Comparison of Glasgow-Blatchford score and full Rockall score systems to predict clinical outcomes in patients with upper gastrointestinal bleeding

Abstract

BackgroundVarious risk scoring systems have been recently developed to predict clinical outcomes in patients with upper gastrointestinal bleeding (UGIB). The two commonly used scoring systems include full Rockall score (RS) and the Glasgow-Blatchford score (GBS). Bleeding scores were assessed in terms of prediction of clinical outcomes in patients with UGIB.Patients and methodsTwo hundred patients (age >18 years) with obvious symptoms of UGIB in the emergency department of Rasoul Akram Hospital were enrolled. Full RS and GBS were calculated. We followed the patients for records of rebleeding and 1-month mortality. A receiver operating characteristic curve by using areas under the curve (AUCs) was used to statistically identify the best cutoff point.ResultsEighteen patients were excluded from the study due to failure to follow-up. Rebleeding and mortality rate were 9.34% (n=17) and 11.53% (n=21), respectively. Regarding 1-month mortality, full RS was better than GBS (AUC, 0.648 versus 0.582; P=0.021). GBS was more accurate in terms of detecting transfusion need (AUC, 0.757 versus 0.528; P=0.001), rebleeding rate (AUC, 0.722 versus 0.520; P=0.002), intensive care unit admission rate (AUC, 0.648 versus 0.582; P=0.021), and endoscopic intervention rate (AUC, 0.771 versus 0.650; P<0.001).ConclusionWe found the full RS system is better for 1-month mortality prediction while GBS system is better for prediction of other outcomes.

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].…”

Indications of Emergency Endoscopy

“…An upper digestive endoscopy should be performed in less than 12 hours in case of hemodynamic instability that persists despite resuscitation, the occurrence of gastrointestinal bleeding or the presence of blood in the nasogastric tube during hospitalization, or a contraindication for the interruption of anticoagulants 4 . To support the clinical decision, it is possible to rely on the definition of the Rockall score which identifies patients at risk of adverse outcome following acute upper gastrointestinal bleeding (≥5 especially in cases of chronic renal failure) or the Glasgow-Blatchford score (≥12, which takes into account urea, hemoglobin, systolic blood pressure and clinical markers) 5 . In case of minor bleeding (Rockall <3, Glasgow˝-Blatchford <5), performing an endoscopy within 24 hours reduces the length of hospital stay 5 .…”

“…To support the clinical decision, it is possible to rely on the definition of the Rockall score which identifies patients at risk of adverse outcome following acute upper gastrointestinal bleeding (≥5 especially in cases of chronic renal failure) or the Glasgow-Blatchford score (≥12, which takes into account urea, hemoglobin, systolic blood pressure and clinical markers) 5 . In case of minor bleeding (Rockall <3, Glasgow˝-Blatchford <5), performing an endoscopy within 24 hours reduces the length of hospital stay 5 . When the risk is very low, it is possible to let the patient go home by planning a return in the following days and informing on the need to hospitalize in case of recurrence 5 .…”

“…In case of minor bleeding (Rockall <3, Glasgow˝-Blatchford <5), performing an endoscopy within 24 hours reduces the length of hospital stay 5 . When the risk is very low, it is possible to let the patient go home by planning a return in the following days and informing on the need to hospitalize in case of recurrence 5 . Contraindications -that nevertheless should be discussed on a case-by-case basis -with emergency endoscopy remain limited: suspicion of associated perforation, acute coronary artery disease associated or induced, anticoagulant overdose.…”

Comparison of three risk scores to predict outcomes in upper gastrointestinal bleeding; modifying Glasgow-Blatchford with albumin

“…Moreover, since GBS is the preferred scoring system in predicting the need for clinical intervention [20,[24][25][26], our third objective was to assess whether addition of albumin to this system can increase its predictive accuracy in predicting mortality or not.…”