Prospective Comparison of the AIMS65 Score, Glasgow-Blatchford Score, and Rockall Score for Predicting Clinical Outcomes in Patients with Variceal and Nonvariceal Upper Gastrointestinal Bleeding

Chang, Arunchai; Ouejiaraphant, Chokethawee; Akarapatima, Keerati; Rattanasupa, Attapon; Prachayakul, Varayu

doi:10.5946/ce.2020.068

Cited by 33 publications

(34 citation statements)

References 31 publications

(56 reference statements)

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“…23 Risk scores help predict occurrences of mortality during the hospital stay, the frequency of rebleeding, the need for transfusion and the need for hemostatic procedures through endoscopy. [1][2][3]24 In a study comparing the RS with other risk scores, the AUC value (AUC: 0.624; P < 0.05) for the RS of patients who needed transfusion was similar to that of our study (AUC: 0.648; P = 0.002). 24 In the same study, when the cutoff value for the RS was taken as 6, the sensitivity was 42.9% and the specificity was 90.5%, for predicting mortality.…”

Section: Discussionsupporting

confidence: 83%

“…[1][2][3]24 In a study comparing the RS with other risk scores, the AUC value (AUC: 0.624; P < 0.05) for the RS of patients who needed transfusion was similar to that of our study (AUC: 0.648; P = 0.002). 24 In the same study, when the cutoff value for the RS was taken as 6, the sensitivity was 42.9% and the specificity was 90.5%, for predicting mortality. 24 In our study, in terms of predicting mortality, the sensitivity was calculated as 70.6% and the specificity was 62.2% when the cutoff value for RS was taken as 7; while the sensitivity was 57.8% and the specificity was 85.3% when the cutoff value for PI was taken as 1.1.…”

Section: Discussionsupporting

confidence: 83%

“…24 In the same study, when the cutoff value for the RS was taken as 6, the sensitivity was 42.9% and the specificity was 90.5%, for predicting mortality. 24 In our study, in terms of predicting mortality, the sensitivity was calculated as 70.6% and the specificity was 62.2% when the cutoff value for RS was taken as 7; while the sensitivity was 57.8% and the specificity was 85.3% when the cutoff value for PI was taken as 1.1. Also, according to the ROC analysis that was conducted to predict mortality, the AUC value for PI (AUC: 0.743; P < 0.001) was found to be higher than that of RS (AUC: 0.725; P < 0.001).…”

Section: Discussionmentioning

confidence: 92%

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Perfusion index: Could this be a new triage tool for upper gastrointestinal system bleeding in the emergency department? A prospective cohort study

et al. 2021

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BACKGROUND: Many scoring systems for predicting mortality, rebleeding and transfusion needs among patients with upper gastrointestinal bleeding (UGIB) have been developed. However, no scoring system can predict all these outcomes. OBJECTIVE: To show whether the perfusion index (PI), compared with the Rockall score (RS), helps predict transfusion needs and prognoses among patients presenting with UGIB in emergency departments. In this way, critical patients with transfusion needs can be identified at an early stage. DESIGN AND SETTING: Prospective cohort study in an emergency department in Turkey, conducted between June 2018 and June 2019. METHODS: Patients' demographic parameters, PI, RS, transfusion needs and prognosis were recorded. RESULTS: A total of 219 patients were included. Blood transfusion was performed in 174 patients (79.4%). The PI cutoff value for prediction of the need for blood transfusion was 1.17, and the RS cutoff value was 5. The area under the curve (AUC) value for PI (AUC: 0.772; 95% confidence interval, CI: 0.705-0.838; P < 0.001) was higher than for RS (AUC: 0.648; 95% CI: 0.554-0.741; P = 0.002). 185 patients (84.5%) were discharged, and 34 patients (15.5%) died. The PI cutoff value for predicting mortality was 1.1, and the RS cutoff value was 7. The AUC value for PI (AUC: 0.743; 95% CI: 0.649-0.837; P < 0.001) was higher than for RS (AUC: 0.725; 95% CI: 0.639-0.811; P < 0.001). CONCLUSION: PI values for patients admitted to emergency departments with UGIB on admission can help predict their need for transfusion and mortality risk.

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Section: Discussionsupporting

confidence: 83%

Section: Discussionsupporting

confidence: 83%

Section: Discussionmentioning

confidence: 92%

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Perfusion index: Could this be a new triage tool for upper gastrointestinal system bleeding in the emergency department? A prospective cohort study

et al. 2021

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“…On the contrary, our study population is different geographically and chronologically, and represents a true external validation. In a recent external validation study, Chang et al reported an AUROC of 0.8 for GBS, which is similar to the value we found in our study [12]. In another study, Chan and al.…”

Section: Comparison With Other Publicationssupporting

confidence: 92%

External validation and comparison of the Glasgow-Blatchford bleeding score, the Rockall score and the AIMS65 score in upper gastro-intestinal hemorrhage: A cross-sectional observational study in Western Switzerland

