MAP(ASH): A new scoring system for the prediction of intervention and mortality in upper gastrointestinal bleeding

Redondo–Cerezo, Eduardo; Vadillo-Calles, Francisco; Stanley, Adrian; Laursen, Stig Borbjerg; Laine, Loren; Dalton, Harry R.; Ngu, Jing Hieng; Schultz, Michael; Jiménez-Rosales, Rita

doi:10.1111/jgh.14811

Cited by 23 publications

(30 citation statements)

References 31 publications

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“…In this sense, we performed an analysis excluding cirrhotic patients and individuals with a diagnosis of portal hypertension, with similar results to what was found for the whole population. Not surprisingly, cirrhosis was also an independent risk factor for mortality in old patients, similar to what has been observed in younger patients 16–18,20,21 …”

Section: Discussionsupporting

confidence: 72%

“…Not surprisingly, cirrhosis was also an independent risk factor for mortality in old patients, similar to what has been observed in younger patients. [16][17][18]20,21 However, in the multivariate analysis creatinine levels, cirrhosis and being an inpatient were independent predictive factors for 30day mortality. Eventually, renal failure has been previously related to the risk of gastrointestinal bleeding in different settings, and also included in some GI bleeding prognostic scores.…”

Section: Ta B L E 3 Differences Between Ops Who Died and Survivedmentioning

confidence: 87%

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Upper gastrointestinal bleeding in patients 80 years old and over. A comparison with younger patients and risk factors analysis for in‐hospital and delayed mortality

et al. 2021

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Introduction Outcomes in old patients with upper gastrointestinal bleeding (UGIB) have been scarcely studied. Our aim was to compare very old individuals (>80 years old) with younger patients with UGIB, and to identify risk factors for the main outcomes. Methods A single‐centre prospectively collected database was analysed. Descriptive, inferential and multivariate logistic regression models were performed. Main clinical outcomes were in‐hospital and delayed 6‐month mortality. Results 698 patients were included, 143 very old and 555 aged <80. Old patients differed from younger ones in comorbidities (85.9% vs. 62%, P < .0001), oral anticoagulants (32.3% vs. 12.7%; P < .0001), and antiplatelets intake (32.3% vs. 21.2%; P < .007). No differences were found in the need for endoscopic interventions, blood unit transfusions, hospital stay, in‐hospital rebleeding and mortality. Among very old patients, creatinine levels were higher in those who died compared with the ones who survived (1.92 ± 1.46 vs. 1.25 ± 0.59 mg/dL; P = .002), they had lower haemoglobin levels (8.1 ± 1.4 vs. 9.1 ± 2.4 g/dL; P = .04) and longer hospital stays (17.75 ± 15.5 vs. 8.1 ± 8.4 days; P < .0001). Logistic regression showed creatinine levels (OR: 2.42; 95% CI: 1.24–4.74; P = .01), cirrhosis (OR: 2.88, 95% CI: 1.88–17.34; P = .04) and being an impatient (OR: 3.90; 95% CI: 1.11–20; P = .035) were independent risk factors for mortality in older patients. They had an increased delayed 6‐month mortality compared with younger patients (17.5% vs. 8%, P = .001). Conclusions Creatinine levels, cirrhosis or the onset of UGIB while being an inpatient were independent risk factors for mortality in very old patients. Delayed mortality was higher among them, mostly caused by cardiovascular events and neoplasms, but not in‐hospital mortality.

