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Original Article

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Optimizing the Risk Assessment in Upper Gastrointestinal Bleeding: Comparison of 5 Scores Predicting 7 Outcomes

Cúrdia Gonçalves T.a,b,c · Barbosa M.a,b,c · Xavier S.a,b,c · Boal Carvalho P.a,b,c · Firmino Machado J.d · Magalhães J.a,b,c · Marinho C.a,b,c · Cotter J.a,b,c

Author affiliations

aGastroenterology Department, Hospital da Senhora da Oliveira, Guimarães, Portugal
bLife and Health Sciences Research Institute, School of Medicine, University of Minho, Braga, Portugal
cICVS/3B’s, PT Government Associate Laboratory, Braga/Guimarães, Portugal
dUnidade de Saúde Pública Porto Ocidental, Porto, Portugal

Corresponding Author

Dr. Tiago Cúrdia Gonçalves

Gastroenterology Department, Hospital da Senhora da Oliveira

Rua dos Cutileiros, Creixomil

PT–4835-044 Guimarães (Portugal)

E-Mail tiagogoncalves@hospitaldeguimaraes.min-saude.pt

Keywords: Upper gastrointestinal bleedingRisk assessmentScoresOutcomes

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GE Port J Gastroenterol 2018;25:299–307
https://doi.org/10.1159/000486802

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Abstract

Introduction: Although different scores have been suggested to predict outcomes in the setting of upper gastrointestinal bleeding (UGIB), few comparative studies between simplified versions of older scores and recent scores have been published. We aimed to evaluate the accuracy of pre- (PreRS) and postendoscopic Rockall scores (PostRS), the Glasgow-Blatchford score (GBS) and its simplified version (sGBS), as well as the AIMS65 score in predicting different clinical outcomes. Methods: In this retrospective study, PreRS, PostRS, GBS, sGBS, and AIMS65 score were calculated, and then, areas under the receiver operating characteristic curve were used to evaluate the performance of each score to predict blood transfusion, endoscopic therapy, surgery, admission to intensive/intermediate care unit, length of hospital stay, as well as 30-day rebleeding or mortality. Results: PreRS, PostRS, GBS, and sGBS were calculated for all the 433 included patients, but AIMS65 calculation was only possible for 315 patients. Only the PreRS and PostRS were able to fairly predict 30-day mortality. The GBS and sGBS were good in predicting blood transfusion and reasonable in predicting surgery. None of the studied scores were good in predicting the need for endoscopic therapy, admission to intensive/intermediate care unit, length of hospital stay, and 30-day rebleeding. Conclusions: Owing to the identified limitations, none of the 5 studied scores could be singly used to predict all the clinically relevant outcomes in the setting of UGIB. The sGBS was as precise as the GBS in predicting blood transfusion and surgery. The PreRS and PostRS were the only scores that could predict 30-day mortality. An algorithm using the PreRS and the sGBS as an initial approach to patients with UGIB is presented and suggested.

© 2018 Sociedade Portuguesa de Gastrenterologia Published by S. Karger AG, Basel

Otimização da abordagem do risco na hemorragia digestiva alta: comparação de cinco scores na predição de sete outcomes

