokliene, the level of oxidation of neutral plasma proteins, and a 5G4 and G43A polymorphism of the PAI-1 gene. Each of the criteria has been given a certain number of points. We have analyzed the relationship between the number of points that have been determined in the examined patients and the development of recurrent bleeding. The data analysis has been performed using the One Way ANOVA method.
Results. We offer a step-by-step prediction. The criteria, that are determined during the initial examination of the patient and the FEGDS, have been counted into the scale for preliminary prediction. The main scale additionally includes the data of laboratory research. Not all of the included criteria are yet available in everyday practice. Therefore, we have developed two types of the main predictive scale – basic and advanced. The basic type of the main scale contains some routine criteria like the total number of white blood cells, total protein, creatinine, prothrombin index, plasma recalcification time, test indicators for the fibrinogen B presence. The extended type contains criteria for the fibrinolysis condition, proteolysis, redox reactions, and the results of genetic studies. The prognostic ability of various scale types has been conducted. The sensitivity of the scale for preliminary prediction is 89.66%, and the specificity is 86.8%. The sensitivity of the main basic scale is 92.86%, and the specificity is 92.16%. The sensitivity of the extended main scale increases to 100%, and the specificity- up to 95.83%.
Conclusions. The use of the developed prognostic scale allows to determine the need for the application of preventive agents both during the primary FEGDS and during the next stage of treatment.
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