Cargando…
Use of the NOBLADS Score to Predict Endoscopic Treatment in Patients with Colonic Diverticular Bleeding by Age Stratification
OBJECTIVE: A high NOBLADS score reflecting the severity of lower gastrointestinal bleeding contributes to the identification of stigmata of recent hemorrhage (SRH) in colonic diverticular bleeding (CDB). The burden of colonoscopy is particularly high in elderly patients; therefore, we investigated t...
Autores principales: | , , , , , , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
The Japanese Society of Internal Medicine
2022
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9646343/ https://www.ncbi.nlm.nih.gov/pubmed/35314553 http://dx.doi.org/10.2169/internalmedicine.9202-21 |
_version_ | 1784827144174567424 |
---|---|
author | Takasu, Ayaka Ikeya, Takashi Shiratori, Yasutoshi Dai, Zhehao Yoshimoto, Takaaki Yamamoto, Kazuki Okamoto, Takeshi Okuyama, Shuhei Takagi, Koichi Fukuda, Katsuyuki |
author_facet | Takasu, Ayaka Ikeya, Takashi Shiratori, Yasutoshi Dai, Zhehao Yoshimoto, Takaaki Yamamoto, Kazuki Okamoto, Takeshi Okuyama, Shuhei Takagi, Koichi Fukuda, Katsuyuki |
author_sort | Takasu, Ayaka |
collection | PubMed |
description | OBJECTIVE: A high NOBLADS score reflecting the severity of lower gastrointestinal bleeding contributes to the identification of stigmata of recent hemorrhage (SRH) in colonic diverticular bleeding (CDB). The burden of colonoscopy is particularly high in elderly patients; therefore, we investigated the utility of the NOBLADS score for managing CDB by age stratification. The NOBLADS score performance in SRH prediction was estimated by the area under the receiver operating characteristic calculation and a multiple logistic regression model. METHODS: This was a single-center, retrospective cohort study. Patients who underwent initial colonoscopy with CDB between April 2008 and December 2019 were divided into a young group (<65 years old) and an elderly group (≥65 years old). We further categorized patients according to colonoscopy findings as SRH-positive, with successful endoscopic hemostasis performance, and SRH-negative, with suspected CDB. The main outcome measure was successful SRH identification. RESULTS: Four-hundred and seventeen CDB patients were included, of whom 250 (60.0%) were elderly. There were 72 (43.1%) SRH-positive patients in the young group and 94 (37.6%) in the elderly group. The areas under the receiver operating characteristic curves of the NOBLADS score predicting SRH identification were 0.76, 0.71, and 0.81 for all ages, young patients, and elderly patients, respectively. A multiple logistic regression analysis showed that SRH identification was significantly associated with NOBLADS scores in both groups. Eighty-one patients (32.4%) scored ≥4 in the elderly group, and 60 of those were SRH-positive (74.1%). All 27 patients (10.8%) who scored ≥4 with extravasation on computed tomography were found to have SRH. CONCLUSION: The NOBLADS score is useful for predicting SRH identification, especially in elderly patients. |
format | Online Article Text |
id | pubmed-9646343 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | The Japanese Society of Internal Medicine |
record_format | MEDLINE/PubMed |
spelling | pubmed-96463432022-11-18 Use of the NOBLADS Score to Predict Endoscopic Treatment in Patients with Colonic Diverticular Bleeding by Age Stratification Takasu, Ayaka Ikeya, Takashi Shiratori, Yasutoshi Dai, Zhehao Yoshimoto, Takaaki Yamamoto, Kazuki Okamoto, Takeshi Okuyama, Shuhei Takagi, Koichi Fukuda, Katsuyuki Intern Med Original Article OBJECTIVE: A high NOBLADS score reflecting the severity of lower gastrointestinal bleeding contributes to the identification of stigmata of recent hemorrhage (SRH) in colonic diverticular bleeding (CDB). The burden of colonoscopy is particularly high in elderly patients; therefore, we investigated the utility of the NOBLADS score for managing CDB by age stratification. The NOBLADS score performance in SRH prediction was estimated by the area under the receiver operating characteristic calculation and a multiple logistic regression model. METHODS: This was a single-center, retrospective cohort study. Patients who underwent initial colonoscopy with CDB between April 2008 and December 2019 were