Abstract
Background: One of the major challenges in managing acute upper gastrointestinal bleeding involves the identification of patients who are at high risk of rebleeding and death; conversely, the identification of patients who are suitable for early discharge and outpatient endoscopy is also important for effective resource. The use of Rockall system has been shown to represent accurate and valid predictor of rebleeding and death. The aim of this prospective study was to evaluate validity of Rockall score for prediction of rebleeding and mortality in Egyptian patients with upper gastrointestinal bleeding. Patients and Methods: 50 patients presented with upper GI bleeding were subjected to detailed clinical, laboratory, sonographic and endoscopic examination together with Rockall score calculation. Results: According to the findings of upper GI endoscopy patients were further subdivided into two subgroups as follows: Group 1 (n = 32): Patients with portal hypertension manifested by variceal bleeding and/or portal hypertensive gastropathy; and Group 2 (n = 18): other causes of acute upper gastrointestinal bleeding (peptic ulcer disease, Mallory Weiss syndrome…). Clinical condition of the patients was assessed after 48 hours and mortality was recorded. Rockall score was the highest in mortality group, and higher in rebleeding group than stable group (P < 0.01). Rockall score was higher in Child C than Child B and Child A among hepatic patients (P < 0.01). The cutoff value of Rockall score = 3.5 was the best for prediction of rebleeding with sensitivity 100%, specificity 53%, while the cutoff value = 6.5 was the best for prediction of mortality with sensitivity 100% and 93.5% specificity. Conclusion: Rockall score is clinically useful in prediction of rebleeding and mortality in patients with upper gastrointestinal bleeding. It can accurately differentiate between patients with stable condition that could be discharged from hospital and those who require hospitalization and this could help to minimize hospital stay and cost.
Highlights
One of the major challenges in managing UGIB involves the identification of patients at high risk of rebleeding and death; the identification of patients who are suitable for early discharge and outpatient endoscopy is important for effective resource use [5]
This study aims to assess the validity of the Rockall score for the prediction of rebleeding and death in Egyptian patients with upper gastrointestinal bleeding
According to the findings of upper GI endoscopy the patient group was further subdivided into two subgroups as follows: Group 1 (n = 32): Patients with portal hypertension manifested by variceal bleeding and/or portal hypertensive gastropathy (PHG)
Summary
Significant upper GI bleeding is often caused by hemorrhage from varices, ulcers, Dieulafoy lesions, MalloryWeiss tears and neoplasms [2] Patients and those with chronic medical diseases as liver cell failure, chronic renal failure and ischemic heart disease withstand AUGIB less well than younger, fitter patients, and have a higher risk of death [3] [4]. One of the major challenges in managing UGIB involves the identification of patients at high risk of rebleeding and death; the identification of patients who are suitable for early discharge and outpatient endoscopy is important for effective resource use [5]. One of the major challenges in managing acute upper gastrointestinal bleeding involves the identification of patients who are at high risk of rebleeding and death; the identification of patients who are suitable for early discharge and outpatient endoscopy is important for effective resource. Conclusion: Rockall score is clinically useful in prediction of rebleeding and mortality in patients with upper gastrointestinal
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