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Almaghrabi MM, Gandhi M, Guizzetti L, Iansavitchene A, Oakland K, Jairath V, Sey M. A115 A SYSTEMATIC REVIEW AND META-ANALYSIS OF LOWER GASTROINTESTINAL BLEEDING RISK SCORES TO PREDICT ADVERSE OUTCOMES. J Can Assoc Gastroenterol 2021. [DOI: 10.1093/jcag/gwab002.113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Acute lower gastrointestinal bleeding (LGIB) is a common reason for emergency hospitalization. In most patients, bleeding resolves spontaneously but some cases can be fatal. Risk prediction scores can be useful in risk stratifying patients with LGIB at the time of presentation although the most discriminative LGIB risk score is unknown.
Aims
To perform a systematic review and meta-analysis comparing LGIB risk prediction scores.
Methods
Following the PRISMA statement, a systematic search for relevant publications after 1990 was conducted in Ovid Medline, EMBASE, Web of Science and CENTRAL electronic databases. We also searched published conference abstracts over the past 5 years. Studies with a primary aim of deriving or validating a LGIB risk score were included. Title and abstracts were reviewed by two independent reviewers followed by full text review and data extraction by both reviewers. Diagnostic classification data for combinations of risk score and clinical outcome were meta-analyzed using a hierarchical summary receiver operator characteristic curve (ROC) model, allowing for random-effects by study, and fixed-effect of the risk score thresholds to influence both sensitivity and specificity. Area under the summary ROC were estimated from model parameters for the pre-specified LGIB risk score thresholds-of-interest.
Results
Our search identified 2,331 citations for review, of which 100 remained after the title and abstract screen, and 18 ultimately met criteria for inclusion in the meta-analysis after full text review. From these, we identified 21 risk prediction scores for LGIB, although only four had sufficient number of papers to meta-analyze (Oakland, Strate, NOBLADS, and BLEED score). For the outcome safe discharge from hospital, the Oakland score had an area under the receiver operating characteristics curve (AUROC) of 85.5% (95% CI: 82.1%, 88.3%). For the outcome major bleeding, the Oakland score had an AUROC of 78.9% (95% CI: 75.1%, 82.2%); the Strate score had an AUROC of 74.4% (95% CI: 70.4%, 78.0%); the NOBLADS score had an AUROC of 60.3% (95% CI: 55.9%, 64.5%); and the BLEED score had an AUROC of 65.6% (95% CI: 61.4%, 69.7%). For the outcome, need for hemostasis, the Oakland had an AUROC of 99.0% (95% CI: 97.7%, 99.6%); the Strate score had an AUROC of 82.1% (95% CI: 78.5%, 85.2%); the NOBLADS score had an AUROC of 23.9% (95% CI: 20.3%, 27.8%). For the outcome, need for transfusion, the Oakland score had an AUROC of 99.0% (95% CI: 97.7%, 99.6%); the NOBLADS score had an AUROC of 87.7% (95% CI: 84.5%, 90.3%).
Conclusions
The Oakland score was the most discriminative risk prediction model for safe discharge from hospital, major bleeding, need for hemostasis, and need for transfusion.
Funding Agencies
None
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Affiliation(s)
| | - M Gandhi
- Grand River Hospital, Kitchener, ON, Canada
| | | | | | - K Oakland
- HCA International Ltd, London, London, United Kingdom
| | - V Jairath
- Medicine, Western University, London, ON, Canada
| | - M Sey
- Western University, London, ON, Canada
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Oakland K, Cosentino D, Cross T, Bucknall C, Dorudi S, Walker D. External validation of the Surgical Outcome Risk Tool (SORT) in 3305 abdominal surgery patients in the independent sector in the UK. Perioper Med (Lond) 2021; 10:4. [PMID: 33494817 PMCID: PMC7836595 DOI: 10.1186/s13741-020-00173-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 12/17/2020] [Indexed: 11/15/2022] Open
Abstract
Background Assessing the risk of post-surgical mortality is a key component of pre-surgical planning. The Surgical Outcome Risk Tool (SORT) uses pre-operative variables to predict 30-day mortality. The aim of this study was to externally validate SORT in patients undergoing major abdominal surgery. Methods Data were collected from patients treated in five independent hospitals in the UK. Individualised SORT scores were calculated, and area under the receiver operating characteristic (AUROC) and precision-recall curves (PRC) plus 95% confidence intervals (CI) were drawn to test the ability of SORT to identify in-hospital death. Outcomes of patients with a SORT predicted risk of mortality of ≥ 5% (high risk) were compared to those with a predicted risk of < 5% (standard risk). Results The study population comprised 3305 patients, mean age 51 years, 2783 (84.2%) underwent elective surgery most frequently involving the colon (24.6%), or liver, pancreas or gallbladder (18.2%). Overall, 1551 (46.9%) patients were admitted to ICU and 29 (0.88%) died. The AUROC of SORT for discriminating patients at risk of death in hospital was 0.899 (95% CI 0.849 to 0.949) and the PRC 0.247. In total, 72 (2.18%) patients were stratified as high risk. There were more unplanned ICU admissions and deaths in this group compared to the standard risk group (25.0% and 3.3%, versus 3.1% and 0.5%, respectively). Conclusion We externally validated SORT in a large population of abdominal surgery patients. SORT performed well in patients with lower risk profiles, but underpredicted adverse outcomes in the higher risk group.