divided into a young group (<65 years old) and an elderly group (≥65 years old). We further categorized patients according to colonoscopy findings as SRH-positive, with successful endoscopic hemostasis performance, and SRH-negative, with suspected CDB. The main outcome measure was successful SRH identification. RESULTS: Four-hundred and seventeen CDB patients were included, of whom 250 (60.0%) were elderly. There were 72 (43.1%) SRH-positive patients in the young group and 94 (37.6%) in the elderly group. The areas under the receiver operating characteristic curves of the NOBLADS score predicting SRH identification were 0.76, 0.71, and 0.81 for all ages, young patients, and elderly patients, respectively. A multiple logistic regression analysis showed that SRH identification was significantly associated with NOBLADS scores in both groups. Eighty-one patients (32.4%) scored ≥4 in the elderly group, and 60 of those were SRH-positive (74.1%). All 27 patients (10.8%) who scored ≥4 with extravasation on computed tomography were found to have SRH. CONCLUSION: The NOBLADS score is useful for predicting SRH identification, especially in elderly patients. The Japanese Society of Internal Medicine 2022-03-19 2022-10-15 /pmc/articles/PMC9646343/ /pubmed/35314553 http://dx.doi.org/10.2169/internalmedicine.9202-21 Text en Copyright © 2022 by The Japanese Society of Internal Medicine https://creativecommons.org/licenses/by-nc-nd/4.0/The Internal Medicine is an Open Access journal distributed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License. To view the details of this license, please visit (https://creativecommons.org/licenses/by-nc-nd/4.0/). |
spellingShingle | Original Article Takasu, Ayaka Ikeya, Takashi Shiratori, Yasutoshi Dai, Zhehao Yoshimoto, Takaaki Yamamoto, Kazuki Okamoto, Takeshi Okuyama, Shuhei Takagi, Koichi Fukuda, Katsuyuki Use of the NOBLADS Score to Predict Endoscopic Treatment in Patients with Colonic Diverticular Bleeding by Age Stratification |
title | Use of the NOBLADS Score to Predict Endoscopic Treatment in Patients with Colonic Diverticular Bleeding by Age Stratification |
title_full | Use of the NOBLADS Score to Predict Endoscopic Treatment in Patients with Colonic Diverticular Bleeding by Age Stratification |
title_fullStr | Use of the NOBLADS Score to Predict Endoscopic Treatment in Patients with Colonic Diverticular Bleeding by Age Stratification |
title_full_unstemmed | Use of the NOBLADS Score to Predict Endoscopic Treatment in Patients with Colonic Diverticular Bleeding by Age Stratification |
title_short | Use of the NOBLADS Score to Predict Endoscopic Treatment in Patients with Colonic Diverticular Bleeding by Age Stratification |
title_sort | use of the noblads score to predict endoscopic treatment in patients with colonic diverticular bleeding by age stratification |
topic | Original Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9646343/ https://www.ncbi.nlm.nih.gov/pubmed/35314553 http://dx.doi.org/10.2169/internalmedicine.9202-21 |
work_keys_str_mv | AT takasuayaka useofthenobladsscoretopredictendoscopictreatmentinpatientswithcolonicdiverticularbleedingbyagestratification AT ikeyatakashi useofthenobladsscoretopredictendoscopictreatmentinpatientswithcolonicdiverticularbleedingbyagestratification AT shiratoriyasutoshi useofthenobladsscoretopredictendoscopictreatmentinpatientswithcolonicdiverticularbleedingbyagestratification AT daizhehao useofthenobladsscoretopredictendoscopictreatmentinpatientswithcolonicdiverticularbleedingbyagestratification AT yoshimototakaaki useofthenobladsscoretopredictendoscopictreatmentinpatientswithcolonicdiverticularbleedingbyagestratification AT yamamotokazuki useofthenobladsscoretopredictendoscopictreatmentinpatientswithcolonicdiverticularbleedingbyagestratification AT okamototakeshi useofthenobladsscoretopredictendoscopictreatmentinpatientswithcolonicdiverticularbleedingbyagestratification AT okuyamashuhei useofthenobladsscoretopredictendoscopictreatmentinpatientswithcolonicdiverticularbleedingbyagestratification AT takagikoichi useofthenobladsscoretopredictendoscopictreatmentinpatientswithcolonicdiverticularbleedingbyagestratification AT fukudakatsuyuki useofthenobladsscoretopredictendoscopictreatmentinpatientswithcolonicdiverticularbleedingbyagestratification |