A Comparison of the ABC and AIMS65 Scores in Predicting Outcomes in Patients with Acute Upper Gastrointestinal Bleeding: A Retrospective Multicenter Study.

Background: Numerous prognostic risk scores have been created to forecast outcomes in individuals dealing with acute upper and lower gastrointestinal bleeding. When evaluating patients with gastrointestinal bleeding, distinguishing between upper gastrointestinal bleeding (UGIB) and lower gastro intestinal bleeding can pose challenges. Cases of hematochezia characterized by bright red blood in stools, might originate from upper gastrointestinal tract, while instances of melena characterized by dark tarry stools could stem from lower gastrointestinal tract (such as bleeding from the right colon). Given these complexities clinicians would greatly benefit from utilizing a single scoring system that is applicable to both acute UGIB and LGIB cases. Aim: To appraise the recently introduced ABC risk score's ability to predict mortality in both instances of acute upper and lower gastrointestinal bleeding. Methods: A comprehensive analysis was conducted on a cohort of 250 patients who sought medical attention at our institution due to acute upper gastrointestinal (UGI) and lower gastrointestinal (LGI) bleeding over the span of one year. During their admission, we computed the AIM65, GBS, OAKLAND, and ABC scores for these patients. Subsequently, we compared the outcomes in terms of 30 -day mortality and rebleeding rates. To evaluate the predictive performance, we calculated the areas under the receiver operating characteristic curves (AUROC) for each of these scores. Results:The mean age of the patients was 51 years, with a standard deviation of 11.12 years.Among the 250 patients, 157 (62.8%) were male, and 93 (37. 2%) were female. The low -risk group (ABC score 3) constituted 111 patients (44.4%), the medium -risk group (ABC score 4 -7) included 116 patients (46.4%), and the high -risk group (ABC score 8) encompassed 23 patients (9.2%). Throughout the study duration, eight patients passed away. In the context of upper gastrointestinal bleeding (UGIB), the ABC score exhibited robust predictive performance for 30 -day mortality, achieving an AUROC of 0.852. This outperformed both the AIMS -65 score (AUROC 0.752, p < 0.001) and the GBS score (AUROC 0.742, p < 0.001). Concerning lower gastrointestinal bleeding (LGIB), the ABC score also showcased strong performance, comparable to the OAKLAND score (AUROC: 0.8 vs.0.654, p = 0.473).For the prediction of rebleeding, the AUROC values were 0.833 for AIM65, 0.871 for GBS, 0.514 for OAKLAND, and notably higher at 0.959 for the ABC score.These findings underscore the ABC score's effective prognostic capability across various aspects of gastrointestinal bleeding. Conclusions: In our group of patients, the ABC score exhibited strong predictive capabilities for 30 -day mortality & rebleeding rate among individuals with both upper and lower gastrointestinal bleeding, surpassing the performance of other well -established risk scores. This finding holds the potential to significantly influence clinical management choices. This straightforward and innovative scoring system offers valuable insights into prognosis for individuals presenting with gastrointestinal bleeding, and its consistency across different patient populations adds to its reliability.

Esophageal variceal bleeding (EVB) is a serious complication of cirrhosis and a major cause of upper gastrointestinal hemorrhage, carrying substantial risks of mortality and treatment failure. Prognostic scores are essential for guiding management. This study evaluated and compared the predictive accuracy of the ABC and MAP(ASH) scores with established models in cirrhotic patients with EVB. We retrospectively analyzed 278 cirrhotic patients admitted for EVB at Da Nang Hospital, Vietnam, between January 2022 and January 2025 who underwent endoscopic variceal ligation. Data were collected for ABC, MAP(ASH), AIMS65, and Glasgow-Blatchford scores. Primary outcomes were in-hospital mortality and 5-day treatment failure. Predictive performance was assessed using AUROCs and statistical comparisons. The ABC score achieved the highest AUROC for predicting in-hospital mortality (0.88), significantly surpassing the MAP(ASH), GBS, and AIMS65 scores (p < 0.001 for all pairwise comparisons). A similar trend was observed for predicting 5-day treatment failure, where the ABC score again demonstrated the highest AUROC (0.79), outperforming both the GBS and AIMS65 scores; however, it showed comparable performance to MAP(ASH) (p = 0.19). In addition, the ABC score's risk stratification (low, medium, and high) accurately differentiated patients with varying mortality and treatment failure rates. The ABC score is a highly effective and reliable tool for predicting in-hospital mortality and early treatment failure in cirrhotic patients with EVB. While the MAP(ASH) score remains valuable for predicting early treatment failure, the ABC score offers superior overall prognostic accuracy. These findings suggest that the ABC score can guide clinical decisions, particularly in resource-limited settings.