Palavras Chave

Hemorragia digestiva alta · Avaliação do risco · Scores · Outcomes ·

Resumo

Introdução: Apesar dos vários scores propostos para prever os diferentes outcomes no contexto de hemorragia digestiva alta (HDA), poucos estudos se debruçaram sobre a comparação entre eles. Este estudo avaliou o desempenho dos scores de Rockall pré- (PreRS) e pós-endoscópico (PosRS), Glasgow-Blatchford (GBS) e a sua versão simplificada (sGBS), bem como o score AIMS65 na previsão de diferentes outcomes clínicos. Métodos: Neste estudo retrospetivo, foram calculados os scores PreRS, PosRS, GBS, sGBS e AIMS65 e posteriormente as respectivas áreas sob as curvas de ROC para avaliar a capacidade de cada score em predizer necessidade de suporte transfusional, tera­pêutica endoscópica, cirurgia, admissão em unidade de cuidados intensivos/intermédios, tempo de internamento, bem como recidiva hemorrágica ou morte aos 30 dias. Resultados: Em todos os 433 doentes incluídos foram calculados os scores PreRS, PosRS, GBS, sGBS, mas o cálculo do score AIMS65 apenas foi possível em 315 doentes. Apenas o PreRS e o PosRS foram capazes de prever de forma aceitável a mortalidade aos 30 dias. O GBS e o sGBS apresentaram uma boa capacidade de prever necessidade de transfusão e razoável capacidade para prever cirurgia. Nenhum dos cinco scores foi bom a predizer a necessidade de tratamento endoscópico, internamento em unidade de cuidados intensivos/intermédios, tempo de internamento ou recidiva hemorrágica aos 30 dias. Conclusões: Devido às limitações identificadas, nenhum dos scores pode ser usado isoladamente na previsão dos diferentes outcomes no contexto de HDA. O sGBS é tão preciso como o GBS na previsão da necessidade de transfusão ou cirur­gia. Apenas os scores PreRS e PosRS são capazes de prever mortalidade aos 30 dias. É sugerido um algoritmo para a abordagem inicial de doentes com HDA usando os scores PreRS e sGBS.



Related Articles:

References

  1. Longstreth GF: Epidemiology of hospitalization for acute upper gastrointestinal hemorrhage: a population-based study. Am J Gastroenterol 1995;90:206–210.
    External Resources
  2. Terdiman JP: Update on upper gastrointestinal bleeding. Basing treatment decisions on patients’ risk level. Postgrad Med 1998;103:43–47, 51–52, 58–59 passim.
    External Resources
  3. van Leerdam ME, Vreeburg EM, Rauws EA, Geraedts AA, Tijssen JG, Reitsma JB, Tytgat GN: 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;98:1494–1499.
    External Resources
  4. Barkun AN, Bardou M, Kuipers EJ, Sung J, Hunt RH, Martel M, Sinclair P; International Consensus Upper Gastrointestinal Bleeding Conference Group: International consensus recommendations on the management of patients with nonvariceal upper gastrointestinal bleeding. Ann Intern Med 2010;152:101–113.
    External Resources
  5. Laine L, Jensen DM: Management of patients with ulcer bleeding. Am J Gastroenterol 2012;107:345–360; quiz 361.
    External Resources
  6. Rockall TA, Logan RF, Devlin HB, Northfield TC: Risk assessment after acute upper gastrointestinal haemorrhage. Gut 1996;38:316–321.
    External Resources
  7. Blatchford O, Murray WR, Blatchford M: A risk score to predict need for treatment for upper-gastrointestinal haemorrhage. Lancet 2000;356:1318–1321.
    External Resources
  8. 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;74:1215–1224.
    External Resources
