The Novel Scoring System for 30-Day Mortality in Patients with Non-variceal Upper Gastrointestinal Bleeding.

Abstract

Although the mortality rates for non-variceal upper gastrointestinal bleeding (NVUGIB) have recently decreased, it remains a significant medical problem. The main aim of this prospective multicenter database study was to construct a clinically useful predictive scoring system by using our predictors and compare its prognostic accuracy with that of the Rockall scoring system. Data were collected from consecutive patients with NVUGIB. Logistic regression analysis was performed to identify the independent predictors of 30-day mortality. Each independent predictor was assigned an integral point proportional to the odds ratio (OR) and we used the area under the curve to compare the discrimination ability between the new predictive model and the Rockall score. The independent predictors of mortality included age >65years [OR 2.627; 95% confidence interval (CI) 1.298-5.318], hemodynamic instability (OR 2.217; 95% CI 1.069-4.597), serum blood urea nitrogen level >40mg/dL (OR 1.895; 95% CI 1.029-3.490), active bleeding at endoscopy (OR 2.434; 95% CI 1.283-4.616), transfusions (OR 3.811; 95% CI 1.640-8.857), comorbidities (OR 3.481; 95% CI 1.405-8.624), and rebleeding (OR 10.581; 95% CI 5.590-20.030). The new predictive model showed a high discrimination capability and was significantly superior to the Rockall score in predicting the risk of death (OR 0.837;95% CI 0.818-0.855 vs. 0.761; 0.739-0.782; P=0.0123). The new predictive score was significantly more accurate than the Rockall score in predicting death in NVUGIB patients. We need to prospectively validate the accuracy of this score for predicting mortality in NVUGIB patients.