Risk stratification in acute variceal bleeding: Comparison of the AIMS65 score to established upper gastrointestinal bleeding and liver disease severity risk stratification scoring systems in predicting mortality and rebleeding

Abstract

Background and Aim Risk stratification is recommended in all patients with acute variceal bleeding (AVB). It remains unclear whether liver disease severity or upper gastrointestinal bleeding (UGIB) scoring algorithms offer superior predictive ability. We aimed to validate the AIMS65 score as a predictor of mortality in AVB, and to compare AIMS65 with established UGIB and liver disease severity risk stratification scores. Methods International Classification of Diseases, Tenth Revision codes identified patients presenting with AVB to three tertiary centers over a 48‐month period. Patients were risk‐stratified using AIMS65, Rockall, pre‐endoscopy Rockall, Child‐Pugh, Model for End‐stage Liver Disease (MELD) and United Kingdom MELD (UKELD) scores. Primary outcomes were inpatient and 6‐week mortality and inpatient rebleeding. Results Two hundred and twenty‐three patients were included. Inpatient and 6‐week mortality were 13.9% and 15.5% respectively. Prediction of inpatient mortality by AIMS65 (area under the receiver‐operating characteristic curve [AUROC: 0.84]) was equivalent to UGIB (Rockall: 0.79, pre‐Rockall: 0.78) and liver risk scores (MELD: 0.81, UKELD: 0.79, Child‐Pugh: 0.78). AIMS65 score ≥3 best defined high‐ and low‐risk groups for inpatient mortality (mortality 37.7% vs 4.9%). AIMS65 (AUROC: 0.62) was equivalent to UGIB risk scores (pre‐Rockall: 0.64, Rockall: 0.70) in predicting inpatient rebleeding and superior to liver risk scores (MELD: 0.56, UKELD: 0.57, Child‐Pugh: 0.60). Conclusions AIMS65 is equivalent to established UGIB and liver disease severity risk stratification scores in predicting mortality, and superior to liver scores in predicting rebleeding.

Gastrointestinal Bleeding in Patients Admitted to Cardiology: risk factors and a new risk score

“…Recently, it had been reported that the AIMS65 bleeding score could well predict the in-hospital mortality, length of stay and expenses of patients with upper GIB [22,24,25]. In particular, Robertson et al [26] found that the AIMS65 bleeding score had a good ability to predict the death of upper GIB(AUROC: 0.84). However, due to the limitation of sample size in our study, more data are needed to verify the predictive value of the new risk score model on mortality.…”

Surgical Portosystemic Shunts: History, Evolution, and Current Applications

“…20 HVPG > 20 mm Hg following variceal bleeding scientifically increases mortality. 1 Despite advances in its treatment, 6week mortality after variceal hemorrhage is still 15 to 20% in adults [21][22][23] compared with less than 10% in pediatric patients. [24][25][26]…”

Validation of AIMS65 to predict outcomes in acute variceal bleeding: Which risk scoring system outperforms in real practice?

“…In this issue, Robertson et al 8 have reported the effectiveness of AIMS65 for risk stratification of poor clinical outcomes in patients with AVB. Herein, all the patients with presentation of AVB were risk-stratified using AIMS65, Rockall, pre-endoscopy Rockall (pre-Rockall), CTP, MELD and United Kingdom MELD scores on the first day of admission before index endoscopy.…”

“…The aforementioned AIMS65, on the other hand, is a very straightforward scoring system for predicting outcomes of inpatients with UGIB. 8 Nevertheless, the endoscopy-oriented risk scores (endoscopic scores) including GBS, RS and AIMS65 had been synthesized for diverse concepts and different purposes, varying in causes of UGIB including AVB or NVUGIB; even based on either inpatient or outpatient status. We clinicians have felt unmet as most of the existing studies included only a small portion of AVB cohorts; very limited data regarding the prognostic predicting value with special reference to AVB are available.…”

“…Robertson et al 8 have evaluated mortality risk of AVB using AIMS65 at that time point of 48 weeks later. Considering that AVB can repeat or recur for a lifetime once endoscopic hemostasis is achieved at emergent setting, it is important to evaluate the ability to predict prognosis over the longer-term, which would be an informative facet of this original communication among existing studies on the similar topic but which have mostly assessed solely the short-term outcome.…”