AIMS65 Score Research Articles

Risk Stratification in Acute Upper Gastrointestinal Bleeding Occurring in Hospitalized Patients: Comparison of Clinical Risk Scoring Systems and Clinically Significant Bleeding Criteria

Background: Upper gastrointestinal bleeding (UGIB) while being hospitalized is common, resulting in increased disability and mortality. Using the clinical risk scoring system to assess these patients is, therefore, important in assessing the necessity for endoscopic intervention, predicting rebleeding rate, and 30-day mortality rate. Objective: To assess the effectiveness of the clinical risk scoring system in terms of predicting the need of endoscopic intervention, rebleeding rate, and 30-day mortality in in-hospital UGIB patients. Materials and Methods: The patients with in-hospital UGIB who were admitted during August 2014 to August 2018 and underwent esophagogastroduodenoscopy within 72 hours after bleeding onset were included. The data were retrospectively collected. A comparison of the effectiveness of the clinically significant bleeding criteria, Glasgow-Blatchford score, and AIMS65 score was done. Results: One hundred and sixteen patients were included into the study. The main cause of UGIB was stress-related mucosal disease (SRMD) (88.8%). The effective system of predicting the necessity for endoscopic intervention was the clinically significant bleeding criteria (sensitivity 84%, specificity 74%). The effective scoring system for predicting rebleeding rate and 30-day mortality was the AIMS65 score (sensitivity 83%, specificity 59%). Conclusion: In-hospital UGIB is a common condition, mostly associated with SRMD. Patients with clinically significant bleeding would benefit from endoscopic intervention. Keywords: Upper gastrointestinal bleeding, In-hospital UGIB, Clinically significant bleeding, GBS, AIMS65

Application of AIMS65 Score in the Prediction of Clinical Outcomes of Patients with Upper Gastrointestinal Hemorrhage

Background : The AIMS65 score has been recognized as an accurate tool in predicting outcomes in patients with upper gastrointestinal hemorrhage (UGIH). Objective: To determine whether outcomes for patients presenting with UGIH differ depending on low-risk (AIMS65 <2) and high-risk (AIMS65 ≥2) scores. Materials and Methods : We conducted a retrospective comparison of in-hospital mortality, other clinical outcomes, and resource use between low-risk and high-risk UGIH patients in Hatyai Hospital between 2016 and 2017. Results: There were 322 patients with UGIH included in the study, of whom 186 patients (57.8%) were low-risk and 136 patients (42.2%) were high-risk. When compared to low-risk patients, high-risk patients had increased risk of in-hospital mortality (11.8% vs 2.7%, p =0.001; adjusted hazard ratio (HR) 4.04, 95% confidence interval (CI) 1.34-12.16), needed blood transfusion (74.3% vs 39.8%, p <0.001; adjusted HR 4.23, 95%CI 2.42-7.42), endoscopic intervention (44.1% vs 24.7%, p <0.001; adjusted HR 2.06, 95%CI 1.19-3.57 ) and overall intervention (46.3% vs 24.7%, p <0.001; adjusted HR 2.19, 95%CI 1.24-3.86). There was no significant difference in rebleeding between the two groups (3.7% vs 2.2%, p =0.501; adjusted HR 1.71, 95%CI 0.43 – 6.87) . High-risk patients were associated with longer hospitalization (median [IQR] = 5 [4 to 7] days vs 4 [3 to 5] days, p <0.001) and higher hospitalization cost (median [IQR] = 687.4 [450.7 to 1,023.1] vs 537.1 [388.5 to 819.1] US dollars, p <0.001). Conclusion: The AIMS65 score is simple and accurate in predicting clinical outcomes. High-risk patients (AIMS65 ≥ 2) had increased risk of in-hospital mortality and needed of blood transfusion, endoscopic intervention, and overall intervention and were associated with greater hospital stay and cost.

