Comparison of AIMS65, Glasgow-Blatchford, and pre-endoscopy Rockall scoring systems for risk stratification in Egyptian patients with upper gastrointestinal bleeding

Abstract

Background Upper gastrointestinal bleeding (UGIB) is a serious medical emergency. Many scoring systems have been developed to predict bleeding outcomes for patients with UGIB. Recently, the guidelines recommend use of risk scores in UGIB to facilitate accurate triage and assist in clinical decisions. The aim of this study was to compare the AIMS65 with the Glasgow–Blatchford score (GBS) and the pre-endoscopy Rockall score (PRS) for risk stratification among Egyptian patients with UGIB. Patients and methods This prospective study involved 74 adult patients with UGIB. Clinical data, biochemical data, transfusion requirements, endoscopic interventions, and duration of hospitalization were collected. AIMS65, GBS, and PRS scores were calculated for each patient. The ability of these scores to predict clinical outcomes was determined. Results In receiver operating characteristic curve analysis, AIMS65 and GBS were better than PRS when predicting in-hospital mortality (0.95 vs 0.88 vs 0.83). However, the three scoring systems were similar in the prediction of the need for blood transfusion (0.74 vs 0.77 vs 0.69). They had less predictive values regarding endoscopic intervention (0.59 vs 0.57 vs 0.65) and duration of hospitalization (0.57 vs 0.57 vs 0.65). AIMS65 less than or equal to 2 can predict low-risk patients with sensitivity of 100% but with low specificity of 31%. AIMS65 score less than or equal to 2 with hemoglobin greater than 8 g/dl and no history of Chronic Liver Disease was able to detect the low-risk patients with specificity of 82% and 100% sensitivity. Conclusion Among Egyptian patients with UGIB, AIMS65 is comparable to GBS and better than pre-endoscopic Rockall score in detecting in-hospital mortality. The three scoring systems are similar in detecting the need for blood transfusion but they had less predictive values regarding endoscopic intervention and duration of hospitalization. In addition, AIMS65 score less than or equal to 2 with hemoglobin greater than 8 g/dl and no history of CLD can detect the low-risk patients who can be managed as outpatient and do endoscopy in scheduled time with specificity of 82% and 100% sensitivity. This finding needs more studies on a large number of patients to validate our assumption.