Prediction of Adverse Outcomes using Non-Endoscopic Scoring Systems in Patients Over 80 Years of Age Who Present With Upper Gastrointestinal Bleeding in the Emergency Department

Abstract

BACKGROUND:The emergency department (ED) admission rate for elderly patients with non-variceal upper gastrointestinal bleeding (UGIB) is increasing. The AIMS65 and Glasgow-Blatchford score (GBS) are two distinct scoring systems proposed to predict in-hospital and post-discharge mortality, length of stay (LOS), and health-related costs in these patients. The objective of the present study is to evaluate the accuracy of these scoring systems, in conjunction with the Charlson comorbidity index (CCI), to predict 30-day mortality and LOS in UGIB patients who are 80 years of age or older METHODS: A retrospective analysis was undertaken of 182 patients with non-variceal UGIB who were admitted to the ED of Canakkale Onsekiz Mart University Hospital. The AIMS65, GBS, and CCI scores were calculated and adverse patient outcomes were assessed. RESULTS:The mean age of patients was 85.59±4.33 years, and 90 (49.5%) of the patients were males. The AIMS65 was superior to the GBS (area under the receiver operating characteristic curve [AUROC] 0.877 vs. 0.695, respectively) and CCI (AUROC 0.877 vs. 0.526, respectively) in predicting the 30-day mortality. All three scores performed poorly in predicting the LOS in hospital. The cutoff threshold that maximized sensitivity and specificity for mortality was three for the AIMS65 score (

The Accuracy of Pre-Endoscopic Scores for Mortality Prediction in Patients with Upper GI Bleeding and No Endoscopy Performed

“…Some studies have even proposed cut-off values for main scores for several outcomes (2.5 for AIM65, 11.5 for GBS, 1.5 for pre-endoscopic Rockall score [ 1 ], (3 for AIM65, 14 GBS, 5 CCI) [ 35 ]. In a study, the optimal cut-off for mortality for pre-endoscopic Rockall score was 9, and the prediction of 30-day mortality was best realized by the pre-endoscopic Rockall score, while the prediction for the need for intervention was best obtained by using Glasgow-Blatchford original or modified scores [ 2 ].…”

“…Charlson comorbidity index represents a method for estimating the concomitant diseases score and estimating mortality risk by weighing associated diseases, but the importance in UGIB prognosis is currently unclear; the accuracy seems low in the context of UGIB, especially in 30-day mortality [ 35 ]. In our study, CCI had a poor accuracy in UGIB (AUC 0.609).…”