Comparative analysis of four upper gastrointestinal bleeding scoring systems for predicting multiple outcomes: an observational study in the emergency department
-
Najmeh Tohidi
,
Mitra Movahedi
,
Mohammad Rezaei Zadeh Rukerd
,
Hanieh Mirkamali
,
Seyed Danial Alizadeh
,
Mohammad Javad Najafzadeh
,
Amin Honarmand
,
Mehran Ilaghi
,
Pouria Pourzand
,
Amirhossein Mirafzal
Abstract
Objective: Numerous scoring systems have been developed to assess the risk associated with upper gastrointestinal bleeding (UGIB), and several studies have investigated their comparative accuracy in predicting patient outcomes. This study was undertaken to compare four well-known scoring systems, namely the pre-endoscopy Rockall score, full Rockall score, Glasgow-Blatchford Bleeding score (GBS), and AIMS65, with the aim of predicting five distinct outcomes in cases of non-variceal UGIB. Methods: This prospective observational study was conducted focusing on adult patients with UGIB presenting to the emergency department (ED). The primary endpoints of this study included in-hospital mortality, the need for re-endoscopy, the requirements for packed red blood cell (PRBC) transfusion, massive transfusion, and one-month rebleeding. Results: A total number of 320 patients were enrolled, with 44 (13·75%) in-hospital deaths. Based on the area under the curves (AUC), while certain scores outperformed others in specific outcome prediction, the AIMS65 scoring system demonstrated superior predictive capability for both in-hospital mortality (0.91) and massive transfusion (0.71). Regarding PRBC transfusion requirements, both AIMS65 and GBS exhibited similar predictive capacities (AUC=0.67 and 0.68, respectively). In terms of re-endoscopy and one-month rebleeding, the GBS scoring system displayed slightly better performance compared to the other systems (AUC=0.61 and 0.63, respectively). In the composite outcome, all scores had significant associations, and among them, the AIMS-65 score had the highest AUC (0.76). Conclusion: The AIMS65 scoring system was the most reliable tool for predicting in-hospital mortality and, to a lesser extent, massive transfusion requirements, while GBS and AIMS65 could be moderately and cautiously relied on for preparations regarding the need for PRBC transfusion.
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2. Stanley AJ, Laine L. Management of acute upper gastrointestinal bleeding. BMJ. 2019 ;364:l536.
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4. Vora P, Pietila A, Peltonen M, Brobert G, Salomaa V. Thirty-year incidence and mortality trends in upper and lower gastrointestinal bleeding in Finland. JAMA Netw Open. 2020;3(10):e2020172.
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7. Wuerth BA, Rockey DC. Changing epidemiology of upper gastrointestinal hemorrhage in the last decade: a nationwide analysis. Dig Dis Sci. 2018;63:1286-93.
8. Laursen SB. Treatment and prognosis in peptic ulcer bleeding. Dan Med J. 2014;61(1):B4797.
9. Monteiro S, Gonçalves TC, Magalhães J, Cotter J. Upper gastrointestinal bleeding risk scores: who, when and why? World J Gastrointest Pathophysiol. 2016;7(1):86.
10. Bakhtavar HE, Bagi HRM, Rahmani F, Ettehadi A. Clinical scoring systems in predicting the outcome of acute upper gastrointestinal bleeding; a narrative review. Emergency. 2017;5(1).
11. Custovic N, Husic-Selimovic A, Srsen N, Prohic D. Comparison of Glasgow-Blatchford score and Rockall score in patients with upper gastrointestinal bleeding. Med Arch. 2020;74(4):270.
12. Oakland K. Risk stratification in upper and upper and lower GI bleeding: Which scores should we use? Best Pract Res Clin Gastroenterol. 2019;42:101613.
13. Barkun AN, Almadi M, Kuipers EJ, Laine L, Sung J, Tse F, et al. Management of nonvariceal upper gastrointestinal bleeding: guideline recommendations from the international consensus group. Ann Intern Med. 2019;171(11):805-22.
14. Sung JJ, Chiu PW, Chan FKL, Lau JY, Goh KL, Ho LH, et al. Asia-Pacific working group consensus on non-variceal upper gastrointestinal bleeding: an update 2018. Gut. 2018;67(10):1757-68.
