title: The Progetto Nazionale Emorragia Digestiva (PNED) system vs. the Rockall score as mortality predictors in patients with nonvariceal upper gastrointestinal bleeding: A multicenter prospective study.
abstract: BACKGROUND
  The predictive scale for mortality risk in patients with nonvariceal upper gastrointestinal bleeding (NVUGIB) proposed by Italy's PNED (Progetto Nazionale Emorragia Digestiva) group has not been validated in Latin America since its original publication.
  
  
  OBJECTIVE
  To compare the PNED system and the Rockall score as mortality predictors in patients hospitalized for NVUGIB.
  
  
  METHODS
  A multicenter, prospective, cross-sectional, analytic study was conducted that recruited patients diagnosed with nonvariceal upper gastrointestinal bleeding within the time frame of 2011 to 2015. Six Mexican hospital centers participated in the study. The Rockall and PNED system scores were calculated, classifying the patients as having mild, moderate, or severe disease. The association between mortality and risk was determined through the chi-square test and relative risk (RR) calculation. Statistical significance was set at a P<.05.
  
  
  RESULTS
  Information on 198 patients was collected. Only 8 patients (4%) died from causes directly associated with bleeding. According to the Rockall score, 46 patients had severe disease (23.2%), 5 of whom died, with a RR of 5.5 (CI 1.35-22.02, P=.006). In relation to the PNED, only 8 patients had severe disease (4%), 5 of whom died, with a RR of 38.7 (CI 11.4-137.3, P=.001).
  
  
  CONCLUSIONS
  The PNED system was more selective for classifying a case as severe, but it had a greater predictive capacity for mortality, compared with the Rockall score.
authors.affiliation: Centro de Investigación de enfermedades hepáticas y Gastrointestinales, Área de Hepatología, Pachuca de Soto, Hidalgo, México. Electronic address: centro_investigacion_ehg@hotmail.com.
authors.forename: R
authors.initials: R
authors.lastname: Contreras-Omaña
authors.affiliation: Universidad Autónoma del Estado de Hidalgo, Instituto de Ciencias de la Salud, Área Académica de Medicina, Pachuca de Soto, Hidalgo, México.
authors.forename: J A
authors.initials: JA
authors.lastname: Alfaro-Reynoso
authors.affiliation: Hospital General de Zona y Medicina Familiar N.° 1 IMSS, Pachuca de Soto, Hidalgo, México.
authors.forename: C E
authors.initials: CE
authors.lastname: Cruz-Chávez
authors.affiliation: Hospital Civil de Guadalajara Fray Antonio Alcalde, Guadalajara, Jalisco, México.
authors.forename: A
authors.initials: A
authors.lastname: Velarde-Ruiz Velasco
authors.affiliation: Universidad Autónoma del Estado de Hidalgo, Instituto de Ciencias de la Salud, Área Académica de Medicina, Pachuca de Soto, Hidalgo, México.
authors.forename: D I
authors.initials: DI
authors.lastname: Flores-Ramírez
authors.affiliation: Universidad Autónoma del Estado de Hidalgo, Instituto de Ciencias de la Salud, Área Académica de Medicina, Pachuca de Soto, Hidalgo, México.
authors.forename: I
authors.initials: I
authors.lastname: Romero-Hernández
authors.affiliation: Universidad Autónoma del Estado de Hidalgo, Instituto de Ciencias de la Salud, Área Académica de Medicina, Pachuca de Soto, Hidalgo, México.
authors.forename: I
authors.initials: I
authors.lastname: Donato-Olguín
authors.affiliation: Hospital Regional Lic. Adolfo López Mateos ISSSTE, Ciudad de México, México.
authors.forename: X
authors.initials: X
authors.lastname: García-Samper
authors.affiliation: Centro Médico Nacional Siglo XXI, Ciudad de México, México.
authors.forename: A
authors.initials: A
authors.lastname: Bautista-Santos
authors.affiliation: Hospital Regional N.° 1 IMSS, Culiacán, Sinaloa, México.
authors.forename: M
authors.initials: M
authors.lastname: Reyes-Bastidas
authors.affiliation: Hospital Regional 220 del IMSS, Toluca, Estado de México, México.
authors.forename: E
authors.initials: E
authors.lastname: Millán-Marín
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D003430:Cross-Sectional Studies; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000401:mortality*; D006801:Humans; D008297:Male; D008800:Mexico / Q000453:epidemiology; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D018570:Risk Assessment
keywords: Hemorragia digestiva alta no variceal; Intensive therapeutic endoscopy; Mortalidad; Mortality; Nonvariceal upper gastrointestinal bleeding; Progetto Nazionale Emorragia Digestiva; Rockall; Terapia intensiva endoscópica