Comparison of various prognostic scores in variceal and non-variceal upper gastrointestinal bleeding: A prospective cohort study

Rout, G. R.; Sharma, Sanchit; Gunjan, Deepak; Kedia, Saurabh; Nayak, Baibaswata; Shalimar, S.

doi:10.1007/s12664-018-0928-8

Cited by 22 publications

(20 citation statements)

References 35 publications

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“…Thus, our study has shown a marked reduction in the number of endoscopy procedures during the COVID-19 pandemic. However, the number of endoscopy procedures performed for GI bleeding was similar to those reported previously from one centre (130 over 2 months for UGI bleeding - 43% non-variceal and 57% variceal) [6] . Primary hemostasis was achieved in 98.8% of patients with a 4.0% rebleeding rate and 6.7% 28-days mortality in patients with upper GI bleeding.…”

supporting

confidence: 82%

Low risk of transmission of SARS-CoV2 and effective endotherapy for gastrointestinal bleeding despite challenges supports resuming optimum endoscopic services

Agarwal

Chowdhury

Sachdeva

et al. 2021

Digestive and Liver Disease

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supporting

confidence: 82%

Low risk of transmission of SARS-CoV2 and effective endotherapy for gastrointestinal bleeding despite challenges supports resuming optimum endoscopic services

Agarwal

Chowdhury

Sachdeva

et al. 2021

Digestive and Liver Disease

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“…Gaduputi et al[21] reported that the AIMS65 score may be as useful as the Rockall score for predicting the risk of rebleeding and death in noncirrhotic patients. External validation studies confirmed that these scores had poorer predictive ability in patients with variceal bleeding than in those with nonvariceal bleeding[22,23].…”

Section: Discussionmentioning

confidence: 99%

Prognostic value of risk scoring systems for cirrhotic patients with variceal bleeding

Tantai¹,

Liu²,

Yang³

et al. 2019

WJG

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BACKGROUNDAcute variceal bleeding is one of the deadliest complications of cirrhosis, with a high risk of in-hospital rebleeding and mortality. Some risk scoring systems to predict clinical outcomes in patients with upper gastrointestinal bleeding have been developed. However, for cirrhotic patients with variceal bleeding, data regarding the predictive value of these prognostic scores in predicting in-hospital outcomes are limited and controversial.AIMTo validate and compare the overall performance of selected prognostic scoring systems for predicting in-hospital outcomes in cirrhotic patients with variceal bleeding.METHODSFrom March 2017 to June 2019, cirrhotic patients with acute variceal bleeding were retrospectively enrolled at the Second Affiliated Hospital of Xi’an Jiaotong University. The clinical Rockall score (CRS), AIMS65 score (AIMS65), Glasgow-Blatchford score (GBS), modified GBS (mGBS), Canada-United Kingdom-Australia score (CANUKA), Child-Turcotte-Pugh score (CTP), model for end-stage liver disease (MELD) and MELD-Na were calculated. The overall performance of these prognostic scoring systems was evaluated.RESULTSA total of 330 cirrhotic patients with variceal bleeding were enrolled; the rates of in-hospital rebleeding and mortality were 20.3% and 10.6%, respectively. For in-hospital rebleeding, the discriminative ability of the CTP and CRS were clinically acceptable, with area under the receiver operating characteristic curves (AUROCs) of 0.717 (0.648-0.787) and 0.716 (0.638-0.793), respectively. The other tested scoring systems had poor discriminative ability (AUROCs < 0.7). For in-hospital mortality, the CRS, CTP, AIMS65, MELD-Na and MELD showed excellent discriminative ability (AUROCs > 0.8). The AUROCs of the mGBS, CANUKA and GBS were relatively small, but clinically acceptable (AUROCs > 0.7). Furthermore, the calibration of all scoring systems was good for either in-hospital rebleeding or death.CONCLUSIONFor cirrhotic patients with variceal bleeding, in-hospital rebleeding and mortality rates remain high. The CTP and CRS can be used clinically to predict in-hospital rebleeding. The performances of the CRS, CTP, AIMS65, MELD-Na and MELD are excellent at predicting in-hospital mortality.

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“…The prognostic scores such as CRS, GBS, mGBS and AIMS65 predict the need for hospitalization, rebleeding and mortality better among patients with non-variceal UGI bleeding than patients with variceal UGI bleeding. [22] The majority of patients in our study had variceal . CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.…”

Section: Outcomes Of Ugi Bleedmentioning

confidence: 72%

Outcome of Conservative Therapy in COVID-19 Patients Presenting with Gastrointestinal Bleeding

Shalimar

Vaishnav

Elhence

et al. 2020

Preprint

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Background: There is a paucity of data on the management of gastrointestinal(GI) bleeding in patients with COVID-19 amid concerns about the risk of transmission during endoscopic procedures.We aimed to study the outcomes of conservative treatment for GI bleeding in patients with COVID-19. Methods: In this retrospective analysis, 24 of 1342(1.8%) patients with COVID-19, presenting with GI bleeding from 22ndApril to 22ndJuly 2020, were included. Results: The mean age of patients was 45.8+/-12.7 years; 17(70.8%) were males; upper GI(UGI) bleeding: lower GI(LGI) 23:1. Twenty-two(91.6%) patients had evidence of cirrhosis- 21 presented with UGI bleeding while one had bleeding from hemorrhoids. Two patients without cirrhosis were presumed to have non-variceal bleeding. The medical therapy for UGI bleeding included vasoconstrictors- somatostatin in 17(73.9%) and terlipressin in 4(17.4%) patients. All patients with UGI bleeding received proton pump inhibitors and antibiotics. Packed red blood cells(PRBCs), fresh frozen plasma and platelets were transfused in 14(60.9%), 3(13.0%) and 3(13.0%), respectively. The median PRBCs transfused was 1(0-3) unit(s). The initial control of UGI bleeding was achieved in all 23 patients and none required an emergency endoscopy. At 5-day follow-up, none rebled or died. Two patients later rebled, one had intermittent bleed due to gastric antral vascular ectasia, while another had rebleed 19 days after discharge. Three(12.5%) cirrhosis patients succumbed to acute hypoxemic respiratory failure during hospital stay. Conclusion: Conservative management strategies including pharmacotherapy, restrictive transfusion strategy, and close hemodynamic monitoring can successfully manage GI bleeding in COVID-19 patients and reduce need for urgent endoscopy.

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Comparison of various prognostic scores in variceal and non-variceal upper gastrointestinal bleeding: A prospective cohort study

Cited by 22 publications

References 35 publications

Low risk of transmission of SARS-CoV2 and effective endotherapy for gastrointestinal bleeding despite challenges supports resuming optimum endoscopic services

Low risk of transmission of SARS-CoV2 and effective endotherapy for gastrointestinal bleeding despite challenges supports resuming optimum endoscopic services

Prognostic value of risk scoring systems for cirrhotic patients with variceal bleeding

Outcome of Conservative Therapy in COVID-19 Patients Presenting with Gastrointestinal Bleeding

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