Abstract
BackgroundRisk stratification for patients with nonvariceal upper gastrointestinal (NVUGI) bleeding is crucial for successful prognosis and treatment. Recently, the AIMS65 score has been used to predict mortality risk and rebleeding. The purpose of this study was to compare the performance of the AIMS65 score with the Glasgow-Blatchford score (GBS), Rockall score, and pre-endoscopic Rockall score in Korea.MethodsWe retrospectively studied 512 patients with NVUGI bleeding who were treated at a university hospital between 2013 and 2016. The AIMS65, GBS, Rockall score, and pre-endoscopic Rockall score were used to stratify patients based on their bleeding risk. The primary outcome was in-hospital mortality. The secondary outcomes were composite clinical outcomes of mortality, rebleeding, and intensive care unit (ICU) admission. Each scoring system was compared using the receiver-operating curve (ROC).ResultsA total of 17 patients (3.3%) died and rebleeding developed in 65 patients (12.7%). Eighty-six patients (16.8%) required ICU admission. The AIMS65 (area under the curve (AUC) 0.84, 95% confidence interval, 0.81–0.88)) seemed to be superior to the GBS (AUC 0.72, 0.68–0.76), the Rockall score (AUC 0.75, 0.71–0.79), or the pre-endoscopic Rockall score (AUC 0.74, 0.70–0.78) in predicting in-hospital mortality, but there was not a statistically significant difference between the groups (P = 0.07). The AUC value of the AIMS65 was not significantly different from the other scoring systems in prediction of rebleeding, endoscopic intervention, or ICU admission.ConclusionsThe AIMS65 score in NVUGI bleeding patients was comparable to the GBS or Rockall scoring systems when predicting the mortality, rebleeding, or ICU admission. Because AIMS65 is a much easier, readily calculated scoring system compared to the others, we would recommend using the AIMS65 in daily practice.
Highlights
Risk stratification for patients with nonvariceal upper gastrointestinal (NVUGI) bleeding is crucial for successful prognosis and treatment
The aim of this study was to compare the predictive value of the AIMS65 with the GlasgowBlatchford score (GBS), pre-endoscopy Rockall score (PRS), and Rockall score (RS) scores for a large scale of NVUGI bleeding patients in Korea
66 patients were excluded from the study for the following reasons: 30 patients did not have sufficient data for the study; 16 had iatrogenic post-procedural bleedings (endoscopic submucosal dissection for gastric tumors (n = 11), endoscopic mucosal resection (n = 2), endoscopic sphincterotomy (n = 3)), and 20 patients were lost to follow-up (Fig. 1)
Summary
Risk stratification for patients with nonvariceal upper gastrointestinal (NVUGI) bleeding is crucial for successful prognosis and treatment. The AIMS65 score has been used to predict mortality risk and rebleeding. Upper gastrointestinal (UGI) bleeding is a medical emergency with an incidence of mortality of 5–10% [1]. There are some scoring systems have been developed to predict bleeding outcomes for patients with UGI bleeding. The Rockall score (RS) and the Glasgow-Blatchford risk score (GBS) are the most widelyused scoring systems in clinical practice [4, 5]. These scoring systems have been reported to be useful in predicting mortality, rebleeding, need for transfusion, and hemostasis [6, 7]. The GBS is difficult to calculate in routine clinical practice due to complex nature of score calculation, and the RS requires endoscopic findings
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