Comparison of risk scores in upper gastrointestinal bleeding in western India: A prospective analysis

Chandnani, Sanjay; Rathi, Pravin; Sonthalia, Nikhil; Udgirkar, Suhas; Jain, Shubham; Contractor, Qais; Jain, Shreepal; Singh, Anupam

doi:10.1007/s12664-019-00951-w

Cited by 16 publications

(25 citation statements)

References 33 publications

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“…HR, heart rate; SBP, systolic blood pressure; DBP, diastolic blood pressure; RBC, red blood cell; HCT, hematocrit; HB, hemoglobin; PLT, platelet count; CRP, C-reactive protein; PT, prothrombin time; INR, international normalized ratio; ALT, alanine aminotransferase; AST, glutamic oxaloacetic transaminase; BUN, blood urea nitrogen; ALB, albumin; A/G, albumin /globulin ratio; GFR, glomerular filtration rate. 2.6 was used as criteria for hypoalbuminemia and were considered to be independent predictors of death (Gonzalez-Gonzalez et al, 2011Chandnani et al, 2019). Our study showed that the lower the albumin, the greater the risk of death in the ED.…”

Section: Notesmentioning

confidence: 81%

Prediction model of emergency mortality risk in patients with acute upper gastrointestinal bleeding: a retrospective study

Chen

Zheng

Wang

2021

PeerJ

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Background Upper gastrointestinal bleeding is a common presentation in emergency departments and carries significant morbidity worldwide. It is paramount that treating physicians have access to tools that can effectively evaluate the patient risk, allowing quick and effective treatments to ultimately improve their prognosis. This study aims to establish a mortality risk assessment model for patients with acute upper gastrointestinal bleeding at an emergency department. Methods A total of 991 patients presenting with acute upper gastrointestinal bleeding between July 2016 and June 2019 were enrolled in this retrospective single-center cohort study. Patient demographics, parameters assessed at admission, laboratory test, and clinical interventions were extracted. We used the least absolute shrinkage and selection operator regression to identify predictors for establishing a nomogram for death in the emergency department or within 24 h after leaving the emergency department and a corresponding nomogram. The area under the curve of the model was calculated. A bootstrap resampling method was used to internal validation, and decision curve analysis was applied for evaluate the clinical utility of the model. We also compared our predictive model with other prognostic models, such as AIMS65, Glasgow-Blatchford bleeding score, modified Glasgow-Blatchford bleeding score, and Pre-Endoscopic Rockall Score. Results Among 991 patients, 41 (4.14%) died in the emergency department or within 24 h after leaving the emergency department. Five non-zero coefficient variables (transfusion of plasma, D-dimer, albumin, potassium, age) were filtered by the least absolute shrinkage and selection operator regression analysis and used to establish a predictive model. The area under the curve for the model was 0.847 (95% confidence interval [0.794–0.900]), which is higher than that of previous models for mortality of patients with acute upper gastrointestinal bleeding. The decision curve analysis indicated the clinical usefulness of the model. Conclusions The nomogram based on transfusion of plasma, D-dimer, albumin, potassium, and age effectively assessed the prognosis of patients with acute upper gastrointestinal bleeding presenting at the emergency department.

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Section: Notesmentioning

confidence: 81%

Prediction model of emergency mortality risk in patients with acute upper gastrointestinal bleeding: a retrospective study

Chen

Zheng

Wang

2021

PeerJ

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“…Chandnani et al [17] concluded that GBS had better performance in this area than complete RS. This contradicts our findings, although it might be explained with their higher rebleeding rate (16.7 vs. 8.4%) [17].…”

Section: Discussion/conclusionmentioning

confidence: 99%

The Clinical Impact of Rockall and Glasgow-Blatchford Scores in Nonvariceal Upper Gastrointestinal Bleeding