15. Blatchford O, Murray WR, Blatchford M. A risk score to predict need for treatment for uppergastrointestinal haemorrhage. The Lancet. 2000;356(9238):1318-21.
16. 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.
17. Rockall TA, Logan RF, Devlin HB, Northfield TC. Risk assessment after acute upper gastrointestinal haemorrhage. Gut. 1996;38(3):316-21.
18. 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 Gastroenterol. 2018;18(1):1-8.
19. Ruopp MD, Perkins NJ, Whitcomb BW, Schisterman EF. Youden index and optimal cut‐point estimated from observations affected by a lower limit of detection. Biom J J Math Methods Biosci. 2008;50(3):419-30.
20. Deeks JJ, Altman DG. Diagnostic tests 4: likelihood ratios. Bmj. 2004;329(7458):168-9.
21. Mokhtare M, Bozorgi V, Agah S, Nikkhah M, Faghihi A, Boghratian A, et al. Comparison of Glasgow-Blatchford score and full Rockall score systems to predict clinical outcomes in patients with upper gastrointestinal bleeding. Clin Exp Gastroenterol. 2016;337-43.
22. Chandra S, Hess EP, Agarwal D, Nestler DM, Montori VM, Song LMWK, et al. External validation of the Glasgow-Blatchford bleeding score and the Rockall score in the US setting. Am J Emerg Med. 2012 ;30(5):673-9.
23. Bryant RV, Kuo P, Williamson K, Yam C, Schoeman MN, Holloway RH, et al. Performance of the Glasgow-Blatchford score in predicting clinical outcomes and intervention in hospitalized patients with upper GI bleeding. Gastrointest Endosc. 2013;78(4):576-83.
24. 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.
25. Martínez-Cara JG, Jiménez-Rosales R, Úbeda-Muñoz M, de Hierro ML, de Teresa J, Redondo-Cerezo E. Comparison of AIMS65, Glasgow–Blatchford score, and Rockall score in a European series of patients with upper gastrointestinal bleeding: performance when predicting in-hospital and delayed mortality. United Eur Gastroenterol J. 2016;4(3):371-9.
26. Totagi A, Srinivas U, Paramasivan P, Krishnan S, Palaniswamy K, Mohan A, et al. Comparison of complete Rockall score, Glasgow–Blatchford score, and AIMS 65 score for predicting in-hospital mortality in patients presenting with upper gastrointestinal hemorrhage at a Tertiary care hospital in southern India. Gastroenterol Hepatol Endosc Pract. 2021;1(2):55.
27. 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.
28. Tang Y, Shen J, Zhang F, Zhou X, Tang Z, You T. Scoring systems used to predict mortality in patients with acute upper gastrointestinal bleeding in the ED. Am J Emerg Med. 201;36(1):27-32.
29. Park SM, Yeum SC, Kim BW, Kim JS, Kim JH, Sim EH, et al. Comparison of AIMS65 score and other scoring systems for predicting clinical outcomes in Koreans with nonvariceal upper gastrointestinal bleeding. Gut Liver. 2016;10(4):526-31.
30. Lai YC, Hung MS, Chen YH, Chen YC. Comparing AIMS65 score with MEWS, qSOFA score, Glasgow-Blatchford score, and Rockall score for predicting clinical outcomes in cirrhotic patients with upper gastrointestinal bleeding. J Acute Med. 201;8(4):154-67.
31. Marmo R, Koch M, Cipolletta L, Capurso L, Grossi E, Cestari R, et al. Predicting mortality in non-variceal upper gastrointestinal bleeders: validation of the Italian PNED score and prospective comparison with the Rockall score. Am J Gastroenterol. 2010;105(6):1284-91.
32. Kim MS, Choi J, Shin WC. AIMS65 scoring system is comparable to Glasgow-Blatchford score or Rockall score for prediction of clinical outcomes for non-variceal upper gastrointestinal bleeding. BMC Gastroenterol. 2019;19(1):136.
33. Yang HM, Jeon SW, Jung JT, Lee DW, Ha CY, Park KS, et al. Comparison of scoring systems for nonvariceal upper gastrointestinal bleeding: a multicenter prospective cohort study. J Gastroenterol Hepatol. 2016;31(1):119-25.