Mortality risk among patients admitted to the emergency department (ED) with acute upper gastrointestinal (GI) bleeding is heterogeneous, underscoring the importance of early identification of high-risk individuals. This study aimed to evaluate the prognostic performance of the prognostic nutritional index (PNI) in predicting 30-day mortality and to determine whether incorporating PNI into established risk markers enhances prognostic accuracy. In this retrospective cohort study, we analyzed data from 619 patients with acute upper GI bleeding who presented to a tertiary university hospital between January 1, 2018, and December 31, 2024. Demographic, clinical, and laboratory data were extracted from medical records. PNI was calculated using serum albumin and lymphocyte count at the time of admission, with the primary outcome being 30-day mortality. Predictors of mortality were examined using univariable and multivariable logistic regression analyses. The incremental prognostic value of PNI was evaluated through receiver operating characteristic (ROC) analysis and the DeLong test. The median age of participants was 74.0 years (interquartile range: 63.0–81.0), and 38% of the patients were female. The observed 30-day mortality rate was 7.9%. Non-survivors displayed significantly lower PNI levels compared to survivors (37.6 vs. 43.6; P < 0.001). In multivariable analysis, PNI (odds ratio [OR]: 0.847 [0.765–0.938]), lactate level (OR: 1.225 [1.047–1.434]), and the ABC score (OR: 1.201 [1.053–1.370]) were identified as independent predictors of mortality. The risk of mortality increased substantially when low PNI was combined with a high ABC score or elevated lactate level. Incorporating PNI into a baseline model resulted in a modest increase in the area under the receiver operating characteristic curve (AUROC) from 0.708 to 0.774 (P ═ 0.049). In conclusion, PNI serves as an independent predictor of 30-day mortality in patients with acute upper GI bleeding. Its integration with existing risk scores may enhance prognostic discrimination and facilitate early risk stratification in the ED.

Objective:Upper gastrointestinal (GI) bleeding constitutes a significant number of admissions to the emergency department, and it has high rates of morbidity and mortality. In this study, the contribution of new scores, such as The International Bleeding Risk Score (ABC score) and the Horibe GI bleeding prediction score (HARBINGER), to clinical practice was investigated. Using scores that are easy to calculate and memorable when used in the emergency department enables a more efficient use of medical resources. In addition, it may contribute to solving the problems regarding determining the need for intensive care in patients with upper GI bleeding.Methods:This study was conducted retrospectively on patients over the age of 18 who were admitted to the emergency department between September 1, 2018 and August 31, 2019. The HARBINGER and ABC scores and the Glasgow Blatchford score (GBS) were calculated for each patient. Following that, the need for intensive care, mortality, re-bleeding rate, and transfusion need were compared.Results:This study included 184 patients. When predicting the need for intensive care, the ABC score had a higher AUC value than the GBS and HARBINGER score, even when there was a low cut-off value (cut-off value >4). (AUC =0.944, specificity =0.74, sensitivity =0.83).Conclusion:This study found that the ABC score could be used to predict the need for intensive care in upper GI bleeding, and that it outperformed other scores. Additionally, we concluded that the HARBINGER score, which had a “shock index” among its parameters, was not effective in predicting in-hospital adverse events.

