Comparison of risk scoring systems in patients presenting with acute upper gastrointestinal bleeding

Aims Acute Upper gastrointestinal bleeding (UGIB) is a common emergency in gastroenterology with significant morbidity and mortality. Many scores are used during the first assessment to provide an early and accurate stratification of the need of intervention, re-bleeding and mortality risk.

The aim of this study was to assess and compare the performance of the Age, Blood tests and Comorbidities (ABC) score , the MAP(ASH) score , Glasgow-Blatchford (GBS) score and AIM65 score in predicting the need for intervention, re-bleeding and short term mortality among Tunisian population with UGIB.

Methods This was a retrospective study conducted at Sahloul university hospital between January 2023 and October 2023 including all patients hospitalized for acute UGIB.

The diagnosis of UGIB was based on patient presentations: hematemesis, melena or both. Demographic information, comorbidities, physical examination, laboratory results and treatments were recorded. ABC, MAP(ASH), GBS, and AIMS65 were calculated for all patients. The area under the receiver operating characteristic (AUROC) curve was determined to compare the predictive power of each scoring system.

Results A total of 63 patients were included. The mean age was 62,8 years and 57,1% were males. Major comorbidities, including liver, heart and renal diseases were present in 44,4% of patients.The endoscopic findings included peptic ulcer in 33,3%, esophageal varices in 22,2%, gastric varices in 4,8% , reflux esophagitis in 15,9%, upper gastrointestinal tumors in 1,6%, angiodysplasia in 3 patients, aorto-digestive fistulae in 1 patient and 1 case of gastric arteriovenous malformation . In nine patients, no evident cause of UGIB was identified. Endoscopic therapy was required in 20,6% in order to achieve haemostasis, 6,3% proceeded to surgery and 1 patient needed radiological intervention. Blood transfusion was indicated in 50,8% of patients. Re-bleeding was noted in 14,3% of the patients and short term mortality occurred in 3,17%. When comparing ROC curves, we found that GBS (AUC=0,87) was superior to ABC (AUC=0,639) , to MAP(ASH) (AUC=0,653) and AIM65 (AUC=0,71) in predicting the need for transfusion (p<0.0001 ,p<0.0001 ,p=0.004 ;respectively). The scoring systems showed comparable results in predicting rebleeding (GBS: AUC=0,746, ABC: AUC=0,72, MAP(ASH): AUC=0,65, AIM65: AUC=0,674). They also showed comparable results in predicting the need for endoscopic treatment and surgery. In our study, these scores were good predictors of in-hospital mortality (GBS: AUC=0,9, ABC: AUC=0,79, MAP(ASH): AUC=0,96, AIM65: AUC=0,94) but without significant differences.

Conclusions Results from our study concluded that these scoring systems are performant in assessing patients presenting with UGIB. In addition to its simplicity, the GBS was found to be superior to the other scores in predicting the need for blood transfusion and comparable to them in other outcomes. Therefore we suggest its routinely use in emergency settings.

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Artikel online veröffentlicht:
15. April 2024