Risk Stratification of Acute Upper Gastrointestinal Bleeding by AIMS65, Rockall, Glasgow Blatchford and Baylor Scores

Abstract

Abstract Background Upper gastrointestinal bleeding (UGIB) is the most common cause of emergency admission in gastrointestinal disease. Despite the development of endoscopic therapies and pharmacological management, UGIB is still associated with considerable rates of mortality and morbidity, and high medical expenses. Different scoring systems have been suggested for diagnosing these patients. Aim of the Work In this study we aimed to compare the predictive value of three scoring systems Rockall, Glasgow Blatchfors scale (GBS) and AIMS65 in patients with UGIB. Patients and Methods This study was conducted on 120 adult Egyptian patients presented by UGIB at Emergency department of Ain Shams University Hospital in Cairo, Egypt at a period from October 2020 to June 2021. Patients underwent upper endoscopy within first day from an attack of UGIB. AIMS65, GBS, and PRS scores were calculated for each patient. The ability of these scores to predict clinical outcomes was determined. Area under the receiver-operating-characteristics (ROC) curve, sensitivity, specificity, positive and negative predictive values were calculated for rebleeding and mortality. Results GBS was superior to AIMS65, Rockall and Baylor scores in identifying the patients who are likely to need interventional endoscopy "cutoff ≥8.5, sensitivity 80.8%, specificity 54.4%", need blood transfusion "cutoff ≥11.5, sensitivity 54.2%, specificity 90.3%. While AIMS65 score was superior to GBS and other scores in prediction of unfavorable outcomes, namely risk of need for ICU admission "Cutoff ≥1.5, sensitivity 86.4% specificity 96.1%", need for rebleeding in hospital "cutoff ≥1.5, sensitivity 92.7%, specificity 96.2%" and death in hospital "cutoff ≥2.5, sensitivity 90.9%, specificity 98.2%. The reasons for differences in cutoff values compared to previous studies can including ethnicity, UGIB aetiology, period of follow up and number of patients. Conclusion Early risk stratification is recommended in patients presenting with acute UGIB to identify patients at higher risk of bleeding or death and guide management decisions regarding timing of endoscopy, triage to appropriate level of care, and disposition. The optimal cutoff of each scoring system should be specified for different population to maximize the power of identifying UGIB patients at high risk of death.