Rivieri¹,

Carron²,

Schoepfer³

et al. 2021

Preprint

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Background: Upper gastro-intestinal bleeding presents a high incidence in Emergency department. This study aims to externally validate and determine the performance of the Rockall score, the Glasgow-Blatchford bleeding, the modified Glasgow Blatchford score (mGBS) and the AIMS65 score in an Emergency department.Methods: We performed a retrospective cross-sectional observational study between January 1, 2015 and December 31, 2019. We performed Receiver-Operating Characteristic curve and area under the curve (AUROC) to compare discrimination for each scores. The primary outcome was need for intervention or death, including transfusion, endoscopic or surgery intervention. The secondary outcome was in-hospital death.Results: We enrolled 1,521 patients with UIGB. Mean age was 68 [52 – 81] years old, 62 % were men. Melena and/or hematemesis were the most common complain at ED (73%). Primary outcome was positive for 422 patients (27.7%), 76 patients (5%) were positive for our secondary outcome. The Glasgow-Blatchford score and the modified Glasgow-Blatchford score shown the highest area AUROC, respectively 0.774 (95% CI=0.750-0.798) and 0.782 (95% CI=0.759-0.805). AIMS-65 and Pre-endoscopic Rockall score shown lower discrimination, respectively, 0.684 (95% CI=0.657-0.711) and 0.647 (95% CI=0.618-0.675).Conclusion: Regarding our primary outcome, the modified Glasgow-Blatchford score and the Glasgow-Blatchford score presented a good performance. A GBS or mGBS of 0 is safe to rule-out patients with UIGB from ED. Performance of AIMS-65 score and Pre-endoscopic Rockall score were moderate.

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“…The data collected included age, sex, hypertension, diabetes, cerebral vascular disease, cardiovascular disease, chronic lung disease (chronic obstructive pulmonary disease, asthma, interstitial lung disease), chronic liver disease, chronic kidney disease, reason for ICU admission, Simplified Acute Physiology Score (SAPS) II at ICU admission, and length of ICU stay before suspected GI bleeding. Information on the PaO 2 /FiO 2 ratio (PF ratio), Glasgow-Blatchford score (GBS), [ 10 ] initiation of mechanical ventilation, vasopressor use, EGD findings, and laboratory findings on suspected GI bleeding were also retrieved. The outcomes were: requirement of red blood cell (RBC) transfusion and change of hemoglobin level for a week after suspected GI bleeding, re-suspected bleeding events requiring RBC transfusion during hospital stay (from 1 week after suspected GI bleeding to last hospital day), length of ICU stay, and ICU mortality.…”

Section: Methodsmentioning

confidence: 99%

Clinical outcomes of esophagogastroduodenoscopy in critically ill patients using high-dose proton pump inhibitor for suspected bleeding

Kwack

2021

Medicine

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Esophagogastroduodenoscopy (EGD) is a useful procedure performed for gastrointestinal (GI) bleeding. No definite clinical guidelines recommend EGD implementation in intensive care unit (ICU) patients with suspected GI bleeding. The objective of this study was to compare the clinical effectiveness of EGD in critically ill patients who are using high-dose proton pump inhibitor (PPI) for suspected GI bleeding. We retrospectively analyzed ICU patients using high-dose PPI for suspected GI bleeding from January 2012 to September 2020. Major cases of GI bleeding, such as those with hematemesis and hematochezia, were excluded, and 1:1 propensity score matching was performed. The change in hemoglobin level, requirement of red blood cell transfusion, re-suspected bleeding event, length of ICU stay, and ICU mortality were compared between the EGD and non-EGD groups. Of the 174 subjects included, 52 patients underwent EGD within 24 hours of PPI administration. In the EGD group, 22 (42.3%) patients showed normal findings, while esophagitis and gastritis were most common abnormal finding (n = 11, 21.2%), and 14 patients (26.9%) underwent a hemostatic procedure. While comparing the 2 groups, the EGD group required a higher amount of red blood cell transfusion (packs) than the non-EGD group for a week (3.04 ± 0.44 vs 2.07 ± 0.25, P = .01). There was no significant difference in the change in hemoglobin level after 1 week ( P = .15). After propensity score matching, the EGD group showed similar the requirement of red blood cell transfusion and change in hemoglobin level for a week ( P = .52, P = .97, respectively). In analyses for all patients and propensity score matched patients, there was no statistically significant difference in term of re-suspected bleeding event rate, duration of ICU stay, and ICU mortality. However, re-suspected bleeding event rate and ICU mortality were lower trend in the EGD group than the non-EGD group. This study showed that EGD had no definite clinical benefit in ICU patients using high-dose PPI for suspected GI bleeding and aggressive EGD is not necessarily recommended. However, it is necessary to consider EGD in patients who are tolerant.

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Prospective Comparison of the AIMS65 Score, Glasgow-Blatchford Score, and Rockall Score for Predicting Clinical Outcomes in Patients with Variceal and Nonvariceal Upper Gastrointestinal Bleeding

Cited by 33 publications

References 31 publications

Perfusion index: Could this be a new triage tool for upper gastrointestinal system bleeding in the emergency department? A prospective cohort study

Perfusion index: Could this be a new triage tool for upper gastrointestinal system bleeding in the emergency department? A prospective cohort study

External validation and comparison of the Glasgow-Blatchford bleeding score, the Rockall score and the AIMS65 score in upper gastro-intestinal hemorrhage: A cross-sectional observational study in Western Switzerland

Clinical outcomes of esophagogastroduodenoscopy in critically ill patients using high-dose proton pump inhibitor for suspected bleeding

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