1. Introduction

One of the concomitant diseases against the background of which ulcerative gastroduodenal bleedings are particularly difficult is coronary artery disease (CAD). According to the modern version, CAD includes unstable angina, acute coronary syndrome (ACS) with and without ST elevation, as well as acute myocardial infarction [1-6].

It should be noted that CAD and ulcerative gastroduodenal bleedings (UGDB) even individually take first places in the structure of general morbidity and mortality. In cases of the combined development of these nosologies, the mutually addictive effect of one pathological process on another is observed. It leads to high mortality, ranging from 37 to 70% with conservative and up to 90% with surgical treatments of such patients [7-14].

The providing effective emergency medical care to such patients involves assessing the severity of their general condition by predicting the severity of the existing combined pathologies course and to determine an adequate and individualized treatment tactics on this basis [15-23].

However, clear criteria for assessing the severity of the combined course of UGDB and various forms of CAD have not been finally developed. Unfortunately, the criteria available in the literature are scattered and are mainly based on hemodynamic parameters; do not give the opportunity for a comprehensive, more holistic assessment of the condition of such patients.

Aim of this study was to develop an integrated rating scale for predicting the severity of ulcerative gastroduodenal bleedings in combination with various forms of coronary artery disease.

2. Material and Methods

We accomplished this task by modifying and adapting Simplified Acute Physiology Score (SAPS) SAPS scale to the UGDB with CAD. Retrospective studies were conducted to determine the prognostic significance and statistical significance of empirically selected anthropometric, clinical, instrumental and laboratory risk indicators for development and assessing the severity of UGDB with CAD. Statistical analysis was carried out separately in groups of patients who had the development of severe course of ulcerative gastroduodenal bleedings with coronary artery disease (117 patients) and in the group of patients who had no development of severe course (131 patients) in the Department of Emergency Surgery and Emergency Cardiology of the Republican Research Centre of Emergency Medicine in 2019. The critical value of χ2 was 3.84. The excess of the calculated indicators χ2 of this critical value was evaluated by us as evidence of the statistical reliability of this indicator (P <).

3. Results and Discussion

As a result of all our relevant calculations, the following indicators turned out to be prognostically significant and statistically reliable: age, systolic blood pressure, pulse for 1 minute, respiratory rate for 1 minute, consciousness, coagulation time, hemoglobin, platelet count, prothrombin, blood urea, blood hematocrit, blood loss, Algover index, Forrest hemostasis, myocardial ischemia, ejection fraction (EF), stroke volume (SV) (Tab. 1).

Table 1. The reliability and likelihood of the development of UGDB with CAD severe course in the presence of the studied factors (n=248)

After highlighting the above pointed indices, we had to establish the rules for predicting the severity category of the UGDB with CAD course at the presence of a specific indicator. Each indicator was assigned a prognostic score of 1 to 3, depending on the degree of its severity and on the degree of its reliability (value χ2). We strictly adhered to the rule that the greater was the severity and, accordingly, the value of χ2, the higher score was received by one or another indicator. As a result, we obtained a new modified integrated forecast scale for the severity category of the course of UGDB with CAD which is given in Table. 2.

Table 2. Modified severity category prediction scale of UGDB with CAD

Subsequently, the points were summed up. Based on the sum of the points we have developed gradations for predicting the severity category of UGDB with CAD course from 17.0 to 26.8 points (light), from 26.9 to 35.7 (moderate), from 35.8 to 51 0 (severe). Prospective studies on identifing the effectiveness of this scale allowed us to conclude that there was more than 80% coincidence of the preliminary determination of the severity category and the final diagnosis in 62 examined patients. This served as the primary basis for the assumption of the reliability and adequacy of the integrated predicting scale proposed by us.

For the further conformity of the severity category of UGDB with CAD according to our integrated scale to the principles of evidence-based medicine, we calculated their “sensitivity” and “specificity”. The term “sensitivity” refers to the proportion of patients with the severity of the disease in whom the diagnostic test is positive, and “specificity” refers to the proportion of patients with the severity of the disease in whom the diagnostic test is negative (according to R. Fletcher “Clinical Epidemiology”). The obtained results are given in Tab. 3.

Table 3. Indicators of “sensitivity” and “specificity” of the prognosis scale for the category of severity of UGDB with CAD in patients of the main group

We have received the rationalization certificate No. 00114 dated by January 11, 2020 from the Tashkent Institute of Post Education Doctors for the developed integrated scale of predicting the category of severity of the course of UGDB with CAD.

4. Conclusions

Thus, conducting retrospective studies to determine the prognostic significance and statistical significance of empirically selected anthropometric, clinical, instrumental and laboratory indicators allowed us to develop an integrated scale for predicting the category of severity of the UGDB course in combination with various forms of CAD.

Our proposed new integrated scale for predicting the category of severity of the course of UGDB in combination with various forms of CAD has high sensitivity, specificity and fully complies with the requirements of practical emergency surgery.

Its widespread use will make it possible to objectify the assessment of the severity of UGDB in combination with various forms of CAD, which accordingly will lead to improved treatment results in these patients.