Comparison of Non-Endoscopic Scores for the Prediction of Outcomes in Patients of Upper Gastrointestinal Bleed in an Emergency of a Tertiary Care Referral Hospital: A Prospective Cohort Study

Abstract

BACKGROUND: Traditionally peptic ulcer disease was the most common cause of upper gastrointestinal (UGI) bleed but with the changing epidemiology; other etiologies of UGI bleed are emerging. Many scores have been described for predicting outcomes and the need for intervention in UGI bleed but prospective comparison among them is scarce. OBJECTIVE: This study was planned to determine the etiological pattern of UGI bleed and to compare Glasgow Blatchford score, Pre-Endoscopy Rockall score, AIMS65, and Modified Early Warning Score (MEWS) as predictors of outcome. METHODS: In this prospective cohort study 268 patients of UGI bleed were enrolled and followed up for 8 weeks. Glasgow Blatchford score, Endoscopy Rockall score, AIMS65, and MEWS were calculated for each patient, and the area under the receiver operating characteristic (AUC-ROC) curve for each score was compared. RESULTS: The most common etiology for UGI bleed were gastroesophageal varices 150 (63.55%) followed by peptic ulcer disease 29 (12.28%) and mucosal erosive disease 27 (11.44%). Total 38 (15.26%) patients had re-bleed and 71 (28.5%) patients died. Overall, 126 (47%) patients required blood component transfusion, 25 (9.3%) patients required mechanical ventilation and 2 (0.74%) patients required surgical intervention. Glasgow Blatchford score was the best in predicting the need for transfusion (cut off - 10, AUC-ROC= 0.678). Whereas AIMS65 with a score of ≥2 was best in predicting re-bleed (AUC-ROC=0.626) and mortality (AUC-ROC=0.725). CONCLUSION: Gastrointestinal bleed was most commonly of variceal origin at our tertiary referral center in Northern India. AIMS65 was the best & simplest score with a score of ≥2 for predicting re-bleed and mortality.

Abordagens Cirúrgicas Em Úlceras Pépticas Perfuradas: Comparação Entre Técnicas Laparoscópicas E Abertas

“…Durante o exame físico, é essencial estar atento a sinais de dor abdominal intensa e rigidez, indicativos de peritonite. A história clínica do paciente é cuidadosamente avaliada para identificar fatores de risco, como uso crônico de anti-inflamatórios não esteroides (AINEs), história de úlceras pépticas prévias ou infecção por H. pylori, e para documentar a apresentação dos sintomas 8,9 .…”

“…Portanto, as úlceras pépticas perfuradas constituem uma emergência cirúrgica grave, com potencial risco de vida se não tratadas prontamente. Historicamente, a abordagem aberta foi a técnica padrão para o tratamento dessas perfurações, permitindo uma ampla exposição da cavidade abdominal e um manejo direto das complicações associadas 7,8,9 .…”

“…No entanto, a escolha da técnica ideal não é simples e depende de diversos fatores, como a condição clínica do paciente, a experiência do cirurgião e a disponibilidade de recursos hospitalares. A decisão entre a abordagem laparoscópica e a aberta deve considerar esses aspectos para garantir a melhor recuperação e prognóstico para o paciente 5,6,8 .…”