  9. Cheng DW, Lu YW, Teller T, Sekhon HK, Wu BU: A modified Glasgow Blatchford Score improves risk stratification in upper gastrointestinal bleed: a prospective comparison of scoring systems. Aliment Pharmacol Ther 2012;36:782–789.
    External Resources
  10. Nakamura S, Matsumoto T, Sugimori H, Esaki M, Kitazono T, Hashizume M: Emergency endoscopy for acute gastrointestinal bleeding: prognostic value of endoscopic hemostasis and the AIMS65 score in Japanese patients. Dig Endosc Society 2014;26:369–376.
    External Resources
  11. Hanley JA, McNeil BJ: A method of comparing the areas under receiver operating characteristic curves derived from the same cases. Radiology 1983;148:839–843.
    External Resources
  12. Kim BJ, Park MK, Kim SJ, Kim ER, Min BH, Son HJ, Rhee PL, Kim JJ, Rhee JC, Lee JH: Comparison of scoring systems for the prediction of outcomes in patients with nonvariceal upper gastrointestinal bleeding: a prospective study. Dig Dis Sci 2009;54:2523–2529.
    External Resources
  13. Church NI, Dallal HJ, Masson J, Mowat NA, Johnston DA, Radin E, Turner M, Fullarton G, Prescott RJ, Palmer KR: Validity of the Rockall scoring system after endoscopic therapy for bleeding peptic ulcer: a prospective cohort study. Gastrointest Endosc 2006;63:606–612.
    External Resources
  14. Custodio Lima J, Garcia Montes C, Kibune Nagasako C, Soares Ruppert Reis GF, Mei­relles Dos Santos JO, Guerrazzi F, Mesquita MA: Performance of the Rockall scoring system in predicting the need for intervention and outcomes in patients with nonvariceal upper gastrointestinal bleeding in a Brazilian setting: a prospective study. Digestion 2013;88:252–257.
    External Resources
  15. Stanley AJ, Dalton HR, Blatchford O, Ashley D, Mowat C, Cahill A, Gaya DR, Thompson E, Warshow U, Hare N, Groome M, Benson G, Murray W: Multicentre comparison of the Glasgow Blatchford and Rockall scores in the prediction of clinical end-points after upper gastrointestinal haemorrhage. Aliment Pharmacol Ther 2011;34:470–475.
    External Resources
  16. Bryant RV, Kuo P, Williamson K, Yam C, Schoeman MN, Holloway RH, Nguyen NQ: Performance of the Glasgow-Blatchford score in predicting clinical outcomes and intervention in hospitalized patients with upper GI bleeding. Gastrointest Endosc 2013;78:576–583.
    External Resources
  17. Laursen SB, Hansen JM, Schaffalitzky de Muckadell OB: The Glasgow Blatchford score is the most accurate assessment of patients with upper gastrointestinal hemorrhage. Clin Gastroenterol Hepatol 2012;10:1130–1135.e1131.
    External Resources
  18. Ahn S, Lim KS, Lee YS, Lee JL: Blatchford score is a useful tool for predicting the need for intervention in cancer patients with upper gastrointestinal bleeding. J Gastroenterol Hepatol 2013;28:1288–1294.
    External Resources
  19. Dicu D, Pop F, Ionescu D, Dicu T: Comparison of risk scoring systems in predicting clinical outcome at upper gastrointestinal bleeding patients in an emergency unit. Am J Emerg Med 2013;31:94–99.
    External Resources
  20. Jung SH, Oh JH, Lee HY, Jeong JW, Go SE, You CR, Jeon EJ, Choi SW: Is the AIMS65 score useful in predicting outcomes in peptic ulcer bleeding? World J Gastroenterol 2014;20:1846–1851.
    External Resources
  21. Hyett BH, Abougergi MS, Charpentier JP, Kumar NL, Brozovic S, Claggett BL, Travis AC, Saltzman JR: The AIMS65 score compared with the Glasgow-Blatchford score in predicting outcomes in upper GI bleeding. Gastrointest Endosc 2013;77:551–557.
    External Resources

