Two risk scores most accurately predict outcomes after lower GI bleeding

The Oakland score performed best for predicting safe discharge, major bleeding, and transfusion, while the Strate score performed best for hemostasis, according to a recent review and meta-analysis that assessed four scores.

Two risk scores appear to do the best job of stratifying patients hospitalized with lower GI bleeding, a recent systematic review and meta-analysis found.

Researchers examined literature published from Jan. 1, 1990, through Aug. 31, 2021, to find observational and interventional studies that derived or validated a risk score to predict a clinical outcome after lower GI bleeding. Four scores were included. The Oakland score involves seven clinical variables based on history, physical exam, and hemoglobin level, while the Strate score is based on seven clinical variables but does not require bloodwork. The NOBLADS score and the BLEED score include eight and five clinical variables, respectively, and are based on patient history, physical examination, and bloodwork. The main outcomes were summary diagnostic performance measures (sensitivity, specificity, and area under the receiver-operating characteristic curve [AUROC]) determined a priori for each combination of risk score and outcome. The results were published May 27 by JAMA Network Open.

Nine studies were included in the meta-analysis. The Oakland score had an AUROC of 0.86 (95% CI, 0.82 to 0.88) for predicting safe discharge. For major bleeding, the AUROC was 0.93 (95% CI, 0.90 to 0.95), 0.73 (95% CI, 0.69 to 0.77), 0.58 (95% CI, 0.53 to 0.62), and 0.65 (95% CI, 0.61 to 0.69) with the Oakland, Strate, NOBLADS, and BLEED scores, respectively. The Oakland score and the NOBLADS score had AUROCs of 0.99 (95% CI, 0.98 to 1.00) and 0.88 (95% CI, 0.85 to 0.90) for transfusion. For hemostasis, the AUROCs were 0.36 (95% CI, 0.32 to 0.40), 0.82 (95% CI, 0.79 to 0.85), and 0.24 (95% CI, 0.20-0.28) with the Oakland, Strate, and NOBLADS scores, respectively.

The researchers noted that the included studies were mostly of patients from Europe and North America and that all of the risk scores examined short-term outcomes, among other limitations. They concluded that based on their analysis of these four risk scores for lower GI bleeding, the Oakland score was most discriminative for predicting safe discharge, major bleeding, and need for transfusion, while the Strate score was most discriminative for predicting need for hemostasis. “These scores can be used to predict outcomes from [lower GI bleeding] and guide clinical care accordingly,” the researchers wrote.