A comparative study of scoring systems that accurately predict the prognosis of lower gastrointestinal bleeding

Abstract

Lower gastrointestinal bleeding (LGIB) can be fatal; therefore, several scoring systems have been developed to predict its prognosis. We aimed to compare the mortality predictions and evaluate the usefulness of various scoring systems. MethodsThe medical records of 3,794 patients who visited the emergency department with hematochezia between January 2016 and December 2021 were retrospectively reviewed. We calculated the areas under the receiver operating characteristic curves (AUROCs) for 30-day mortality and prolonged hospital stay (≥ 10 days), based on the age, blood tests, and comorbidities (ABC); AIMS65; Glasgow Blatchford; Oakland; Rockall (pre-endoscopy); and SHA 2 PE scores. We compared the predictive accuracy of each score. ResultsData for 963 patients (median age, 69 years; males, 54.5%; median hospital stay, 6 days) with colonoscopy-con rmed LGIB were analyzed. The 30-day mortality rate was 3.5%. The most common causes of LGIB were ischemic colitis and diverticulum hemorrhage in 19.3% and 19.2% of the cases, respectively. The AIMS65 (AUROC, 0.845) and ABC (AUROC, 0.835) scores were superior in predicting 30day mortality (both p < 0.001). The SHA 2 PE score was the most accurate predictor of prolonged hospital stay (AUROC, 0.728; p < 0.001). Through multivariate regression analysis, 30-day mortality was correlated with albumin level ≤ 3.0 g/dL, international normalized ratio > 1.5, blood urea nitrogen level ≥ 30 mg/dL, and systolic blood pressure (SBP) < 100 mmHg. Prolonged hospital stay was correlated with liver cirrhosis, hemoglobin ≤ 10 g/dL, albumin level ≤ 3.0 g/dL, and SBP < 100 mmHg. ConclusionThe recently developed scoring systems accurately predict LGIB prognosis, and their usefulness in clinical decision-making was con rmed.

Comparison of scoring systems for predicting clinical outcomes of acute lower gastrointestinal bleeding: A prospective cohort study

“…Although AIMS65 score and GBS were designed for UGIB, 31,32 they include information on factors affecting LGIB progression 15,16 ; these scores may also effectively stratify LGIB risks. Nakamura et al.…”

“…Different cutoff values for identifying high risks for severe bleeding have been reported 10,16 . The optimal cutoff values for predicting severe LGIB were 22, 1, and 5 for the Oakland score, AIMS65 score, and GBS, respectively.…”

“…We determined the relationship between each score and primary outcome events separately using logistic regression analysis. After univariate analysis, sex, age, variables with probabilities (p < 0.1), and established risk factors for severe LGIB [15][16][17] were included in the multivariate analysis. All statistical analyses were performed using STATA version 15.1…”

“…29 A meta-analysis of LGIB risk prognostication models revealed that the Oakland score had the most discriminative performance in predicting the need for blood transfusion and major bleeding. Although AIMS65 score and GBS were designed for UGIB, 31,32 they include information on factors affecting LGIB progression 15,16 ; these scores may also effectively stratify LGIB risks. Nakamura et al reported the precision of the AIMS65 score in the prognostication of patients with UGIB and LGIB.…”

“…Different cutoff values for identifying high risks for severe bleeding have been reported. 10,16 The optimal cutoff values for predicting severe LGIB were 22, 1, and 5 for the Oakland score, AIMS65 score, and GBS, respectively. Cutoff values could be affected by differences in several factors depending on study populations, including geographical area, ethnicity, local medical resources, and the aim of the cutoff value.…”