34. Tandon P, Bishay K, Fisher S, Yelle D, Carrigan I, Wooller K, et al. Comparison of clinical outcomes between variceal and non-variceal gastrointestinal bleeding in patients with cirrhosis. J Gastroenterol Hepatol. 2018;33(10):1773-9.
2. Stanley AJ, Laine L. Management of acute upper gastrointestinal bleeding. BMJ. 2019 ;364:l536.
3. Rajan SS, Sawe HR, Iyullu AJ, Kaale DA, Olambo NA, Mfinanga JA, et al. Profile and outcome of patients with upper gastrointestinal bleeding presenting to urban emergency departments of tertiary hospitals in Tanzania. BMC Gastroenterol. 2019;19:212.
4. Vora P, Pietila A, Peltonen M, Brobert G, Salomaa V. Thirty-year incidence and mortality trends in upper and lower gastrointestinal bleeding in Finland. JAMA Netw Open. 2020;3(10):e2020172.
5. Van Leerdam ME, Vreeburg EM, Rauws EAJ, Geraedts AAM, Tijssen JGP, 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.
6. Abougergi MS, Travis AC, Saltzman JR. The in-hospital mortality rate for upper GI hemorrhage has decreased over 2 decades in the United States: a nationwide analysis. Gastrointest Endosc. 2015;81(4):882-8. e1.
7. Wuerth BA, Rockey DC. Changing epidemiology of upper gastrointestinal hemorrhage in the last decade: a nationwide analysis. Dig Dis Sci. 2018;63:1286-93.
8. Laursen SB. Treatment and prognosis in peptic ulcer bleeding. Dan Med J. 2014;61(1):B4797.
9. Monteiro S, Gonçalves TC, Magalhães J, Cotter J. Upper gastrointestinal bleeding risk scores: who, when and why? World J Gastrointest Pathophysiol. 2016;7(1):86.
10. Bakhtavar HE, Bagi HRM, Rahmani F, Ettehadi A. Clinical scoring systems in predicting the outcome of acute upper gastrointestinal bleeding; a narrative review. Emergency. 2017;5(1).
11. Custovic N, Husic-Selimovic A, Srsen N, Prohic D. Comparison of Glasgow-Blatchford score and Rockall score in patients with upper gastrointestinal bleeding. Med Arch. 2020;74(4):270.
12. Oakland K. Risk stratification in upper and upper and lower GI bleeding: Which scores should we use? Best Pract Res Clin Gastroenterol. 2019;42:101613.
13. Barkun AN, Almadi M, Kuipers EJ, Laine L, Sung J, Tse F, et al. Management of nonvariceal upper gastrointestinal bleeding: guideline recommendations from the international consensus group. Ann Intern Med. 2019;171(11):805-22.
14. Sung JJ, Chiu PW, Chan FKL, Lau JY, Goh KL, Ho LH, et al. Asia-Pacific working group consensus on non-variceal upper gastrointestinal bleeding: an update 2018. Gut. 2018;67(10):1757-68.
15. Blatchford O, Murray WR, Blatchford M. A risk score to predict need for treatment for uppergastrointestinal haemorrhage. The Lancet. 2000;356(9238):1318-21.
16. 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.
17. Rockall TA, Logan RF, Devlin HB, Northfield TC. Risk assessment after acute upper gastrointestinal haemorrhage. Gut. 1996;38(3):316-21.
18. 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 Gastroenterol. 2018;18(1):1-8.
19. Ruopp MD, Perkins NJ, Whitcomb BW, Schisterman EF. Youden index and optimal cut‐point estimated from observations affected by a lower limit of detection. Biom J J Math Methods Biosci. 2008;50(3):419-30.
20. Deeks JJ, Altman DG. Diagnostic tests 4: likelihood ratios. Bmj. 2004;329(7458):168-9.
21. Mokhtare M, Bozorgi V, Agah S, Nikkhah M, Faghihi A, Boghratian A, et al. Comparison of Glasgow-Blatchford score and full Rockall score systems to predict clinical outcomes in patients with upper gastrointestinal bleeding. Clin Exp Gastroenterol. 2016;337-43.