Maia

Falcão

Silva

et al. 2021

GE Port J Gastroenterol

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Introduction: Risk stratification in patients with nonvariceal upper gastrointestinal bleeding (NVUGIB) is crucial for proper management. Rockall score (RS; pre-endoscopic and complete) and Glasgow-Blatchford score (GBS) are some of the most used scoring systems. This study aims to analyze these scores’ ability to predict various clinical outcomes and possible cutoff points to identify low- and high-risk patients. Secondarily, this study intents to evaluate the appropriateness of patients’ transfers to our facility, which provides a specialized emergency endoscopy service. Methods: This study was retrospectively conducted at Centro Hospitalar Universitário do Porto and included patients admitted to the Emergency Department with acute manifestations of NVUGIB between January 2016 and December 2018. Receiver operating characteristic (ROC) curves and corresponding areas under the curve (AUC) were calculated. Transferred patients from other institutions and nontransferred (directly admitted to this institution) patients were also compared. Results: Of a total of 420 patients, 23 (5.9%) died, 34 (8.4%) rebled, 217 (51.7%) received blood transfusion, 153 (36.3%) received endoscopic therapy, 22 (5.7%) had surgery, and 171 (42.3%) required hospitalization in the Intermediate or Intensive Care Unit. Regarding mortality prediction, both complete RS (AUC 0.756, p < 0.001) and pre-endoscopic RS (AUC 0.711, p = 0.001) showed good performance. In the prediction of rebleeding, only complete RS (AUC 0.735, p < 0.001) had discriminative ability. GBS had good performance in the prediction of transfusion (AUC 0.785, p < 0.001). No score showed discriminative capability in the prediction of other outcomes. Transferred and nontransferred patients had similar pre-endoscopic RS (3.41 vs. 3.34, p = 0.692) and GBS (13.29 vs. 12.29, p = 0.056). Only patients with GBS ≥6 were transferred to our facility. There were no adverse outcomes recorded in any group when GBS was ≤3. Discussion/Conclusion: Complete RS and pre-endoscopic RS are effective at predicting mortality, but only complete RS showed good performance at predicting rebleeding. GBS is better at predicting transfusion requirement. Our study suggests that a transfer can possibly be reconsidered if GBS is ≤3, although current recommendations only propose outpatient care when GBS is 0 or 1. Patients’ transfers were appropriate, considering the high GBS scores and the outcomes of these patients.

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“…The first step in the treatment of all the patients with bleeding from the digestive tract is a rapid assessment of the severity of bleeding, immediately followed by the measures of liquid volume reimbursement which include an initial fluid administration through wide intravenous lines [13,14]. With bleeding from the upper parts of the digestive system under conditions of the highest quality of treatment, progress in the diagnostics and non-surgical methods of haemostasis, technological advances in the field of intensive care, mortality rate is 7-10% and has not changed for the last forty years [14,15]. The level of mortality because of the bleeding from the upper parts of the digestive system requires urgent diagnostic and therapy [15].…”

Section: Discussionmentioning

confidence: 99%

“…With bleeding from the upper parts of the digestive system under conditions of the highest quality of treatment, progress in the diagnostics and non-surgical methods of haemostasis, technological advances in the field of intensive care, mortality rate is 7-10% and has not changed for the last forty years [14,15]. The level of mortality because of the bleeding from the upper parts of the digestive system requires urgent diagnostic and therapy [15]. Duodenal ulcers are definitely the leading cause of bleeding from the upper parts of the digestive tract [16].…”

Section: Discussionmentioning

confidence: 99%

The causes of upper gastrointestinal bleeding and urgent gastroscopy at the Center for Emergency Medicine of the Clinical Center Kragujevac

Milojković-Kicevska¹,

Kovačević²,

Janicijevic-Petrovic³

et al. 2019

Timočki medicinski glasnik

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Introduction: Digestive tract bleeding is a clinical problem that requires hospitalization. Hemorrhages from the upper parts of the digestive system have an incidence of 150/100000 persons per year and are the reason for 1.5% of all emergency hospitalizations. The most common cause of bleeding is gastroduodenal ulcer and erosion in three quarters of cases. Endoscopic haemostatic and gastric acidity status are the most important in the treatment of patients. Aim: To analyze the causes of bleeding from the upper parts of digestive tract and the justification for the urgent gastroscopy. The study was conducted at the Clinical Center Kragujevac in Kragujevac, Serbia. Methods: The study included patients (200) who reported to the emergency room of the Emergency Medicine Center with the clinical picture of bleeding from the upper parts of the digestive tract. Results: Most patients had ulcerative changes at gastric level (58.6%). The most common symptom was melena present in 152 patients. Endoscopic therapy was administered to 44 patients, with 38 patients (86.4%) resulting in arresting bleeding. Conclusion: Hemorrhages from the upper parts of the digestive tract are most commonly caused by peptic ulcers, more common in older, male patients. The first form of diagnosis and therapy is endoscopy, with an efficacy greater than 70%.

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Comparison of risk scores in upper gastrointestinal bleeding in western India: A prospective analysis

Cited by 16 publications

References 33 publications

Prediction model of emergency mortality risk in patients with acute upper gastrointestinal bleeding: a retrospective study

Prediction model of emergency mortality risk in patients with acute upper gastrointestinal bleeding: a retrospective study

The Clinical Impact of Rockall and Glasgow-Blatchford Scores in Nonvariceal Upper Gastrointestinal Bleeding

The causes of upper gastrointestinal bleeding and urgent gastroscopy at the Center for Emergency Medicine of the Clinical Center Kragujevac

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