Optimizing the Risk Assessment in Upper Gastrointestinal Bleeding: Comparison of 5 Scores Predicting 7 Outcomes

Abstract

Introduction: Although different scores have been suggested to predict outcomes in the setting of upper gastrointestinal bleeding (UGIB), few comparative studies between simplified versions of older scores and recent scores have been published. We aimed to evaluate the accuracy of pre- (PreRS) and postendoscopic Rockall scores (PostRS), the Glasgow-Blatchford score (GBS) and its simplified version (sGBS), as well as the AIMS65 score in predicting different clinical outcomes. Methods: In this retrospective study, PreRS, PostRS, GBS, sGBS, and AIMS65 score were calculated, and then, areas under the receiver operating characteristic curve were used to evaluate the performance of each score to predict blood transfusion, endoscopic therapy, surgery, admission to intensive/intermediate care unit, length of hospital stay, as well as 30-day rebleeding or mortality. Results: PreRS, PostRS, GBS, and sGBS were calculated for all the 433 included patients, but AIMS65 calculation was only possible for 315 patients. Only the PreRS and PostRS were able to fairly predict 30-day mortality. The GBS and sGBS were good in predicting blood transfusion and reasonable in predicting surgery. None of the studied scores were good in predicting the need for endoscopic therapy, admission to intensive/intermediate care unit, length of hospital stay, and 30-day rebleeding. Conclusions: Owing to the identified limitations, none of the 5 studied scores could be singly used to predict all the clinically relevant outcomes in the setting of UGIB. The sGBS was as precise as the GBS in predicting blood transfusion and surgery. The PreRS and PostRS were the only scores that could predict 30-day mortality. An algorithm using the PreRS and the sGBS as an initial approach to patients with UGIB is presented and suggested.

Comparing the performance of the ABC, AIMS65, GBS, and pRS scores in predicting 90-day mortality or rebleeding among emergency department patients with acute upper gastrointestinal bleeding: A prospective multicenter study

“…[ 22 ] A study of 433 UGIB patients found that AIMS65 was inferior to GBS at predicting rebleeding. [ 29 ] In our study, although the four risk scores are effective in predicting rebleeding, it is consistent with the results of most previous studies, that is, the AUROCs of 4 scores are all less than 0.7. It may indicate that it is difficult to directly predict and evaluate whether rebleeding will occur in UGIB people through vital signs or biochemical indicators at admission.…”

Comparison of Non-Endoscopic Scores for the Prediction of Outcomes in Patients of Upper Gastrointestinal Bleed in an Emergency of a Tertiary Care Referral Hospital: A Prospective Cohort Study

“…In our study population, none of the scores were predictive of prolonged hospital stay of >3 days which was similar to another study (21) . GBS was the best in predicting the need for blood transfusion as seen by Robertson et al and Goncalves et al (21,27) . The cut-off score for the need for blood transfusion was found ≥10 which was consistent with Robertson et al (21) .…”

“…GBS and AIMS65 were also fairly predictive for need intensive care unit admission with cut off at 12 and 2 respectively. AIMS65 followed by MEWS were predictive for the need for surgical intervention at a cutoff score of ≥3 and ≥4 respectively whereas Goncalves et al have reported GBS as the only score predictive for surgical intervention (27) . However, patients undergoing surgical intervention were very few (only two); hence predictive ability may not be clinically acceptable.…”

“…As the epidemiology of UGI bleed varies from region to region, a well-validated scoring system needs to be in place for a regional set up. Commonly used validated scoring systems for predicting patient outcomes are GBS, AIMS65, PRS and MEWS (10,21,26,27) .…”

Aspectos clínicos y etiológicos de la hemorragia digestiva alta y sus escalas de evaluación

“…La AIMS65 destaca sobre las otras escalas debido a que presenta una menor complejidad, lo que le permite ser más usada en la práctica clínica diaria 57 . 61,62 .…”