Tu1496 THE ABC SCORE ACCURATELY PREDICTS MORTALITY IN HOSPITALIZED PATIENTS THAT DEVELOP UPPER GASTROINTESTINAL BLEEDING

Abstract

Hospitalized patients that develop upper gastrointestinal bleeding (UGIB) have different patient characteristics, etiology and worse outcome than patients admitted from the community with UGIB. The utility of risk scoring systems has not been validated in this patient group. The aim of this study is to compare the accuracy of different risk scoring systems in hospitalized patients that develop UGIB. Consecutive hospitalized patients that developed UGIB in Canterbury, New Zealand, between June 2015 and February 2019 were included. Patients who had onset of UGIB less than 24 hours from the time of admission were excluded. UGIB risk assessment scores (Glasgow Blatchford, AIM65, ABC, full Rockall, admission Rockall and PNED scores) were calculated and their abilities to predict predefined clinical endpoints: 30 day mortality, endoscopic intervention and a composite endpoint (30 day mortality or endoscopic intervention) were compared using area under the receiver operating curve (AUROC). By convention AUROC>0.8 is considered accurate. A total of 229 patients were included. The median patient age was 74 years (range 31-94), 63% were male, and median duration from hospitalization to onset of bleeding was 5 days (range 1-71). Forty-six (20%) required endoscopic intervention, 35 (15%) died within 30 days and median duration from onset of bleeding to death was 13 days (range 0-30). Baseline characteristics, endoscopy findings, interventions, outcomes, and mean risk assessment scores are shown in Table 1. The ABC score accurately predicted 30 day mortality (AUROC 0.85), compared with PNED score (AUROC 0.80, p=0.22), full Rockall score (AUROC 0.75, p<0.05), Glasgow Blatchford score (AUROC 0.71, p<0.05), and AIM65 score (AUROC 0.70, p<0.05) (Figure 1). Patients with an ABC score ≤3 had a 30 day mortality rate of 1.6%, compared to 7.5% and 42% for scores of 4-7 and ≥8, respectively. The need for endoscopic intervention and the composite endpoint (30 day mortality or need for endoscopic intervention) were not accurately predicted by the Glasgow Blatchford score (AUROC 0.76 and 0.76, respectively), ABC score (AUROC 0.68 and 0.76), AIM65 score (AUROC 0.61 and 0.65), or admission Rockall score (AUROC 0.58 and 0.67). No patients with a Glasgow Blatchford score of ≤1 required endoscopic intervention or died within 30 days of bleeding onset. The ABC score accurately predicts mortality in hospitalised patients that develop UGIB. A Glasgow Blatchford Score of ≤1 can be used to identify low risk patients that may not require urgent endoscopy. These results show that UGIB risk assessment scores are a useful tool in risk stratifying hospitalised patients that develop UGIB.View Large Image Figure ViewerDownload Hi-res image Download (PPT)