Comparison of risk scoring systems for predicting clinical outcomes in patients with acute upper gastrointestinal bleeding by Rockall score, Glasgow-Blatchford score, AIM65 score and ABC score
Keywords:
upper gastrointestinal bleeding, Rockall score, Glasgow-Blatchford score, AIM65 score , ABC scoreAbstract
Objectives This study aimed to determine the performance of the Rockall score (RS), Glasgow-Blatchford score (GBS), AIM65 score and ABC score in predicting of in-hospital mortality, rebleeding in 30 days, ICU admission and blood transfusion requirement in patients with upper gastrointestinal bleeding (UGIB).
Methods Retrospective cohort study was conducted at Lamphun Hospital in patients over than 15 years old with UGIB between July 2019 and December 2021. Data were retrieved from medical record and selected for ICD10 (C15, C16, C17, K20.81, K20.91, K21.01, K22, K25-K29, K31.81, K31.82, K92.0-K92.9, I85, I86.4). Baseline clinical data, outcome and risk scores were collected and analyzed.
Results Of the 423 study patients, the most common causes of UGIB were peptic ulcers (59.1%) and varices (22.9%). A hundred and four patients (24.6%) were received endoscopic treatment and 2 patients were received surgery. A hundred and forty-seven patients had hemodynamic instability, 36 patients (8.5%) required ICU admission, 15 patients (3.5%) had rebleed and 9 patients (2.1%) died. The risk scores that best predicted clinical outcomes for in-hospital mortality was AIM65 score (AUROC 0.822, p-value <0.001), rebleeding was RS (AUROC 0.708, p-value 0.002), ICU admission was AIM65 score (AUROC 0.781, p-value <0.001) and blood transfusion requirement was GBS (AUROC 0.873, p-value <0.001). AIM65 score is the best of risk scores that predict the composited clinical outcomes (AUROC 0.7476, p-value 0.0041) with score≥1 had 87.76 % of sensitivity and 42.51% of specificity.
Conclusions Clinical risk scores can be used in predicting clinical outcome which AIM65 score can prioritize management in patient with UGIB.
References
Wuerth BA, Rockey DC. Changing Epidemiology of Upper Gastrointestinal Hemorrhage in the Last Decade: A Nationwide Analysis. Dig Dis Sci. 2018;63(5):1286-93. doi: 10.1007/s10620-017-4882-6.
Button LA, Roberts SE, Evans PA, Goldacre MJ, Akbari A, Dsilva R, et al. Hospitalized incidence and case fatality for upper gastrointestinal bleeding from 1999 to 2007: a record linkage study. Aliment Pharmacol Ther. 2011;33(1):64-76. doi: 10.1111/j.1365-2036.2010.04495.x.
van Leerdam ME, Vreeburg EM, Rauws EA, Geraedts AA, Tijssen JG, Reitsma JB, et al. Acute upper GI bleeding: did anything change? Time trend analysis of incidence and outcome of acute upper GI bleeding between 1993/1994 and 2000. Am J Gastroenterol. 2003;98(7):1494-9. doi: 10.1111/j.1572-0241.2003.07517.x.
Blatchford O, Davidson LA, Murray WR, Blatchford M, Pell J. Acute upper gastrointestinal haemorrhage in west of Scotland: case ascertainment study. BMJ. 1997;315(7107):510-4. doi: 10.1136/bmj.315.7107.510.
Sangchan A, Sawadpanitch K, Mairiang P, Chunlertrith K, Sukeepaisarnjaroen W, Sutra S, et al. Hospitalized incidence and outcomes of upper gastrointestinal bleeding in Thailand. J Med Assoc Thai. 2012;95 Suppl 7:S190-5.
Rockall TA, Logan RF, Devlin HB, Northfield TC. Risk assessment after acute upper gastrointestinal haemorrhage. Gut. 1996;38(3):316-21. doi: 10.1136/gut.38.3.316.
Rockall TA, Logan RF, Devlin HB, Northfield TC. Selection of patients for early discharge or outpatient care after acute upper gastrointestinal haemorrhage. National Audit of Acute Upper Gastrointestinal Haemorrhage. Lancet. 1996;347(9009):1138-40. doi: 10.1016/s0140-6736(96)90607-8.
Blatchford O, Murray WR, Blatchford M. A risk score to predict need for treatment for upper-gastrointestinal haemorrhage. Lancet. 2000;356(9238):1318-21. doi: 10.1016/S0140-6736(00)02816-6.
