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.