Article / Publication Details

First-Page Preview
Abstract of Original Article

Received: November 06, 2017
Accepted: January 07, 2018
Published online: May 02, 2018
Issue release date: November/December 2018

Number of Print Pages: 9
Number of Figures: 2
Number of Tables: 2

ISSN: 2341-4545 (Print)
eISSN: 2387-1954 (Online)

For additional information: https://www.karger.com/PJG

References

  1. Longstreth GF: Epidemiology of hospitalization for acute upper gastrointestinal hemorrhage: a population-based study. Am J Gastroenterol 1995;90:206–210.
    External Resources
  2. Terdiman JP: Update on upper gastrointestinal bleeding. Basing treatment decisions on patients’ risk level. Postgrad Med 1998;103:43–47, 51–52, 58–59 passim.
    External Resources
  3. van Leerdam ME, Vreeburg EM, Rauws EA, Geraedts AA, Tijssen JG, Reitsma JB, Tytgat GN: 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;98:1494–1499.
    External Resources
  4. Barkun AN, Bardou M, Kuipers EJ, Sung J, Hunt RH, Martel M, Sinclair P; International Consensus Upper Gastrointestinal Bleeding Conference Group: International consensus recommendations on the management of patients with nonvariceal upper gastrointestinal bleeding. Ann Intern Med 2010;152:101–113.
    External Resources
  5. Laine L, Jensen DM: Management of patients with ulcer bleeding. Am J Gastroenterol 2012;107:345–360; quiz 361.
    External Resources
  6. Rockall TA, Logan RF, Devlin HB, Northfield TC: Risk assessment after acute upper gastrointestinal haemorrhage. Gut 1996;38:316–321.
    External Resources
  7. Blatchford O, Murray WR, Blatchford M: A risk score to predict need for treatment for upper-gastrointestinal haemorrhage. Lancet 2000;356:1318–1321.
    External Resources
  8. 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;74:1215–1224.
    External Resources
  9. Cheng DW, Lu YW, Teller T, Sekhon HK, Wu BU: A modified Glasgow Blatchford Score improves risk stratification in upper gastrointestinal bleed: a prospective comparison of scoring systems. Aliment Pharmacol Ther 2012;36:782–789.
    External Resources
  10. Nakamura S, Matsumoto T, Sugimori H, Esaki M, Kitazono T, Hashizume M: Emergency endoscopy for acute gastrointestinal bleeding: prognostic value of endoscopic hemostasis and the AIMS65 score in Japanese patients. Dig Endosc Society 2014;26:369–376.
    External Resources
  11. Hanley JA, McNeil BJ: A method of comparing the areas under receiver operating characteristic curves derived from the same cases. Radiology 1983;148:839–843.
    External Resources
  12. Kim BJ, Park MK, Kim SJ, Kim ER, Min BH, Son HJ, Rhee PL, Kim JJ, Rhee JC, Lee JH: Comparison of scoring systems for the prediction of outcomes in patients with nonvariceal upper gastrointestinal bleeding: a prospective study. Dig Dis Sci 2009;54:2523–2529.
    External Resources
  13. Church NI, Dallal HJ, Masson J, Mowat NA, Johnston DA, Radin E, Turner M, Fullarton G, Prescott RJ, Palmer KR: Validity of the Rockall scoring system after endoscopic therapy for bleeding peptic ulcer: a prospective cohort study. Gastrointest Endosc 2006;63:606–612.
    External Resources
  14. Custodio Lima J, Garcia Montes C, Kibune Nagasako C, Soares Ruppert Reis GF, Mei­relles Dos Santos JO, Guerrazzi F, Mesquita MA: Performance of the Rockall scoring system in predicting the need for intervention and outcomes in patients with nonvariceal upper gastrointestinal bleeding in a Brazilian setting: a prospective study. Digestion 2013;88:252–257.
    External Resources
  15. Stanley AJ, Dalton HR, Blatchford O, Ashley D, Mowat C, Cahill A, Gaya DR, Thompson E, Warshow U, Hare N, Groome M, Benson G, Murray W: Multicentre comparison of the Glasgow Blatchford and Rockall scores in the prediction of clinical end-points after upper gastrointestinal haemorrhage. Aliment Pharmacol Ther 2011;34:470–475.
    External Resources
  16. Bryant RV, Kuo P, Williamson K, Yam C, Schoeman MN, Holloway RH, Nguyen NQ: Performance of the Glasgow-Blatchford score in predicting clinical outcomes and intervention in hospitalized patients with upper GI bleeding. Gastrointest Endosc 2013;78:576–583.
    External Resources
  17. Laursen SB, Hansen JM, Schaffalitzky de Muckadell OB: The Glasgow Blatchford score is the most accurate assessment of patients with upper gastrointestinal hemorrhage. Clin Gastroenterol Hepatol 2012;10:1130–1135.e1131.
    External Resources
  18. Ahn S, Lim KS, Lee YS, Lee JL: Blatchford score is a useful tool for predicting the need for intervention in cancer patients with upper gastrointestinal bleeding. J Gastroenterol Hepatol 2013;28:1288–1294.
    External Resources
  19. Dicu D, Pop F, Ionescu D, Dicu T: Comparison of risk scoring systems in predicting clinical outcome at upper gastrointestinal bleeding patients in an emergency unit. Am J Emerg Med 2013;31:94–99.
    External Resources
  20. Jung SH, Oh JH, Lee HY, Jeong JW, Go SE, You CR, Jeon EJ, Choi SW: Is the AIMS65 score useful in predicting outcomes in peptic ulcer bleeding? World J Gastroenterol 2014;20:1846–1851.
    External Resources
  21. Hyett BH, Abougergi MS, Charpentier JP, Kumar NL, Brozovic S, Claggett BL, Travis AC, Saltzman JR: The AIMS65 score compared with the Glasgow-Blatchford score in predicting outcomes in upper GI bleeding. Gastrointest Endosc 2013;77:551–557.
    External Resources
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2018, Vol.25, No. 6

November/December 2018

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