Scoring systems used to predict mortality in patients with acute upper gastrointestinal bleeding in the ED

Tang, Yunping; Shen, Jie; Zhang, Feng; Zhou, Xiaoyong; Tang, Zhongyan; You, Tingting

doi:10.1016/j.ajem.2017.06.053

Cited by 41 publications

(43 citation statements)

References 20 publications

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“…In a European study, the usefulness of GBS, Pre-RS, and AIMS65 in patients with UGIB was assessed; however, there was no difference in mortality or re-bleeding frequency among the three scoring systems, and GBS was the best predictor of transfusion [24]. In another European study of 309 patients with UGIB, AIMS65, GBS, and Pre-RS were reported to be similar when predicting patient mortality; however, the need for endoscopic intervention was better predicted by AIMS65 and GBS [25,26]. In a study on the utility of GBS and AIMS65 conducted in the United States and involving 165 patients with NVUGIB aged ≥65 years, GBS was superior to AIMS65 in predicting mortality [15].…”

Section: Discussionmentioning

confidence: 99%

Validation of a new risk score system for non-variceal upper gastrointestinal bleeding

et al. 2020

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Background: Recently, a new international bleeding score was developed to predict 30-day hospital mortality in patients with upper gastrointestinal bleeding (UGIB). However, the efficacy of this newly developed scoring system has not been extensively investigated. We aimed to validate a new scoring system for predicting 30-day mortality in patients with non-variceal UGIB and determine whether a higher score is associated with re-bleeding, length of hospital stay, and endoscopic failure. Methods: A retrospective study was performed on 905 patients with acute non-variceal UGIB who were examined in our hospital between January 2013 and December 2017. Baseline characteristics, endoscopic findings, rebleeding, admission, and mortality were reviewed. The 30-day mortality rate of the new international bleeding risk score was calculated using the receiver operating characteristic curves and compared to the pre-endoscopy Rockall score, AIMS65, Glasgow Blatchford score, and Progetto Nazionale Emorragia Digestiva score. To verify the variable for the 30-day mortality of the new scoring system, we performed multivariate logistic regression using our data and further analyzed the score items. Results: The new international bleeding scoring system showed higher receiver operating characteristic (ROC) curve values in predicting mortality (area under ROC curve 0.958; [95% confidence interval (CI)]), compared with such as AIMS65 (

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Section: Discussionmentioning

confidence: 99%

Validation of a new risk score system for non-variceal upper gastrointestinal bleeding

et al. 2020

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“…The AIMS65 score is also easily used by front-line physicians who may have little experience of managing AVB. A recent study by Tang et al 31 concluded that, for these reasons, the AIMS65 score may be the ideal risk stratification score in patients with UGIB presenting to the emergency department. Inclusion of altered mental status into the AIMS65 score highlights the importance of this parameter in UGIB, as impaired mental status is a significant contributor to outcomes such as ICU admission, LOS and mortality.…”

Section: Discussionmentioning

confidence: 99%

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

Robertson

Shawish

et al. 2019

Digestive Endoscopy

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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.

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“…Of the total 97 cases, 49 were classified as mild cases, and 48 were classified as moderate/severe cases according to bleeding severity. The effect of PPI use on bleeding severity was compared and analyzed between the groups, along with the lesions responsible for the bleeding, underlying diseases exacerbated by aging, and patient characteristics selected as risk factors for UGIB (age, sex, underlying disease [hypertension/diabetes/dyslipidemia/cerebrovascular disease/heart disease/hepatic cirrhosis/kidney disease/dementia/extra-gastrointestinal malignant tumors], antithrombotic drugs [antithrombotic drugs/anticoagulants], NSAID use) [ 1 , 2 , 7 , 19 – 21 ]. Additionally, correlations between PPI use/dose and clinical UGIB symptoms (estimated blood volume, SI, total transferred blood volume) were also analyzed.…”

Section: Methodsmentioning

confidence: 99%

Daily Usage of Proton Pump Inhibitors May Reduce the Severity of Critical Upper Gastrointestinal Bleeding in Elderly Patients

Matsuda

Nosaka

Akazawa

et al. 2020

Gastroenterology Research and Practice

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Introduction. We retrospectively examined the relationship between daily proton pump inhibitor (PPI) use and severity of upper gastrointestinal bleeding (UGIB), mainly in the elderly. Methods. We included 97 patients with nonvariceal UGIB diagnosed at our hospital from January 2012 to October 2017. Bleeding severity was assessed using the shock index (SI) and estimated bleeding volume; 49 patients met the criterion for the mild group and 48 for the moderate/severe group. The effect of PPI use on bleeding severity was compared between the groups. The relationships of PPI use and dose with the clinical symptoms of UGIB were also analyzed. Results. Among the 97 patients, 17 (17.5%) habitually used PPIs. The rate of habitual PPI use was significantly higher in the mild group, indicating as an independent factor contributing to a reduction in the severity of UGIB in a multiple logistic regression analysis (30.6% vs. 4.2%; OR 10.147; 95% CI 2.174–47.358, P<0.01). When analyzing data for a subgroup of patients older than 75 years, we found the protective PPI effect to be even higher in the mild UGIB group than in the moderate/severe group (37.0% vs. 5.6%; OR 10.000; 95% CI 1.150–86.951, P<0.05). Conversely, we found no association between PPI prescription and UGIB symptoms in patients younger than 75 years. The mean estimated bleeding volume and SI in the 17 habitual PPI users were both significantly less than those among the 80 nonhabitual users, respectively (P<0.05). The proportion of patients with mild UGIB was similar between the low- and high-dose PPI users. Conclusions. Particularly in elderly patients with nonvariceal UGIB, habitual PPI use can alleviate the clinical symptoms of UGIB by suppressing the volume of bleeding, regardless of the adapted dose of PPIs.

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Scoring systems used to predict mortality in patients with acute upper gastrointestinal bleeding in the ED

Cited by 41 publications

References 20 publications

Validation of a new risk score system for non-variceal upper gastrointestinal bleeding

Validation of a new risk score system for non-variceal upper gastrointestinal bleeding

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

Daily Usage of Proton Pump Inhibitors May Reduce the Severity of Critical Upper Gastrointestinal Bleeding in Elderly Patients

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