Abstract
Objective:This study aimed to compare the performances of the Glasgow–Blatchford Bleeding Score (GBS), pre-endoscopic Rockall score (PRS), complete Rockall score (CRS), and Cedars–Sinai Medical Center Predictive Index (CSMCPI) in predicting clinical outcomes in patients with upper gastrointestinal bleeding (UGIB).Methods:Patients who were admitted to the emergency department because of UGIB and underwent endoscopy within the first 24 hour were included in this study. The GBS, PRS, CRS, and CSMCPI were propectively calculated. The performances of these scores were assessed using a receiver operating characteristic curve.Results:A total of 153 patients were included in this study. For the prediction of high-risk patients, area under the curve (AUC) was obtained for GBS (0.912), PRS (0.968), CRS (0.991), and CSMCPI (0.918). For the prediction of rebleeding, AUC was obtained for GBS (0.656), PRS (0.625), CRS (0.701), and CSMCPI (0.612). For the prediction of 30-day mortality, AUC was obtained for GBS (0.658), PRS (0.757), CRS (0.823), and CSMCPI (0.745).Conclusion:These results suggest that effectiveness of CRS is higher than that of other scores in predicting high-risk patients, rebleeding and 30-day mortality in patients with UGIB.
Highlights
Acute upper gastrointestinal bleeding (UGIB) is managed on an inpatient basis, with emergency departments (ED) usually diagnosing the condition and initiating treatment.[1]
30 who underwent endoscopy after 24 hour of presentation were excluded from the study, three patients who underwent emergency surgery and 17 who did not accept endoscopy were excluded from the study
For the prediction of rebleeding, the area under the curve (AUC) was obtained for Glasgow–Blatchford Bleeding Score (GBS) (0.656; 95% CI, 0.557–0.756; p=0.01), pre-endoscopic Rockall score (PRS) (0.625; 95% CI, 0.514–0.735; p=0.039), complete Rockall score (CRS) (0.701; 95% CI, 0.607–0.795; p=0.001), and Cedars–Sinai Medical Center Predictive Index (CSMCPI) (0.612; 95% CI, 0.508–0.717; p=0.064)
Summary
Acute upper gastrointestinal bleeding (UGIB) is managed on an inpatient basis, with emergency departments (ED) usually diagnosing the condition and initiating treatment.[1] The clinical severities of UGIB) are various, ranging from insignificant bleeding to fatal outcomes.[2] Bleeding generally stops spontaneously in over 80% of cases with no need for intervention. Low-risk patients may be more efficiently managed in the community and do not require hospital admission.[1]. Accurate identification of high-risk patients can help physicians decide on hospital admission or discharge, the level of assistance (early endoscopy or not), and the type of treatment (medical, endoscopic, or surgical intervention)in UGIB.[2] In recent years, several practice guidelines and risk scores that combine clinical and endoscopic parameters have
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