Evaluation of scoring models for identifying the need for therapeutic intervention of upper gastrointestinal bleeding: A new prediction score model for Japanese patients

Iino, Chikara; Mikami, Taisei; Igarashi, Takasato; Aihara, Tomoyuki; Ishii, Kentaro; Sakamoto, Jyuichi; Tono, Hiroshi; Fukuda, Shinsaku

doi:10.1111/den.12666

Cited by 24 publications

(33 citation statements)

References 21 publications

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“…R EGARDING THE OUTCOMES after UGIB in Japan, although there have been numerous reports on rebleeding or the need for additional intervention, [20][21][22] only a few studies addressed all-cause mortality with a relatively small number of cases with mortality (range, 6-47). [9][10][11]23 Since endoscopic treatment is currently used to successfully treat most cases of UGIB, and only a small portion of patients experience a fatal outcome, the accumulation of data from multiple centers is required to perform meaningful analyses on mortality after UGIB.…”

Section: Discussionmentioning

confidence: 99%

Effects of anti‐thrombotic drugs on all‐cause mortality after upper gastrointestinal bleeding in Japan: A multicenter study with 2205 cases

Matsuhashi

Fukuda

Mikami

et al. 2021

Digestive Endoscopy

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Objects: Although anti-thrombotic use is recognized as a risk factor for upper gastrointestinal bleeding (UGIB), there has been no clear evidence that it worsens the outcomes after the bleeding. The aim of this study is to investigate the effects of anti-thrombotic agents on in-hospital mortality following UGIB.Methods: Information on clinical parameters, including usage of anti-thrombotic agents, was retrospectively collected from consecutive patients with UGIB at 12 high-volume centers in Japan between 2011 and 2018. The all-cause in-hospital mortality rate was evaluated according to the usage of antithrombotic agents.Results: Clinical data were collected from 2205 patients with endoscopically confirmed UGIB. Six hundred and forty-five (29.3%) patients used anti-thrombotic agents. The all-cause inhospital mortality rate was 5.7% (125 deaths). After excluding 29 cases in which death occurred due to end-stage malignancy, 96 deaths (bleeding-related, n = 22 ; non-bleeding-related, n = 74) were considered "preventable." Overall, the "preventable" mortality rate in anti-thrombotic users was significantly higher than that in non-users (6.0% vs. 3.7%, P < 0.05). However, the "preventable" mortality of anti-thrombotic users showed a marked improvement over time; although the rate in users remained significantly higher than that in non-users until 2015 (7.3% vs. 4.2%, P < 0.05), after 2016, the difference was no longer statistically significant (4.8% vs. 3.5%). Conclusions:Although the usage of anti-thrombotic agents worsened the outcomes after UGIB, the situation has recently been improving. We speculate that the recent revision of the Japanese guidelines on the management of anti-thrombotic treatment after UGIB may have partly contributed to improving the survival of users of anti-thrombotic agents.

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Section: Discussionmentioning

confidence: 99%

Effects of anti‐thrombotic drugs on all‐cause mortality after upper gastrointestinal bleeding in Japan: A multicenter study with 2205 cases

Matsuhashi

Fukuda

Mikami

et al. 2021

Digestive Endoscopy

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“…have been developed, and these are used according to the individual circumstances of each institution. [3][4][5][6] Recently, the new international bleeding scoring system, which is useful for predicting 30-day mortality, 7 and the new Japanese scoring system, which is useful for predicting the need for endoscopic hemostasis, 8 were introduced. However, although many studies have evaluated the usefulness of existing indicators, few have compared the usefulness of the newly introduced scoring systems with existing systems.…”

Section: Introductionmentioning

confidence: 99%

Which scoring system should be used for non‐variceal upper gastrointestinal bleeding? Old or new?

