Abstract
Risk assessment for upper gastrointestinal bleeding (UGIB) is important; however, current scoring systems are insufficient. We aimed to develop and validate a prediction model for rapidly determining the occurrence of hypotension in non-variceal UGIB patients with normotension (systolic blood pressure ≥90 mmHg) at emergency department presentation. In this prospective observational cohort study, consecutive non-variceal UGIB patients between January 2012 and April 2017 were enrolled. We developed and validated a new prediction model through logistic regression, with the occurrence of hypotension <24 h as the primary outcome. Among 3363 UGIB patients, 1439 non-variceal UGIB patients were included. The risk factors for the occurrence of hypotension were lactate level, blood in nasogastric tube, and systolic blood pressure. The area under the curve (AUC) of the new scoring model (LBS—Lactate, Blood in nasogastric tube, Systolic blood pressure) in the development cohort was 0.74, higher than the value of 0.64 of the Glasgow–Blatchford score for predicting the occurrence of hypotension. The AUC of the LBS score in the validation cohort was 0.83. An LBS score of ≤2 had a negative predictive value of 99.5% and an LBS score of ≥7 had a specificity of 97.5% in the validation cohort. The new LBS score stratifies normotensive patients with non-variceal UGIB at risk for developing hypotension.
Highlights
The morbidity and mortality of upper gastrointestinal bleeding (UGIB) have decreased recently, this condition remains a burden to public health, with a mortality rate of 6–12% and hospital costs of more than US$2.5 billion yearly in the United States [1]
We excluded 1038 patients with liver cirrhosis, 519 patients who presented with low initial systolic blood pressure (SBP), 313 patients with advanced neoplasm, and 54 patients without lactate measurement
1439 non-variceal UGIB patients who presented with normotension were included
Summary
The morbidity and mortality of upper gastrointestinal bleeding (UGIB) have decreased recently, this condition remains a burden to public health, with a mortality rate of 6–12% and hospital costs of more than US$2.5 billion yearly in the United States [1]. Med. 2019, 8, 37 in initial decisions such as the timing of endoscopy, time of discharge, and level of care (e.g., ward vs step-down vs intensive care) [2]. Several risk scoring systems such as the Glasgow–Blatchford score (GBS) and the Rockall score have been developed for assessing patients with UGIB, and they are useful tools for identifying low-risk patients (especially the GBS). They have limitations in identifying high-risk patients who will require inpatient endoscopy, embolization, and surgical treatment, and in identifying patients at high risk for hemodynamic instability [3,4,5,6,7]. The subjectivity of the definitions of hepatic disease and cardiac disease included in the GBS makes its application in clinical practice difficult
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