Chatten K, Purssell H, Banerjee AK, Soteriadou S, Ang Y. Glasgow Blatchford Score and risk stratifications in acute upper gastrointestinal bleed: can we extend this to 2 for urgent outpatient management? Clin Med (Lond). 2018;18(2):118-22. doi: 10.7861/clinmedicine.18-2-118.
Li Y, Lu Q, Wu K, Ou X. Evaluation of Six Preendoscopy Scoring Systems to Predict Outcomes for Older Adults with Upper Gastrointestinal Bleeding. Gastroenterol Res Pract. 2022;2022:9334866. doi: 10.1155/2022/9334866.
Saltzman JR, Tabak YP, Hyett BH, Sun X, Travis AC, Johannes RS. A simple risk score accurately predicts in-hospital mortality, length of stay, and cost in acute upper GI bleeding. Gastrointest Endosc. 2011;74(6):1215-24. doi: 10.1016/j.gie.2011.06.024.
Laursen SB, Oakland K, Laine L, Bieber V, Marmo R, Redondo-Cerezo E, et al. ABC score: a new risk score that accurately predicts mortality in acute upper and lower gastrointestinal bleeding: an international multicentre study. Gut. 2021;70(4):707-16. doi: 10.1136/gutjnl-2019-320002.
Mules TC, Stedman C, Ding S, Burt M, Gearry R, Chalmers‐Watson T, et al. Comparison of Risk Scoring Systems in Hospitalised Patients who Develop Upper Gastrointestinal Bleeding. GastroHep. 2021;3(1):5-11. doi: 10.1002/ygh2.436
Laine L, Barkun AN, Saltzman JR, Martel M, Leontiadis GI. ACG Clinical Guideline: Upper Gastrointestinal and Ulcer Bleeding. Am J Gastroenterol. 2021;116(5):899-917. doi: 10.14309/ajg.0000000000001245.
Garg SK, Anugwom C, Campbell J, Wadhwa V, Gupta N, Lopez R, et al. Early esophagogastroduodenoscopy is associated with better Outcomes in upper gastrointestinal bleeding: a nationwide study. Endosc Int Open. 2017;5(5):E376-86. doi: 10.1055/s-0042-121665.
Laine L, McQuaid KR. Endoscopic therapy for bleeding ulcers: an evidence-based approach based on meta-analyses of randomized controlled trials. Clin Gastroenterol Hepatol. 2009;7(1):33-47; quiz 1-2. doi: 10.1016/j.cgh.2008.08.016.
Gu L, Xu F, Yuan J. Comparison of AIMS65, Glasgow-Blatchford and Rockall scoring approaches in predicting the risk of in-hospital death among emergency hospitalized patients with upper gastrointestinal bleeding: a retrospective observational study in Nanjing, China. BMC gastroenterology. 2018;18(1):98. doi: 10.1186/s12876-018-0828-5.
Chang A, Ouejiaraphant C, Akarapatima K, Rattanasupa A, Prachayakul V. 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. Clin Endosc. 2021;54(2):211-21. doi: 10.5946/ce.2020.068.
Thandassery RB, Sharma M, John AK, Al-Ejji KM, Wani H, Sultan K, et al. Clinical Application of AIMS65 Scores to Predict Outcomes in Patients with Upper Gastrointestinal Hemorrhage. Clin Endosc. 2015;48(5):380-4. doi: 10.5946/ce.2015.48.5.380.
Robertson M, Majumdar A, Boyapati R, Chung W, Worland T, Terbah R, et al. Risk stratification in acute upper GI bleeding: comparison of the AIMS65 score with the Glasgow-Blatchford and Rockall scoring systems. Gastrointest Endosc. 2016;83(6):1151-60. doi: 10.1016/j.gie.2015.10.021.
Chang A, Akarapatima K, Rattanasupar A, Prachayakul V. Application of AIMS65 Score in the Prediction of Clinical Outcomes of Patients with Upper Gastrointestinal Hemorrhage. J Med Assoc Thai 2020;103(12):22-8.
Stanley AJ, Laine L, Dalton HR, Ngu JH, Schultz M, Abazi R, et al. Comparison of risk scoring systems for patients presenting with upper gastrointestinal bleeding: international multicentre prospective study. BMJ. 2017;356:i6432. doi: 10.1136/bmj.i6432.
Liu S, Zhang X, Walline JH, Yu X, Zhu H. Comparing the Performance of the ABC, AIMS65, GBS, and pRS Scores in Predicting 90-day Mortality Or Rebleeding Among Emergency Department Patients with Acute Upper Gastrointestinal Bleeding: A Prospective Multicenter Study. J Transl Int Med. 2021;9(2):114-22. doi: 10.2478/jtim-2021-0026.
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