UTILITY OF SHOCK INDEX FOR RISK STRATIFICATION IN ACUTE LOWER GASTROINTESTINAL BLEEDING

Aims The aim of this study was compare the utility of Shock Index (SI) for predicting outcomes on acute lower gastrointestinal bleeding (LGB).

Methods SI (heart rate divided by systolic blood pressure) is a simple tool. The outcomes considered: a) Transfusion, b) Treatment (endoscopic, vascular embolization or surgery), c) Clinical intervention (transfusion and treatment), d) Rebleeding,and e) Readmission in patients with LGB between scores used for risk prediction in upper gastrointestinal bleeding (Glasgow-Blachford Score (GBS) and Pre-endoscopic Rockall) and in LGB (Oakland, Strate, Velayos and Newman scores).

Retrospective study from January 2013 to December 2017. Area under the receiver operating characteristic (AUROC) curve were calculated for SI and the different risk scores for each outcome.

Results A total of 406 patients were identified. Median age was 76.6 years, 53.8% were men. The most common source bleeding was diverticular (28.3%). SI was not useful to predict any outcome. The SI was similar to the acute LGB scores for prediction rebleeding or readmission. The GBS and Oakland score was the best for predicting transfusion and clinical intervention. All the risk scores were more accurate for determining need transfusion than need treatment or clinical intervention.

The AUROC curve and outcomes are shown in [table 1].

Tab. 1 Auroc and Ic 95 % for Shock Index and Risk Scores

Score	Transfusion	Treatment	Clinical intervention	Rebleeding
Shock index	0.58(0.51–0.64)	0.49(0.4–0.57)	0.55(0.49–0.61)	0.58(0.45–0.69)
Gbs/pre endoscopic rockall	0.89(0.85–0.92)/0.70(0.65–0.70)	0.65(0.56–0.73)/0.56(0.49–0.64)	0.72(0.63–0.81)/0.68(0.62–0.73)	0.72(0.63–0.81)/0.68(0.60–0.76)
Oakland/strate/velayos/newman/	0.89(0.85–0.93)/0.67(0.62–0.73)/0.78(0.74–0.82)/0.78(0.73–0.82)	0.63(0.55–0.72)/0.60(0.52–0.67)/0.65(0.57–0.73)/0.64(0.56–0.71)	0.82(0.77–0.86)/0.65(0.60–0.71)/0.74(0.70–0.79)/0.75(0.70–0.79)	0.74(0.65–0.83)/0.67(0.59–0.76)/0.68(0.60–0.76)/0.68(0.60–0.75)

Conclusions SI was not useful to predict any outcome. Both Oakland Score and GBS were superior for predicting transfusion or clinical intervention. The GBS may be and useful tool for risk stratification in LGB. If can be used for as common score for predicting need of clinical intervention in upper and lower gastrointestinal bleeding.