Introduction. Upper gastrointestinal bleeding (UGIB) is a potentially life-threatening gastrointestinal emergency, and effective management depends on early risk stratification. The Glasgow–Blatchford and Rockall scores are commonly used prognostic measures for UGIB, although these scoring systems are relatively difficult to apply in early emergency settings. AIMS65 with five items, albumin, international normalized ratio, mental status, systolic blood pressure, and age (>65 years), showed efficacy in predicting long-term hospitalization and mortality. This study aimed to investigate the usefulness of the prothrombin time-international normalized ratio-to-albumin ratio (PTAR) in the emergency room for early UGIB risk stratification. Methods. We retrospectively examined patients who visited a tertiary academic hospital’s emergency department (ED) with UGIB as the chief presentation between January 2019 and December 2020. The cutoff values and diagnostic accuracies of the PTAR, Glasgow–Blatchford score, AIMS65 score, pre-endoscopy, and complete Rockall score were analyzed, and the performance of the PTAR was compared with that of other risk stratification methods. In total, 519 patients were enrolled: 163 patients were admitted in the intensive care unit (ICU) and 35 died during admission. Multiple logistic regression analyses confirmed the association of the PTAR with ICU admission and mortality. The adjusted odd ratio (aOR) of the PTAR for ICU admission care was 8.376 (2.722–25.774), and the aOR of the PTAR for mortality was 27.846 (8.701–89.116). Conclusions. The PTAR measured in the ED is an independent factor related to ICU admission and mortality in patients with UGIB. Using ED blood laboratory results, which are reported relatively quickly and are easy to acquire and calculate, the PTAR can be used as a risk stratification marker in the early emergency setting.

中文翻译：

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国际标准化比率与白蛋白比率作为上消化道出血严重程度的新标志物

简介。上消化道出血 (UGIB) 是一种可能危及生命的消化道急症，有效的管理取决于早期风险分层。Glasgow-Blatchford 和 Rockall 评分是 UGIB 常用的预后指标，尽管这些评分系统在早期紧急情况下相对难以应用。AIMS65 有五个项目，白蛋白、国际标准化比率、精神状态、收缩压和年龄（>65 岁），显示出预测长期住院和死亡率的功效。本研究旨在调查急诊室凝血酶原时间-国际标准化比率与白蛋白比率 (PTAR) 对早期 UGIB 风险分层的有用性。方法. 我们回顾性检查了 2019 年 1 月至 2020 年 12 月期间以 UGIB 为主要表现的三级学术医院急诊科 (ED) 的患者。PTAR、Glasgow-Blatchford 评分、AIMS65 评分、内窥镜检查前、分析了完整的 Rockall 评分，并将 PTAR 的表现与其他风险分层方法的表现进行了比较。总共有 519 名患者入组：163 名患者入住重症监护病房 (ICU)，35 名患者在入院期间死亡。多元逻辑回归分析证实了 PTAR 与 ICU 入院率和死亡率的相关性。用于 ICU 入院护理的 PTAR 调整后的比值比 (aOR) 为 8.376 (2.722-25.774)，死亡率 PTAR 的 aOR 为 27.846 (8.701-89.116)。结论。在 ED 中测量的 PTAR 是与 UGIB 患者入住 ICU 和死亡率相关的独立因素。使用 ED 血液实验室结果报告相对较快且易于获取和计算，PTAR 可用作早期紧急情况下的风险分层标记。