Comparative analysis of four upper gastrointestinal bleeding scoring systems for predicting multiple outcomes: an observational study in the emergency department

Abstract

Objective: Numerous scoring systems have been developed to assess the risk associated with upper gastrointestinal bleeding (UGIB), and several studies have investigated their comparative accuracy in predicting patient outcomes. This study was undertaken to compare four well-known scoring systems, namely the pre-endoscopy Rockall score, full Rockall score, Glasgow-Blatchford Bleeding score (GBS), and AIMS65, with the aim of predicting five distinct outcomes in cases of non-variceal UGIB. Methods: This prospective observational study was conducted focusing on adult patients with UGIB presenting to the emergency department (ED). The primary endpoints of this study included in-hospital mortality, the need for re-endoscopy, the requirements for packed red blood cell (PRBC) transfusion, massive transfusion, and one-month rebleeding. Results: A total number of 320 patients were enrolled, with 44 (13·75%) in-hospital deaths. Based on the area under the curves (AUC), while certain scores outperformed others in specific outcome prediction, the AIMS65 scoring system demonstrated superior predictive capability for both in-hospital mortality (0.91) and massive transfusion (0.71). Regarding PRBC transfusion requirements, both AIMS65 and GBS exhibited similar predictive capacities (AUC=0.67 and 0.68, respectively). In terms of re-endoscopy and one-month rebleeding, the GBS scoring system displayed slightly better performance compared to the other systems (AUC=0.61 and 0.63, respectively). In the composite outcome, all scores had significant associations, and among them, the AIMS-65 score had the highest AUC (0.76). Conclusion: The AIMS65 scoring system was the most reliable tool for predicting in-hospital mortality and, to a lesser extent, massive transfusion requirements, while GBS and AIMS65 could be moderately and cautiously relied on for preparations regarding the need for PRBC transfusion.