Utility of Prognostic Scores for Non Variceal Bleeding in a Mexican Population: A Prospective Clinical Trial

Abstract

Utility of Prognostic Scores for Non Variceal Bleeding in a Mexican Population: A Prospective Clinical Trial Jose A. Gonzalez-Gonzalez, Arnoldo Guerrero, Elsa E. Jimenez, Dora A. Garcia-Cantu, Eduardo Hinojo, Hector J. Madonado-Garza Introduction: The Blatchford, Baylor and Rockall scores have been reported useful in predicting the risk of complications in patients (pts) with non variceal bleeding (NVB). Objective: To evaluate the utility of Blatchford, Baylor and Rockall scores in pts with NVB. Methods: We prospectively studied all pts admitted to our institution with NVB from 2000-2003, with information obtained from our database. Exclusion criteria included in-hospital NVB, portal hypertension, previous endoscopic treatment, pts referred from other institutions. The Blatchford, Baylor and Rockall scores were applied. High and low risk groups were defined as previously published. Demographic data, co-morbidities, clinical manifestations of GI bleed, use of NSAID’s, Helicobacter pylori status, blood transfusions, endoscopic diagnosis and treatment, rebleeding rate, length of hospital stay, surgery and death were recorded. Statistical analysis: The variables are expressed as mean, range and standard deviation. Chi-square and Fisher’s exact test for comparisons. Results: We included 253 pts; M/F 177/76, mean age 59 yrs (range 17-102). Alcohol abuse 170 (67%), smoking 126 (50%), NSAID 97 (34%), previous NVB 51 (20%), HpC 175 (69%), mean blood transfusion: one unit per patient. Melena 72%, hematemesis: coffee ground 35% and bright red 27%. Etiology: Gastric ulcers 123 (49%), erosive gastritis 75 (30%), duodenal ulcers 70 (28%), erosive esophagitis 32 (13%). The endoscopic treatment used was epinephrine injection plus BICAP 92 (36%). Rebleeding 6 (2%) and surgery 1 patient. Mortality 14 (6%). We found 7 pts with 0 Blatchford criteria, observing no rebleeding or death and 1/7 pts need endoscopic treatment. In the overall group the Baylor score predicted the need for endoscopic treatment: low risk 66/212 (31%) vs high risk 26/41 pts (63%) (pZ0.0001). The Baylor score was also useful to predict rebleeding after endoscopic treatment: low risk 0/41pts (0%) vs high risk 2/18 pts (11%) (pZ 0.03). The Rockall score was useful to predict the need for endoscopic treatment: low risk (!2) 17/81 (21%) vs high risk (O2) 75/172 (43%) (p Z 0.0005) and also for mortality: low risk 1/81 (1%) vs high risk 14/172 (8.1%) (p Z 0.03). Conclusion: Blatchford score was not useful in our population. The Rockall and Baylor scores are useful tools to stratified the risk of complications in patients with NVB.