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Affiliation(s)
- K Oakland
- Digestive Diseases and Renal Department, HCA Healthcare UK, 242 Marylebone Road, London, NW1 6JL, UK.
| | - D Cosentino
- Clinical Informatics Department, HCA Healthcare UK, 242 Marylebone Road, London, NW1 6JL, UK
| | - T Cross
- Clinical Informatics Department, HCA Healthcare UK, 242 Marylebone Road, London, NW1 6JL, UK
| | - C Bucknall
- Digestive Diseases and Renal Department, HCA Healthcare UK, 242 Marylebone Road, London, NW1 6JL, UK
| | - S Dorudi
- Princess Grace Hospital, HCA Healthcare UK, 42-52 Nottingham Place, London, W1U 5NY, UK
| | - D Walker
- Princess Grace Hospital, HCA Healthcare UK, 42-52 Nottingham Place, London, W1U 5NY, UK.,Centre for Perioperative Medicine, University College London, Gower Street, London, WC1E 6BT, UK
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Oakland K, Jairath V, Murphy MF. Advances in transfusion medicine: gastrointestinal bleeding. Transfus Med 2017; 28:132-139. [DOI: 10.1111/tme.12446] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Revised: 06/26/2017] [Accepted: 06/27/2017] [Indexed: 01/22/2023]
Affiliation(s)
- K. Oakland
- Clinical Research; NHS Blood and Transplant; Oxford UK
- National Heart and Lung Institute; Imperial College; London UK
| | - V. Jairath
- Division of Epidemiology and Biostatistics; Western University; London Canada
- Department of Medicine, Division of Gastroenterology; University Hospital; London Canada
| | - M. F. Murphy
- Clinical Research; NHS Blood and Transplant; Oxford UK
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Oakland K, Nadler R, Cresswell L, Jackson D, Coughlin PA. Systematic review and meta-analysis of the association between frailty and outcome in surgical patients. Ann R Coll Surg Engl 2016; 98:80-5. [PMID: 26741674 PMCID: PMC5210486 DOI: 10.1308/rcsann.2016.0048] [Citation(s) in RCA: 75] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/28/2015] [Indexed: 12/27/2022] Open
Abstract
INTRODUCTION Frailty is becoming increasingly prevalent in the elderly population although a lack of consensus regarding a clinical definition hampers comparison of clinical studies. More elderly patients are being assessed for surgical intervention but the effect of frailty on surgical related outcomes is still not clear. METHODS A systematic literature search for studies prospectively reporting frailty and postoperative outcomes in patients undergoing surgical intervention was performed with data collated from a total of 12 studies. Random effects meta-analysis modelling was undertaken to estimate the association between frailty and mortality rates (in-hospital and one-year), length of hospital stay and the need for step-down care for further rehabilitation/nursing home placement. RESULTS Frailty was associated with a higher in-hospital mortality rate (pooled odds ratio [OR]: 2.77, 95% confidence interval [CI]: 1.62-4.73), a higher one-year mortality rate (pooled OR: 1.99, 95% CI: 1.49-2.66), a longer hospital stay (pooled mean difference: 1.05 days, 95% CI: 0.02-2.07 days) and a higher discharge rate to further rehabilitation/step-down care (pooled OR: 5.71, 95% CI: 3.41-9.55). CONCLUSIONS The presence of frailty in patients undergoing surgical intervention is associated with poorer outcomes with regard to mortality and return to independence. Further in-depth studies are required to identify factors that can be optimised to reduce the burden of frailty in surgical patients.
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Affiliation(s)
- K Oakland
- Cambridge University Hospitals NHS Foundation Trust , UK
| | - R Nadler
- Cambridge University Hospitals NHS Foundation Trust , UK
| | | | | | - P A Coughlin
- Cambridge University Hospitals NHS Foundation Trust , UK
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