Validation of Oakland score for predicting adverse outcomes of acute lower gastrointestinal bleeding

Abstract

Background: Gastrointestinal bleeding is a common emergency in medical facilities. In clinical practice, there are many scales used to evaluate the risk of poor prognosis (Rockall, Glasgow, Blatch Ford) and mainly applied in upper gastrointestinal tract. However, the prognosis of lower gastrointestinal tract diseases remains limited. The appropriate selection and the application of scales for assessing the risks of poor prognosis in acute lower gastrointestinal bleeding (ALGIB) cases are essential, assist the physician to direct the intensive management attitude as well as the waste of human resources and health economy. Oakland score has been considered as a simple, convenient score to assist clinicians quickly, accurately stratify the risk of ALGIB patients. This study aimed to validate the Oakland score for predicting adverse outcomes of ALGIB patients. Methods: A cross-sectional study was conducted at Cho Ray Hospital from Jan 2021 to May 2021, including patients aged ≥ 16 years who had indication of admission due to symptoms suggesting ALGIB and underwent lower gastrointestinal endoscopy. These patients were then followed-up to observe the adverse outcomes, including blood transfusion, endoscopic intervention, surgery and death. Area under the receiver operating characteristic curve (AUC) and the best cut-off value of Oakland score for predicting adverse outcomes of ALGIB patients were analyzed using SPSS software. Results: A total of 70 patients with mean age 59.5 ± 16.4, male/female ratio (1.5 : 1) was recruited in this study. 27/70 (38.6%) stopped bleeding spontaneously without any interventions. The rate of clinical outcomes was blood transfusion (33/43, 76.7%), endoscopic intervention (5/43, 11.6%), blood transfusion plus endoscopic intervention (2/43, 4.7%), blood transfusion plus surgery (2/43, 4.7%), blood transfusion plus DSA plus surgery (1/43, 2.3%), respectively. AUC for predicting blood transfusion and adverse outcomes of ALGIB patients were 0.95 (0.91 - 0.99) and 0.91 (0.84 - 0.98), respectively. Oaklad score threshold of 21 showed that sensitivity and specificity for predicting blood transfusion were 94.7% and 78.1%, sensitivity and specificity for predicting adverse outcomes of ALGIB patients were 81.5% and 90.7% respectively. Conclusions: Oakland is an excellent score in order to predict clinical outcomes on ALGIB patients. Key words: Oakland; acute lower gastrointestinal bleeding; colonoscopy