22. Chandra S, Hess EP, Agarwal D, Nestler DM, Montori VM, Song LMWK, et al. External validation of the Glasgow-Blatchford bleeding score and the Rockall score in the US setting. Am J Emerg Med. 2012 ;30(5):673-9.
23. Bryant RV, Kuo P, Williamson K, Yam C, Schoeman MN, Holloway RH, et al. Performance of the Glasgow-Blatchford score in predicting clinical outcomes and intervention in hospitalized patients with upper GI bleeding. Gastrointest Endosc. 2013;78(4):576-83.
24. 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.
25. Martínez-Cara JG, Jiménez-Rosales R, Úbeda-Muñoz M, de Hierro ML, de Teresa J, Redondo-Cerezo E. Comparison of AIMS65, Glasgow–Blatchford score, and Rockall score in a European series of patients with upper gastrointestinal bleeding: performance when predicting in-hospital and delayed mortality. United Eur Gastroenterol J. 2016;4(3):371-9.
26. Totagi A, Srinivas U, Paramasivan P, Krishnan S, Palaniswamy K, Mohan A, et al. Comparison of complete Rockall score, Glasgow–Blatchford score, and AIMS 65 score for predicting in-hospital mortality in patients presenting with upper gastrointestinal hemorrhage at a Tertiary care hospital in southern India. Gastroenterol Hepatol Endosc Pract. 2021;1(2):55.
27. 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.
28. Tang Y, Shen J, Zhang F, Zhou X, Tang Z, You T. Scoring systems used to predict mortality in patients with acute upper gastrointestinal bleeding in the ED. Am J Emerg Med. 201;36(1):27-32.
29. Park SM, Yeum SC, Kim BW, Kim JS, Kim JH, Sim EH, et al. Comparison of AIMS65 score and other scoring systems for predicting clinical outcomes in Koreans with nonvariceal upper gastrointestinal bleeding. Gut Liver. 2016;10(4):526-31.
30. Lai YC, Hung MS, Chen YH, Chen YC. Comparing AIMS65 score with MEWS, qSOFA score, Glasgow-Blatchford score, and Rockall score for predicting clinical outcomes in cirrhotic patients with upper gastrointestinal bleeding. J Acute Med. 201;8(4):154-67.
31. Marmo R, Koch M, Cipolletta L, Capurso L, Grossi E, Cestari R, et al. Predicting mortality in non-variceal upper gastrointestinal bleeders: validation of the Italian PNED score and prospective comparison with the Rockall score. Am J Gastroenterol. 2010;105(6):1284-91.
32. Kim MS, Choi J, Shin WC. AIMS65 scoring system is comparable to Glasgow-Blatchford score or Rockall score for prediction of clinical outcomes for non-variceal upper gastrointestinal bleeding. BMC Gastroenterol. 2019;19(1):136.
33. Yang HM, Jeon SW, Jung JT, Lee DW, Ha CY, Park KS, et al. Comparison of scoring systems for nonvariceal upper gastrointestinal bleeding: a multicenter prospective cohort study. J Gastroenterol Hepatol. 2016;31(1):119-25.
34. Tandon P, Bishay K, Fisher S, Yelle D, Carrigan I, Wooller K, et al. Comparison of clinical outcomes between variceal and non-variceal gastrointestinal bleeding in patients with cirrhosis. J Gastroenterol Hepatol. 2018;33(10):1773-9.
| Files | ||
| Issue | Vol 8 No 3 (2024): Summer (July) | |
| Section | Original article | |
| DOI | 10.18502/fem.v8i3.16331 | |
| Keywords | ||
| Outcomes Prediction Scoring Systems Upper Gastrointestinal Bleeding | ||
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How to Cite
1.
Tohidi N, Movahedi M, Rezaei Zadeh Rukerd M, Mirkamali H, Alizadeh SD, Najafzadeh MJ, Honarmand A, Ilaghi M, Pourzand P, Mirafzal A. Comparative analysis of four upper gastrointestinal bleeding scoring systems for predicting multiple outcomes: an observational study in the emergency department. Front Emerg Med. 2024;8(3):e24.
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