VALUE OF CANUKA IN RISK STRATIFICATION IN PATIENTS WITH NON-VARICEAL UPPER GASTROINTESTINAL BLEEDING

Abstract

"Background & aims: Guidelines recommend using prognostic scales for risk stratification in patients with non-variceal upper gastrointestinal bleeding. However, scoring system accuracy is suboptimal, and score calculation can be complex. A scoring system is needed to identify patients at risk of adverse outcomes and patients at low risk of harm. CANUKA is a new risk stratification score, developed in 2018. Until now, have not study validated the score yet. The aims of this study was to evaluate the efficacy of the CANUKA score system for risk stratification in patients with non-variceal upper gastrointestinal bleeding. Methods: Between 6/2019 and 6/2020 we prospectively recruited 106 patients with non-variceal upper gastrointestinal bleeding. We performed area under the receiver operating characteristic analyses to test the ability of CANUKA to identify patients who died or had rebleeding, surgical/radiologic intervention to control bleeding, need for therapeutic endoscopy, and transfusion-a poor outcome was defined as 1 or more of these outcomes. Patients at low risk of a poor outcome (safe for management as an outpatient) were identified based on lack of transfusion, rebleeding, therapeutic endoscopy, interventional radiology/surgery, or death. Results: A threshold CANUKA score of 6 or more was best at predicting combined poor outcome, the AUROC was 0.855% with a sensitivity of 86% specificity of 73.2% positive predictive value of 74.1%, and negative predictive value of 85.4%. The AUROC of the CANUKA for predicting need for therapeutic endoscopy, rebleeding, RBC transfusion, and surgical/radiologic intervention to control bleeding, or mortality ware 0.743, 0.902, 0.84%, 0.82 respectively. Identifying low-risk patients, a threshold CANUKA score of ≤ 2, the CANUKA has sensitivity of 100%, specificity of 7.14%, positive predictive value of 100%, and negative predictive value of 49.0%%. Comparison of the CANUKA with the Glasgow–Blatchford Score, the CANUKA score had a statistically significantly higher AUROC for predicting the combined poor outcome (AUROC=0.855 vs AUROC= 0.831; p=0.003). CANUKA had higher sensitivity than the GBS in identifying Low-Risk Patients (100% vs 98%), but the specificity was lower (7.14% vs 19.64%). Conclusions: The efficacy of the CANUKA score system for risk stratification in patients with nonvariceal upper gastrointestinal bleeding was higher than Glasgow–Blatchford Score." Key words: non-variceal upper gastrointestinal bleeding, Canuka