Background and ObjectivesAcute upper gastrointestinal bleeding (UGIB) is a common problem that can cause significant morbidity and mortality. We aimed to compare the performance of the ABC score (ABC), the AIMS65 score (AIMS65), the Glasgow-Blatchford score (GBS), and the pre-endoscopic Rockall score (pRS) in predicting 90-day mortality or rebleeding among patients with acute UGIB.MethodsThis was a prospective multicenter study conducted at 20 tertiary hospitals in China. Data were collected between June 30, 2020 and February 10, 2021. An area under the receiver operating characteristic curve (AUC) analysis was used to compare the performance of the four scores in predicting 90-day mortality or rebleeding.ResultsAmong the 1072 patients included during the study period, the overall 90-day mortality rate was 10.91% (117/1072) and the rebleeding rate was 12.03% (129/1072). In predicting 90-day mortality, the ABC and pRS scores performed better with an AUC of 0.722 (95% CI 0.675–0.768; P<0.001) and 0.711 (95% CI 0.663–0.757; P<0.001), respectively, compared to the AIMS-65 (AUC, 0.672; 95% CI, 0.624–0.721; P<0.001) and GBS (AUC, 0.624; 95% CI, 0.569–0.679; P<0.001) scores. In predicting rebleeding in 90 days, the AUC of all scores did not exceed 0.70.ConclusionIn patients with acute UGIB, ABC and pRS performed better than AIMS-65 and GBS in predicting 90-day mortality. The performance of each score is not satisfactory in predicting rebleeding, however. Newer predictive models are needed to predict rebleeding after UGIB.

Upper gastrointestinal bleeding (UGIB) is a critical medical emergency with a potentially fatal outcome. Early risk stratification is essential for determining the need for urgent interventions. Current guidelines recommend the use of risk-stratification models, among which the ABC score was recently developed. We aimed to validate the performance of the ABC score in comparison with the well-established Glasgow-Blatchford score (GBS), AIMS65, and pre-endoscopic Rockall score (PreRS). This retrospective single-center study included adult patients (≥18 years) who presented to the emergency department of Incheon St. Mary's Hospital with non-variceal UGIB between March 2019 and June 2022. The primary outcome was 30-day all-cause mortality. Secondary outcomes included a composite endpoint of hemostatic intervention (endoscopic, interventional radiologic, or surgical), hypotension (systolic blood pressure <90 mm Hg after 2 h), vasopressor use after 2 h, and rebleeding within 7 days. The predictive performance of the GBS, AIMS65, PreRS, and ABC scores was assessed using the area under the receiver operating characteristic curve (AUROC). Of the 1597 enrolled patients, 116 (7.3%) died within 30 days. The ABC score demonstrated the highest performance (AUROC: 0.806; 95% confidence interval: 0.766-0.845) at predicting 30-day mortality, followed by the PreRS (0.734), GBS (0.679), and AIMS65 (0.558). The GBS had the highest AUROC (0.708), followed by the ABC (0.651), PreRS (0.626), and AIMS65 (0.529). The ABC score outperformed conventional risk models at predicting the 30-day mortality among patients with non-variceal UGIB. However, its predictive power for the need for intervention was inferior to that of the GBS.

Comparison of assessment tools in acute upper gastrointestinal bleeding: Which one at which time point?

Outpatient management of “low-risk” nonvariceal upper GI hemorrhage. Are we ready to put evidence into practice?

Tu1496 THE ABC SCORE ACCURATELY PREDICTS MORTALITY IN HOSPITALIZED PATIENTS THAT DEVELOP UPPER GASTROINTESTINAL BLEEDING

Background Upper GI bleeding (UGIB) remains a common emergency with significant mortality. Scores help triage patients, but it is still unclear which score should be used in the different decision-making moments to identify patients at high or low death risk. We aimed to compare the overall performances of the most validated scores and their cut-off performance to identify patients at low and high death risk. The secondary outcome was to compare the scores' performance for predicting therapeutic endoscopy, the need for transfusion(s), rebleeding, and surgery/interventional radiology. Methods We conducted a prospective multicenter cohort study, including consecutive UGIB patients admitted to 50 Italian hospitals. We collected information to calculate the Rockall, the Progetto Nazionale Endoscopia Digestiva (PNED), the AIMS65, the Glasgow-Blatchford (GBS), and the Age, Blood tests, Comorbidities (ABC) scores, together with demographic figures, clinical data, and outcomes. Results We obtained complete data of 2307 outpatients, including 1887 non-variceal and 420 variceal bleeders. Our cohort's mean age was 67.5 years, with a prevalence of male gender (69%). The GBS has the best overall performance (ROC 0.74) compared to the other scores in identifying low-risk patients (p < .001). At the cut-off 0–1, both GBS and ABC scores provide the highest PPV (100%) for low-risk patients. ABC and PNED scores are the most useful ones (for AUC >80) to assess the high-risk patients for mortality. Conclusions At admission, GBS and ABC scores identify low-risk patients suitable for outpatient management, while PNED and ABC scores identify high-risk patients. During hospitalization, the PNED score should be used to re-assess the mortality risk if a modification of clinical status occurs.