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Section: Discussionsupporting

confidence: 72%

Section: Ta B L E 3 Differences Between Ops Who Died and Survivedmentioning

confidence: 87%

Upper gastrointestinal bleeding in patients 80 years old and over. A comparison with younger patients and risk factors analysis for in‐hospital and delayed mortality

et al. 2021

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“…Notably, despite their simplicity, our novel criteria showed equivalent predictability to other useful but more complex scores, including AIMS65 and PNED. The AUCs of GBS, RS, AIMS65, and PNED for detecting UGIB-associated mortality have been reported to be 0.64-0.87, 0.72-0.81, 0.75-0.91, and 0.77-0.81, respectively ( 12 - 16 , 23 - 25 ). PNED reportedly outperforms RS in predicting the risk of death from UGIB ( 12 ).…”

Section: Discussionmentioning

confidence: 99%

“…For this purpose, various scoring systems, such as the Glasgow-Blatchford score (GBS) ( 9 ), Rockall score (RS) ( 10 ), AIMS65 ( 11 ), and Progetto Nazionale Emorragia Digestiva score (PNED) ( 12 ), have been developed. A retrospective study comprising a large number of participants found that AIMS65 and PNED were useful for predicting mortality caused by UGIB ( 13 ), whereas other studies observed an insufficient power of the GBS, RS, and AIMS65 with regard to predicting mortality ( 14 - 16 ). In addition, these risk scores are based on many clinical and laboratory parameters, making them too complicated to apply in emergency situations.…”

Section: Introductionmentioning

confidence: 99%

Novel and Simple Criteria for Predicting Mortality of Peptic Ulcer Disease

et al. 2021

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Objective Conventional risk scores of peptic ulcer disease (PUD) are based on many parameters, and their application in clinical practice is therefore limited. The aim of this study was to establish simple and reliable criteria for predicting PUD-associated mortality. Methods A total of 499 patients with PUD were divided into 2 groups: the training cohort (n=333) and the validation cohort (n=166). To minimize selection bias due to missing values, we used imputed datasets generated by the multiple imputation method (training-cohort dataset, n=33,300; validation-cohort dataset, n=16,600). Results In the training-cohort dataset, the heart rate-to-systolic blood pressure ratio (HR/SBP) and serum albumin (s-Alb) level were significant independent predictive factors for mortality according to the multivariate analysis [HR/SBP, odds ratio (OR): 1.72; 95% confidence interval (CI), 1.06-2.80, p=0.028; s-Alb, OR: 0.23, 95% CI, 0.11-0.51, p<0.001]. The model comprising HR/SBP and s-Alb was able to detect mortality due to PUD with an area under the curve (AUC) of 0.855. In the validation-cohort dataset, this model also showed good efficacy with an AUC of 0.835. The novel criteria combining HR/SBP and s-Alb developed by a decision tree analysis showed 73.3% sensitivity and 87.6% specificity for predicting mortality in the total-cohort dataset. Our criteria were superior to the Glasgow Blatchford and Rockall scores and similar to the AIMS65 and Progetto Nazionale Emorragia Digestiva scores for predicting mortality. Conclusion The combination of the HR/SBP ratio and s-Alb level is a good predictor of mortality in patients with PUD.

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“…Regarding mortality prediction, AIM65 performs better than GBS and pRS; however, the areas under the receiver operator characteristics curves (AUCs of ROCs) are generally no higher than 0.80, suggesting that the clinical application of predicting this endpoint is limited [ 7 ]. Several new scoring systems have been developed, including the MAP(ASH) and the ABC scores [ 8 , 9 ]. Nevertheless, the accuracy of these scoring systems needs to be verified, especially in older adults with UGIB.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2022

Gastroenterology Research and Practice

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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.

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MAP(ASH): A new scoring system for the prediction of intervention and mortality in upper gastrointestinal bleeding

Abstract: This is the author manuscript accepted for publication and has undergone full peer review but has not been through the copyediting, typesetting, pagination and proofreading process, which may lead to differences between this version and the Version of Record. Please cite this article as

Cited by 23 publications

References 31 publications

Upper gastrointestinal bleeding in patients 80 years old and over. A comparison with younger patients and risk factors analysis for in‐hospital and delayed mortality

Upper gastrointestinal bleeding in patients 80 years old and over. A comparison with younger patients and risk factors analysis for in‐hospital and delayed mortality

Novel and Simple Criteria for Predicting Mortality of Peptic Ulcer Disease

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

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