Comparison of AIMS65, Glasgow–Blatchford score, and Rockall score in a European series of patients with upper gastrointestinal bleeding: performance when predicting in-hospital and delayed mortality

Abstract

Objective: AIMS65 is a score designed to predict in-hospital mortality, length of stay, and costs of gastrointestinal bleeding. Our aims were to revalidate AIMS65 as predictor of inpatient mortality and to compare AIMS65's performance with that of Glasgow-Blatchford (GBS) and Rockall scores (RS) with regard to mortality, and the secondary outcomes of a composite endpoint of severity, transfusion requirements, rebleeding, delayed (6-month) mortality, and length of stay. Methods: The study included 309 patients. Clinical and biochemical data, transfusion requirements, endoscopic, surgical, or radiological treatments, and outcomes for 6 months after admission were collected. Clinical outcomes were in-hospital mortality, delayed mortality, rebleeding, composite endpoint, blood transfusions, and length of stay. Results: In receiver-operating characteristic curve analyses, AIMS65, GBS, and RS were similar when predicting inpatient mortality (0.76 vs. 0.78 vs. 0.78). Regarding endoscopic intervention, AIMS65 and GBS were identical (0.62 vs. 0.62). AIMS65 was useless when predicting rebleeding compared to GBS or RS (0.56 vs. 0.70 vs. 0.71). GBS was better at predicting the need for transfusions. No patient with AIMS65 ¼ 0, GBS 6, or RS 4 died. Considering the composite endpoint, an AIMS65 of 0 did not exclude high risk patients, but a GBS 1 or RS 2 did. The three scores were similar in predicting prolonged in-hospital stay. Delayed mortality was better predicted by AIMS65. Conclusion: AIMS65 is comparable to GBS and RS in essential endpoints such as inpatient mortality, the need for endoscopic intervention and length of stay. GBS is a better score predicting rebleeding and the need for transfusion, but AIMS65 shows a better performance predicting delayed mortality.

British Society of Gastroenterology (BSG)-led multisociety consensus care bundle for the early clinical management of acute upper gastrointestinal bleeding

“…We recommend that patients with gbs ≤1 at presentation are considered for outpatient management Level of evidence: Moderate Level of recommendation: Strong Agreement: 100% Agreement Bundle recommendation: Consider discharge if GBS 0 or 1 (100% agreement) Several comparative studies have assessed preendoscopy and postendoscopy risk scores in AUGIB. [38][39][40][41][42][43][44][45][46][47][48][49] These studies confirm GBS is the best at predicting the clinically important composite end point of need for hospital-based intervention (transfusion, endoscopic therapy, interventional radiology, surgery) or death, with high sensitivity at 98.6%. 39 The clinical utility of existing risk scores to identify patients at high risk of poor outcomes appear limited.…”

Management of non-variceal upper gastrointestinal bleeding: where are we in 2018?

“…In comparison to GBS and RS, it is superior in predicting inpatient mortality 25. AIMS65 score is inferior to GBS and RS in predicting rebleeding.…”

Correlation between the Glasgow-Blatchford score, shock index, and Forrest classification in patients with peptic ulcer bleeding

“…The European Society of Gastrointestinal Endoscopy has recommended assessment using the GBS before endoscopy, with low-risk (GBS 0-1) patients not requiring early endoscopy or hospitalization [17]. Some studies have found that the GBS can better predict rebleeding in patients with upper gastrointestinal bleeding [18][19][20], and a high GBS (GBS > 7) is associated with the risk of rebleeding [21].…”