Evaluation of Six Preendoscopy Scoring Systems to Predict Outcomes for Older Adults with Upper Gastrointestinal Bleeding

Abstract

Objectives. To compare the ability of six preendoscopic scoring systems (ABC, AIMS65, Glasgow Blatchford score (GBS), MAP(ASH), pRS, and T -score) to predict outcomes of upper gastrointestinal bleeding (UGIB) in older adults. Methods. This was a retrospective study of 602 older adults ( age ≥ 65 ) presenting with UGIB at Zhongda Hospital Southeast University from January 2015 to June 2021. Six scoring systems were used to analyze all patients. Results. ABC had the largest area under the curve (AUC) (0.833; 95% confidence interval (CI): 0.801–0.862) and was significantly higher than pRS 0.696 (95% CI: 0.658–0.733, p < 0.01 ) and T -score 0.667 (95% CI: 0.628–0.704, p < 0.01 ) in predicting mortality. MAP(ASH) (0.783; 95% CI: 0.748–0.815) performs the best in predicting intervention and was similar to GBS, T -score, ABC, and AIMS65. The AUCs for MAP(ASH) (0.732; 95% CI: 0.698–0.770), AIMS65 (0.711; 95% CI: 0.672–0.746), and ABC (0.718; 95% CI: 0.680–0.754) were fair for rebleeding, while those of GBS (0.662; 95% CI: 0.617–0.694), T -score (0.641; 95% CI: 0.606–0.684), and pRS (0.609; 95% CI: 0.569–0.648) were performed poorly. MAP(ASH) performs the best in predicting ICU admission (0.784; 95% CI: 0.749–0.816). All the five scores were significantly higher than pRS ( p < 0.05 for ABC, AIMS65 and T -score, p < 0.01 for GBS and MAP). Conclusions. Mortality, intervention, rebleeding, and ICU admission in UGIB for older adults can be predicted well using MAP(ASH). ABC is the most accurate for predicting mortality. Except for rebleeding, GBS has an acceptable performance in predicting ICU admission, mortality, and intervention. AIMS65 and T -score performed moderately, and pRS may not be suitable for the target cohort.

Predictive Significance of the ABC Score for Early Re-Hemorrhage and In-Hospital Mortality in High-Risk Variceal Bleeding among Cirrhotic Patients

“…While we specifically selected patients with cirrhosis who had UGIB due to variceal rupture, other studies included patients with upper gastrointestinal bleeding due to various causes. Nevertheless, the distribution of risk factor groups according to the ABC score in our results is consistent with previous reports, primarily consisting of patients with ABC scores ≥ 4 (moderate and high risk) [9,24,25]. Furthermore, among patients experiencing either reactive hemorrhage or early mortality, the average ABC score was significantly higher than in those without these outcomes (9.1 vs. 6.1 and 9.1 vs. 6.0, p < 0.001, respectively).…”

“…The average ABC score in our study is higher than that in many reports by other authors. For example, the average score in the study by Li Y. et al (2022) was 4.0 [24], Saade M.C. et al reported 5.26 [9], and Jimenez-Rosales R. et al (2023) reported 4.5 [25].…”

“…Our findings are also consistent with other reports worldwide. For instance, Li Y. and colleagues (2022) reported AUROC values of 0.833 for predicting mortality and 0.718 for predicting recurrent hemorrhage [24]. Jimenez-Rosales R. and colleagues (2023) observed an AUROC of 0.80 for healthcare facility mortality prediction, while the forecast for re-hemorrhage was moderate at 0.61 [25].…”

Comparison and validation of the Japanese score and other scoring systems in patients with peptic ulcer bleeding: A retrospective study

“…[18] A multicenter study performed in several countries showed that the GBS outperformed the pre-endoscopic Rockall score and the AIMS65 score when applied to predicting the need for endoscopic interventions. [18][19][20][21] Another study introduced the MAP (ASH) score as a new scoring system for predicting the need for intervention and mortality in patients with UGIB and reported that the GBS predicted the need for endoscopic intervention better than the AIMS65 score and pre-endoscopic Rockall score. [15] However, according to recent studies, for patients aged > 65 years, the GBS and AIMS65 score are ineffective for predicting the need for endoscopic intervention in patients with UGIB.…”

Novel risk score for acute upper gastrointestinal bleeding in elderly patients: a single-centre retrospective study

“…Furthermore, there were few studies on those score systems on geriatric patients to validate whether they suit elderly patients. Our previous research 25 found that MAP(ASH), GBS, AIMS65 and pRS (the preendoscopic Rockall score) only performed reasonably in predicting mortality and intervention with the AUROCs all below 0.8, indicating they might not be very suitable for elderly patients.…”