GLASGOW-BLACHFORD SCORE ACCURATELY PREDICTS THE NEED OF CLINICAL INTERVENTION IN ACUTE LOWER GASTROINTESTINAL BLEEDING. A DIAGNOSTIC ACCURACY EVALUATION STUDY

Aims:

The aim of this study was to compare the accuracy of Glasgow-Blachford score (GBS) with thre risk scores (State, Velayos and Newman) for predicting the need of clinical intervention (endoscopic therapy, vascular embolization and surgery or transfusion) in patients admitted for acute LGB.

Methods:

Retrospective study from January 2013 to December 2015 in a university tertiary care hospital. Patients with acute LGB were identified using the International Classification of Diseases (9th Revision) and Clinical Modification codes for admission diagnosis. Scores were retrospectively calculated according to the clinical reports data. Area under the receiver operating characteristic (AUROC) curve, sensitivity, specificity and predictive values were calculated. Also the best cut-off of each score was chosen from using the AUROC curve values.

Results:

A total of 298 consecutive patients were identified. Median age was 76.1 years (range 25.4 – 96.5), 201 (67.4%) of patients were older than 70 years, and 51% were men. Five patients (1.7%) died, 18 (6%) developed recurrent bleeding, 89 (29.9%) needed transfusion, 30 (12.1%) received endoscopic therapy, and 3 (1%) underwent transcatheter arterial embolization.

GBS AUROC was 0.82 (95% CI:0.76 – 0.87) for the need clinical intervention. GBS was significantly more accurate than Strate score and similar for Newman y Velayos for predicting the need of clinical intervention. Accuracy values for each score are shown in table 1.

Tab. 1:

CLINICAL INTERVENTION. Sensitivity, specificity and predictive values. *Best cut-off.

SCORE	SENSIVITY (%)	ESPECIFICITY (%)	POSITIVE PREDICTIVE VALUE (%)	NEGATIVE PREDICTIVE VALUE (%)
GLASGOW-BLACHFORD ≥4 *	89	59	50	91
STRATE ≥2 *	66	58	86	78
VELAYOS ≥1 *	90	46	44	90
NEWMAN ≥2 *	89	40	32	88

Conclusions:

The GBS may be an useful tool for risk stratification in LGB. It can be useful as common score for predicting the need of clinical intervention in the upper and lower gastrointestinal bleeding.