Utility of clinical and complete Rockall score in Indian patients with upper gastrointestinal bleeding

Abstract

Introduction: Acute upper gastrointestinal bleeding (AUGIB) is an important gastroenterological emergency. Role of Rockall score in stratification of risk of mortality and rebleeding in Indian patients is uncertain. Methods: This study was prospectively conducted on 175 consecutive patients admitted with AUGIB who were 18 years or above. The clinical Rockall score and complete scores calculated at admission and after endoscopy were analyzed for association with the outcome (rebleeding and mortality) for both variceal and non-variceal bleeding. Results: The mean age of the patients was 48.4±16.4 years and 78.9% were males. History of inake of NSAIDs in patients of AUGIB was present in 13.7% and of antiplatelets in 13.7%. Variceal bleed was the most common etiology (45.7%) followed by peptic ulcer disease (24.0%). Overall rates of surgery, rebleed and mortality were 6.9%, 22.9% and 20% respectively. Both clinical and complete Rockall risk scoring systems were useful tools for stratifying patients with AUGIB into high and low risk categories for mortality. However, for the prediction of rebleed, the complete Rockall scoring system was found to be better than the clinical scoring system. These scoring systems performed much better in predicting the outcomes in non-variceal bleed than in patients with variceal bleed. Multivariate analysis showed that patients with age ≥65 years and albumin <3 g/dl were at an increased risk of mortality. Conclusion: Rockall scoring can be used to stratify patients with AUGIB and is more useful in non-variceal bleeding.

Clinical Utility of Risk Scores in Variceal Bleeding

“…In our study variceal bleeding (47%) was most common cause of UGIB with chronic liver disease (43.33%) followed by Coronary artery disease (CAD) (6%) as the most common etiology. This was in consonance with a study from north India (45% & 13% respectively) (4) . Studies from eastern and southern India and all studies from the west report non-variceal as the most common cause with duodenal ulcer leading the list (2,5,7,13,14) .…”

“…Rockall and PNED. Rockall score is the most validated one (4,17) . For need of treatment GBS is validated better than Rockall (15,18) .…”

“…Etiology of UGIB has remained variable in many studies. Although peptic ulcer disease has remained the predominant cause, recent reports have shown an increasing incidence of variceal cause of UGIB in India and Nepal with alcohol being the most common etiology (2)(3)(4)(5)(6) . However, a broad nation-wide multicenter study regarding UGIB as a whole is lacking.…”

“…Data on subgroup, i.e. variceal and nonvariceal analysis, from other studies is also sparse (4) . Management of variceal bleeding differs from non-variceal in radical ways.…”

Scoring systems for upper gastrointestinal bleeding: Which one scores better?

“…They found that the scoring systems predict outcomes better for non-variceal UGIB. These findings are similar to an earlier published study from India [16]. Rout et al found that AIMS65 was the best predictor of mortality, probably because it does include albumin levels and INR, both measures of liver failure.…”