Jeon

Moon

Kwon

et al. 2021

J of Gastro and Hepatol

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Background and Aim: Several scoring systems for predicting outcomes in patients with non-variceal upper gastrointestinal bleeding (NVUGIB) have recently been devised, but not sufficiently validated. We compared the predictive accuracy of several scoring systems and assessed the usefulness of new scoring systems. Methods: The medical records of 1048 patients with NVUGIB were reviewed to collect demographic, clinical, laboratory, and endoscopic data. The areas under the receiver operating characteristic curve (AUROCs) were calculated for the ABC, new Japanese scoring system, Progetto Nazionale Emorrhagia Digestiva (PNED), and other scores to compare their predictive accuracy for 30-day mortality, therapeutic intervention, rebleeding, and prolonged hospital stay (≥ 10 days). Outcome predictors were identified by multivariate analysis. Results: The ABC, new Japanese scoring system, and PNED scores best predicted 30-day mortality (AUROC 0.907), need for therapeutic intervention (AUROC 0.707), and rebleeding (AUROC 0.874), respectively (all P < 0.001). The ABC and PNED scores were similarly better at predicting prolonged hospital stay (ABC AUROC: 0.765; PNED AUROC: 0.790; both P < 0.001). Thirty-day mortality was related to sex, systolic blood pressure (SBP), syncope, estimated glomerular filtration rate (eGFR), albumin, heart failure, disseminated malignancy, chronic obstructive pulmonary disease (COPD), and liver cirrhosis. Sex, age, SBP, hematemesis, blood urea nitrogen, and eGFR independently predicted the need for therapeutic intervention. Sex, SBP, pulse, albumin level, heart failure, disseminated malignancy, and COPD predicted rebleeding. Conclusion:The outcomes of patients with NVUGIB were better predicted by newly developed than by old scoring systems.

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“…15 Despite the plethora of existing scores, a further model has recently been proposed based on seven factors: systolic blood pressure <100 mmHg, syncope, haematemesis, haemoglobin < 100 g/L, blood urea 22.4 mg/dL, estimated glomerular filtration rate <60 mL/min/1.73 m2, and the use of anti-platelet medications. 19 In a cohort of Japanese patients, this score was superior to the pre-endoscopy Rockall and AIMS65 scores in predicting clinical intervention. 19 However, it is requires further study and in particular comparison against the GBS before the exact role in management can be established.…”

Section: Risk Stratificationmentioning

confidence: 91%

“…19 In a cohort of Japanese patients, this score was superior to the pre-endoscopy Rockall and AIMS65 scores in predicting clinical intervention. 19 However, it is requires further study and in particular comparison against the GBS before the exact role in management can be established.…”

Section: Risk Stratificationmentioning

confidence: 91%

Advances in the Therapy of Bleeding Peptic Ulcer

Beales

2018

Clinical Medicine Insights: Therapeutics

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Peptic ulcer bleeding remains an important medical emergency. Important recent advances are reviewed. These include further support for a more restrictive transfusion strategy aiming for a target haemoglobin of 70-90 g/L. The Glasgow-Blatchford score remains the most useful assessment score for identifying the lowest risk patients suitable for outpatient management and predicting the need for intervention. Newer scores such as the AIMS65 and Progetto Nazionale Emorragia Digestive score (PNED) may be more accurate in predicting mortality. Pre-endoscopy erythromycin improves outcomes and is underused. A new disposable Doppler probe appears to provide more accurate determination of both rebleeding risk and the success of endoscopic therapy than purely visual guidance. Over-the-scope clips and haemostatic powders appear to have some role as endoscopic salvage therapies. Non-H. pylori, non-aspirin/non-steroidal anti-inflammatory drug (NSAID) ulcers contribute to an increasing percentage of bleeding peptic ulcers and are associated with a high rebleeding rate. The optimal management of these ulcers remains to be determined.

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Evaluation of scoring models for identifying the need for therapeutic intervention of upper gastrointestinal bleeding: A new prediction score model for Japanese patients

Abstract: We developed a superior scoring model for identifying therapeutic intervention need in Japanese patients with upper gastrointestinal bleeding.

Cited by 24 publications

References 21 publications

Effects of anti‐thrombotic drugs on all‐cause mortality after upper gastrointestinal bleeding in Japan: A multicenter study with 2205 cases

Effects of anti‐thrombotic drugs on all‐cause mortality after upper gastrointestinal bleeding in Japan: A multicenter study with 2205 cases

Which scoring system should be used for non‐variceal upper gastrointestinal bleeding? Old or new?

Advances in the Therapy of Bleeding Peptic Ulcer

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