The Clinical Impact of Rockall and Glasgow-Blatchford Scores in Nonvariceal Upper Gastrointestinal Bleeding.

INTRODUCTION: Risk stratification in patients with nonvariceal upper gastrointestinal bleeding (NVUGIB) is crucial for proper management. Rockall score (RS; pre-endoscopic and complete) and Glasgow-Blatchford score (GBS) are some of the most used scoring systems. This study aims to analyze these scores' ability to predict various clinical outcomes and possible cutoff points to identify low- and high-risk patients. Secondarily, this study intents to evaluate the appropriateness of patients' transfers to our facility, which provides a specialized emergency endoscopy service. METHODS: This study was retrospectively conducted at Centro Hospitalar Universitário do Porto and included patients admitted to the Emergency Department with acute manifestations of NVUGIB between January 2016 and December 2018. Receiver operating characteristic (ROC) curves and corresponding areas under the curve (AUC) were calculated. Transferred patients from other institutions and nontransferred (directly admitted to this institution) patients were also compared. RESULTS: Of a total of 420 patients, 23 (5.9%) died, 34 (8.4%) rebled, 217 (51.7%) received blood transfusion, 153 (36.3%) received endoscopic therapy, 22 (5.7%) had surgery, and 171 (42.3%) required hospitalization in the Intermediate or Intensive Care Unit. Regarding mortality prediction, both complete RS (AUC 0.756, p < 0.001) and pre-endoscopic RS (AUC 0.711, p = 0.001) showed good performance. In the prediction of rebleeding, only complete RS (AUC 0.735, p < 0.001) had discriminative ability. GBS had good performance in the prediction of transfusion (AUC 0.785, p < 0.001). No score showed discriminative capability in the prediction of other outcomes. Transferred and nontransferred patients had similar pre-endoscopic RS (3.41 vs. 3.34, p = 0.692) and GBS (13.29 vs. 12.29, p = 0.056). Only patients with GBS ≥6 were transferred to our facility. There were no adverse outcomes recorded in any group when GBS was ≤3. DISCUSSION/CONCLUSION: Complete RS and pre-endoscopic RS are effective at predicting mortality, but only complete RS showed good performance at predicting rebleeding. GBS is better at predicting transfusion requirement. Our study suggests that a transfer can possibly be reconsidered if GBS is ≤3, although current recommendations only propose outpatient care when GBS is 0 or 1. Patients' transfers were appropriate, considering the high GBS scores and the outcomes of these patients.

INTRODUÇÃO: A gestão adequada de doentes com hemorragia digestiva alta não hipertensiva requer uma estratificação do risco apropriada, sendo o score de Rockall (RS; pré-endoscópico e completo) e o score de Glasgow-Blatchford (GBS) frequentemente usados. Um dos objetivos deste estudo é avaliar o seu valor prognóstico e identificar possíveis pontos de corte que identifiquem doentes de alto e baixo risco. Também se pretende analisar se as transferências de doentes para o nosso hospital são adequadas, uma vez que é nesta instituição que decorre a urgência regional noturna de Gastroenterologia. MÉTODOS: Realizada análise retrospetiva dos doentes admitidos no Serviço de Urgência do Centro Hospitalar Universitário do Porto (CHUP) com hemorragia digestiva alta não hipertensiva desde janeiro de 2016 a dezembro de 2018. A análise foi baseada nas curvas de característica de operação do recetor (ROC) e respetivas áreas (AUC). O grupo de doentes transferidos de outros hospitais para o CHUP foi comparado com o grupo de doentes diretamente admitidos. RESULTADOS: De um total de 420 doentes, 23 (5.9%) morreram, 34 (8.4%) tiveram recidiva hemorrágica, 217 (51.7%) receberam transfusão de sangue, 153 (36.3%) foram tratados endoscopicamente, 22 (5.7%) foram submetidos a cirurgia e 171 (42.3%) ficaram hospitalizados na Unidade de Cuidados Intermédios ou Intensivos. Tanto o RS completo (AUC 0.756, p < 0.001) como o pré-endoscópico (AUC 0.711, p = 0.001) conseguiram prever a mortalidade. Apenas o RS completo (AUC 0.735, p < 0.001) mostrou bom desempenho na previsão da recidiva. O GBS teve bom desempenho na previsão de transfusão (AUC 0.785, p < 0.001). Nenhum dos scores mostrou capacidade de prever outras necessidades. Os doentes transferidos apresentaram RS pré-endoscópico (3.41 vs. 3.34, p = 0.692) e GBS (13.29 vs. 12.29, p = 0.056) semelhantes aos diretamente admitidos. Apenas doentes com GBS ≥6 foram transferidos. Não existe registo de qualquer evento adverso com GBS ≤3. DISCUSSÃO/CONCLUSÃO: O RS completo e pré-endoscópico são eficazes a prever a mortalidade, mas apenas o RS completo consegue prever recidiva hemorrágica. O GBS consegue prever necessidade de transfusão. O nosso estudo sugere que, perante um doente com GBS de 3 ou inferior, a transferência poderá ser reconsiderada, no entanto, as recomendações atuais apenas sugerem gestão em ambulatório quando o GBS é 0 ou 1. As transferências feitas para o CHUP revelaram-se necessárias, pois os doentes apresentaram GBS altos e taxas de eventos adversos significativas.

Correction to: Reliability and validity of the Pittsburgh Sleep Quality Index in breast cancer patients.

There is a typo in the Funding reference cited in the paper. This alteration is fundamental to justify the funding of the project.

Reliability and validity of the Pittsburgh Sleep Quality Index in breast cancer patients.

PURPOSE: We aimed to assess the factor structure, internal consistency, test-retest reliability, and construct validity of the European Portuguese version of the Pittsburgh Sleep Quality Index (PSQI) in breast cancer patients. METHODS: This study was based on a cohort of breast cancer patients, among whom the PSQI was used to measure sleep quality three years after cancer diagnosis (N = 474). A sample of 62 participants underwent additional PSQI testing, wore a wrist actigraph for five consecutive days, and was reevaluated with the PSQI after one month. A confirmatory factor analysis, considering the components suggested by the principal component analysis (PCA), was performed to determine model fit. To evaluate internal consistency and test-retest reliability, Cronbach's alpha and intraclass correlation coefficient (ICC) were calculated, respectively. To assess construct validity, Spearman's correlation coefficients were computed between PSQI scores and actigraphy measures and other theoretical related constructs. RESULTS: PCA suggested one or two components. The latter showed better fit to the data, though the two factors were strongly correlated (r = 0.76) and internal consistency was not satisfactory for one of the factors. Regarding the one-factor model, internal consistency (Cronbach's alpha = 0.70) and test-retest reliability (ICC = 0.76) were adequate. Sleep duration, habitual sleep efficiency, and sleep disturbance dimensions were significantly correlated with the corresponding actigraphy measures; the PSQI global score derived from the one-factor model was more strongly correlated with subjective sleep complaints (r ≥ 0.60). CONCLUSIONS: The unidimensional construct of the European Portuguese version of the PSQI showed adequate reliability and validity among breast cancer patients.