Scores to predict outcomes of upper GI bleeding compared
Researchers calculated three pre-endoscopy scores—admission Rockall, AIMS65, and Glasgow Blatchford—and two postendoscopy scores—full Rockall and PNED.
For patients with upper GI bleeding, the Glasgow Blatchford score most accurately predicted hospital-based interventions or death, according to a recent comparison of risk scoring systems.
The prospective study included 3,012 patients presenting with upper GI bleeding at six hospitals around the world. Researchers calculated three pre-endoscopy scores—admission Rockall, AIMS65 (Albumin level <30 g/L, International normalized ratio >1.5, altered Mental status, Systolic blood pressure ≤90 mm Hg, and age >65 years), and Glasgow Blatchford—and two postendoscopy scores—full Rockall and PNED (progretto nazionale emorragia digestive)—for the studied patients.
The study found that the Glasgow Blatchford score most accurately predicted the composite outcome (transfusion, endoscopic treatment, interventional radiology, surgery, or 30-day mortality), based on the area under the receiver-operating curve (AUROC). A Glasgow Blatchford score ≤1 was the optimum threshold to predict survival without intervention, that is, to identify patients who could be directed to outpatient care, according to the researchers. The PNED and AIMS65 scores showed higher accuracy at predicting mortality alone, but the AUROCS for this and all other studied outcomes (which included rebleeding and length of stay) were below 0.80, suggesting limited clinical utility, they said.
The study compared the five scores that appeared most promising for clinical use, and the results could potentially be used to identify which patients with upper GI bleeds should be directed to urgent endoscopy, which should be moved to a higher level of care, and which could be discharged from the ED for outpatient management, according to the authors. The study was published by The BMJ on Jan. 4.
A limitation of the study is that patients were excluded if they were already inpatients when they developed upper GI bleeding. The authors also noted that guidelines currently suggest outpatient management for patients with a Glasgow Blatchford score of 0. This study found an all-cause mortality rate of 0.4% in patients with scores ≤1, which “compares favourably with accepted low risk thresholds of commonly used scores for other medical conditions,” they wrote. Further studies are needed to clarify the role of scoring systems in care for higher-risk patients, the authors concluded.