Risk Stratification in Egyptian Patients with Upper Gastro Intestinal Bleeding

Abstract

Abstract Introduction Acute upper gastrointestinal bleeding is a common and life-threatening condition. It remains a common cause of visits to the emergency department with an estimated incidence of about 100 per 100000 hospitalizations and being associated with significant morbidity, 30 day mortality and health-care costs. Urgent triage in emergency departments and risk stratification can help to identify patients who warrant urgent diagnostic and therapeutic procedures. We aimed to assess the correlation between Glasgow-Blatchford Bleeding Score, the AIMS65 score and Rockall score in sixty Egyptian patients with upper gastrointestinal bleeding, and to evaluate the best scoring system for risk stratification in these patients. Methods This prospective study included 60 Egyptian patients presented to Ain shams university hospital with upper gastrointestinal bleeding. All patients underwent emergency endoscopic evaluation within 12 hours of presentation. Surgical and radiological interventions were considered for patients who failed or were not feasible for endoscopic therapy. Rockall score, Glascow-Blatchford and AIMS65 were calculated for each patient. Results the age of the studied patients ranging between 20 and 81 years old with a mean age of 55.57 ± 13.14, of them 66.7% were males and 33.3% were females. Most of the patients (90%) had co-morbidities in the form of hepato-billiary diseases (70%), HTN (30%), DM (26.7%), cardiac disease (8.3%), and GIT related disorders (6.7%). Portal hypertension gastropathy was the most common finding in UGIT endoscopy (58.3%) followed by esophageal varcies (56.7%), then gastritis (30%), then peptic ulcer (20%) and lastly gastric mass (6.7%). Rockall score had significant association with altered mental status and liver cirrhosis. Rockall score was found to be the most effective predictor for mortality (sensitivity 100%, specificity 67.92% and AUC 91.0%). Conclusion complete Rockall score is the most effective scoring system for prediction of in hospital mortality in patients with upper gastrointestinal bleeding.