USEFULNESS OF THE MODIFIED ROCKALL INDEX TO PREDICT ADVERSE EVENTS IN UPPER GASTROINTESTINAL BLEEDING DUE TO PEPTIC ULCER

Aims The main prognostic indices for the study of upper gastrointestinal bleeding (UGB) have as a common variable the value of haemoglobin. As the Rockall Index does not include haemoglobin, we want to determine if the Rockall index plus the value of haemoglobin (Modified Rockall Index -RockMod-) can predict adverse events to UGB due to peptic ulcer and compare the RockMod with 2 other forecast index: Glasgow-Blachford and Rockall.

Methods Prospective unicenter study conducted for 5 years. Patients were defined by: 1) Presence of hematemesis, maelenas, hematochezia; 2) Confirmed by EGD<24 h after the onset of bleeding. The adverse outcomes considered were: Hemorrhagic recurrence, Red blood cell transfusion, Endoscopic treatment, Clinical intervention (transfusion, endoscopic treatment, embolization and/or surgery), Mortality. The AUROC and its IC95% were calculated for the RockMod index and compared for each adverse outcome with the other forecast index.

Results A total of 230 patients were identified consecutively. Observational data is shown in [Table 1]. When comparing the ROC curves, we find no differences between the 3 indices for recurrence and mortality. RockMod was better than Rockall's index for predicting transfusion and so was GBS. Regarding clinical intervention and endoscopic treatment, RockMod was the same as the Rockall index and better than GBS. All prognostic indices were more accurate in determining the need for transfusion than in the rest of the results ([Figure 1]).

Fig. 1

Table 1

Mean age (years). Mean±SD	63.8 (±18,2)	Sex: men	152/230 (51%)
Haemoglobin (g/dL). Mean±SD	9,5 (±2,4)	Transfusion	101/230 (43.9%)
Gastric ulcer	93/230 (40.4%)	Mortality at 30 days	7/230 (3%)
Forrest		Recurrency	26/230 (11.3%)
I	51/230 (22,2%)
IIa	59/230 (22,1%)
IIb	3/230 (13%)
IIc	36/230 (15,7%)
III	54/230 (23,5%)
Treatment
Endoscopic	140/230 (60,9%)
Vascular radiology/embolization	9/230 (3,9%)
Surgery	0/230 (0%)

Conclusions The RockMod index is better at predicting transfusion than the Rockall, and equivalent to GBS. They are similar for the rest of the results.

Publication History

Article published online:
14 April 2022