Comparison of Complete Rockall Score, Glasgow–Blatchford Score, and AIMS 65 Score for Predicting In-Hospital Mortality in Patients Presenting with Upper Gastrointestinal Hemorrhage at a Tertiary Care Hospital in Southern India

Abstract

Background: Multiple risk assessment scores are available to triage and stratify patients presenting with upper gastrointestinal (GI) hemorrhage. This study was conducted to compare the accuracy of complete Rockall score (CRS), Glasgow–Blatchford score (GBS), and AIMS65 score (AIMS65-albumin, INR >1.5, impaired mental status, systolic pressure <90 mm Hg, and age >65) in predicting in-hospital mortality in patients presenting with upper GI hemorrhage to the gastroenterology department at a tertiary care hospital in Southern India. The secondary objectives were to compare these three scores in predicting the need for blood transfusion, any intervention (endoscopic or radiological or surgical intervention), or rebleeding in patients presenting with upper GI hemorrhage. Materials and Methods: This was a retrospective analysis of prospectively recorded data which included 207 patients with acute upper GI hemorrhage admitted at a tertiary care hospital at Chennai over 2 years. Demographic, clinical, laboratory, and endoscopic parameters were recorded. CRS, GBS, and AIMS65 scores were calculated. Data regarding in-hospital mortality, need for blood transfusion, endoscopic intervention, radiological intervention, surgical intervention, and rebleeding were collected. Area under receiver operating characteristic curve (AUROC) was compared between the three scores in predicting in-hospital mortality, need for blood transfusion, intervention, and rebleeding. Results: AIMS 65 score >3 (AUROC 0.92) was a better predictor of in-hospital mortality than GBS (AUROC 0.77) and CRS (AUROC 0.69). AIMS65 was a better predictor of rebleeding (AUROC 0.804) than GBS (AUROC 0.676) or CRS (AUROC 0.623). GBS was a better predictor for need of blood transfusion (AUROC 0.785) than AIMS65 (AUROC 0.691) or CRS (AUROC 0.629). Conclusion: AIMS 65 score (>3) was a better predictor of in-hospital mortality than GBS or CRS in patients presenting with acute upper GI hemorrhage due to either variceal and nonvariceal etiology. AIMS 65 was also a better predictor of risk of rebleeding. GBS was a better predictor of need for blood transfusion and need for intervention.