Several risk scores have attempted to risk stratify patients with acute upper gastrointestinal bleeding (UGIB) who are at a lower risk of requiring hospital-based interventions or negative outcomes including death. This systematic review and meta-analysis aimed to compare predictive abilities of pre-endoscopic scores in prognosticating the absence of adverse events in patients with UGIB. We searched MEDLINE, EMBASE, Central, and ISI Web of knowledge from inception to February 2023. All fully published studies assessing a pre-endoscopic score in patients with UGIB were included. The primary outcome was a composite score for the need of a hospital-based intervention (endoscopic therapy, surgery, angiography, or blood transfusion). Secondary outcomes included: mortality, rebleeding, or the individual endpoints of the composite outcome. Both proportional and comparative analyses were performed. Thirty-eight studies were included from 2153 citations, (n = 36,215 patients). Few patients with a low Glasgow-Blatchford score (GBS) cutoff (0, ≤1 and ≤2) required hospital-based interventions (0.02 (0.01, 0.05), 0.04 (0.02, 0.09) and 0.03 (0.02, 0.07), respectively). The proportions of patients with clinical Rockall (CRS = 0) and ABC (≤3) scores requiring hospital-based intervention were 0.19 (0.15, 0.24) and 0.69 (0.62, 0.75), respectively. GBS (cutoffs 0, ≤1 and ≤2), CRS (cutoffs 0, ≤1 and ≤2), AIMS65 (cutoffs 0 and ≤1) and ABC (cutoffs ≤1 and ≤3) scores all were associated with few patients (0.01-0.04) dying. The proportion of patients suffering other secondary outcomes varied between scoring systems but, in general, was lowest for the GBS. GBS (using cutoffs 0, ≤1 and ≤2) showed excellent discriminative ability in predicting the need for hospital-based interventions (OR 0.02, (0.00, 0.16), 0.00 (0.00, 0.02) and 0.01 (0.00, 0.01), respectively). A CRS cutoff of 0 was less discriminative. For the other secondary outcomes, discriminative abilities varied between scores but, in general, the GBS (using cutoffs up to 2) was clinically useful for most outcomes. A GBS cut-off of one or less prognosticated low-risk patients the best. Expanding the GBS cut-off to 2 maintains prognostic accuracy while allowing more patients to be managed safely as outpatients. The evidence is limited by the number, homogeneity, quality, and generalizability of available data and subjectivity of deciding on clinical impact. Additional, comparative and, ideally, interventional studies are needed.

(1) Background: Upper gastrointestinal bleeding due to ruptured varices is a severe complication in patients with cirrhosis, with high rates of recurrent hemorrhage and in-hospital mortality. This study aimed to evaluate the value of the ABC score in predicting two events among 201 cirrhotic patients with high-risk variceal hemorrhage. (2) Methods: The ABC score was calculated and categorized into risk groups of patients, and the association between the ABC score and the rates of early hemorrhagic recurrence and clinic mortality were analyzed. (3) Results: Among 201 patients, 8.0% experienced early rebleeding within five days of admission, and 10.4% died in the hospital. Patients who experienced events had higher average ABC scores compared to those who did not experience these events (p &lt; 0.001), especially in the high-risk group (with ABC score ≥ 8). The ABC score showed an excellent predictive value for in-hospital mortality with an AUROC of 0.804, with the optimal cutoff point being 8 points. Additionally, the ABC score demonstrated an acceptable predictive value for early rebleeding with an AUROC of 0.744, and the best cutoff point was 9 points. (4) Conclusions: The ABC score is closely associated with the rates of early re-hemorrhage and in-hospital mortality in cirrhotic patients with variceal bleeding. This scoring system has the potential for clinical application, aiding in early risk stratification for recurrent bleeding and mortality and allowing for more aggressive interventions in high-risk cases.

ObjectivesExisting scores are not accurate at predicting mortality in upper (UGIB) and lower (LGIB) gastrointestinal bleeding. We aimed to develop and validate a new pre-endoscopy score for predicting mortality in...

Risk stratification in acute upper GI bleeding: comparison of the AIMS65 score with the Glasgow-Blatchford and Rockall scoring systems

Risk scoring systems to predict need for clinical intervention for patients with nonvariceal upper gastrointestinal tract bleeding