Relationship between angiography timing and angiographic visualization of extravasation in patients with acute non-variceal gastrointestinal bleeding

BackgroundAngiographic embolization is now considered the first-line therapy for acute gastrointestinal (GI) bleeding refractory to endoscopic therapy. The success of angiographic embolization depends on the detection of the bleeding site. This study aimed to identify the clinical and procedural predictors for the angiographic visualization of extravasation, including angiography timing, as well as analyze the outcomes of angiographic embolization according to the angiographic visualization of extravasation.MethodsThe clinical and procedural data of 138 consecutive patients (mean age, 66.5 years; 65.9% men) who underwent angiography with or without embolization for acute non-variceal GI bleeding between February 2008 and July 2018 were retrospectively analyzed.ResultsOf the 138 patients, 58 (42%) had active extravasation on initial angiography and 113 (81.9%) underwent embolization. The angiographic visualization of extravasation was significantly higher in patients with diabetes (p = 0.036), a low platelet count (p = 0.048), high maximum heart rate (p = 0.002) and AIMS65 score (p = 0.026), upper GI bleeding (p = 0.025), and short time-to-angiography (p = 0.031). The angiographic embolization was successful in all angiograms, with angiographic visualization of extravasation (100%). The clinical success of patients without angiographic visualization of extravasation (83.9%) was significantly higher than that of patients with angiographic visualization of extravasation (65.5%) (p = 0.004). In multivariate analysis, the time-to-angiography (odds ratio 0.373 [95% CI 0.154–0.903], p = 0.029) was the only significant predictor associated with the angiographic visualization of extravasation. The cutoff value of time-to-angiography was 5.0 h, with a sensitivity and specificity of 79.3% and 47.5%, respectively (p = 0.012).ConclusionsAngiography timing is an important factor that is associated with the angiographic visualization of extravasation in patients with acute GI bleeding. Angiography should be performed early in the course of bleeding in critically ill patients.

Differences in emergency endoscopy outcomes according to gastrointestinal bleeding location

Background and aim With recent technological advances in the field of endoscopic hemostasis, the prognosis of patients with gastrointestinal (GI) bleeding has improved. However, few studies have reported on the clinical course of patients with GI bleeding. This study aimed to evaluate the differences in clinical outcomes of patients with lower GI bleeding (LGIB) compared with upper GI bleeding (UGIB) and the factors related to their prognosis. Methods Patients who had undergone emergency endoscopy for GI bleeding were retrospectively reviewed. The severity of GI bleeding was evaluated using the Glasgow–Blatchford (GB), AIMS65, and NOBLADS scores. Patients in whom obvious GI bleeding relapsed and/or iron deficiency anemia persisted after emergency endoscopy were considered to exhibit rebleeding. Results We reviewed 1697 consecutive patients and divided them into UGIB (1054 patients) and LGIB (643 patients) groups. The proportion of patients with rebleeding was significantly greater in the UGIB group than in the LGIB group; the mortality rate was significantly higher in the UGIB group than in the LGIB group. Multivariate analysis showed that a GB score ≥12 and an AIMS65 score ≥2 were significantly associated with rebleeding in the UGIB group, whereas a NOBLADS score ≥4 was significantly associated with rebleeding in the LGIB group. Notably, the influence of emergency endoscopy differed according to GI bleeding location. Conclusions The clinical course was significantly worse in patients with UGIB than in patients with LGIB. The influence of emergency endoscopy differed according to GI bleeding location.

High-density lipoprotein cholesterol is a predictor of survival in cirrhotic patients with acute gastrointestinal bleeding: a retrospective study

BackgroundLipid profiles are declined in patients with viral liver cirrhosis and correlated with severity of liver disease. Hepatitis B virus (HBV) is the leading cause of liver cirrhosis in China. Our primary aim was to investigate whether serum lipids and lipoproteins associate with survival in patients with HBV-related cirrhosis and acute gastrointestinal bleeding, and develop a 6-week mortality risk score that incorporates it.MethodsFrom January 2008 to December 2015, consecutive cirrhotic patients with acute gastrointestinal bleeding admitted to our hospital were evaluated and randomly divided into the derivation (n = 629) and validation (n = 314) cohorts. A logistic regression model was established to confirm the association between lipoprotein cholesterol and mortality. Accuracy to predict mortality were assessed by area under the receiver operating characteristic curves (AUROCs) and compared using the Hanley and McNeil test.ResultsAmong study subjects, the 6-week mortality rate was 10.6%. High-density lipoprotein cholesterol (HDL-C) level was found to correlate most strongly with prognostic scores. On ROC analysis, HDL-C showed excellent diagnostic accuracy for 6-week mortality. Logistic regression analysis provided a simple algorithm based on the combined use of 4 variables (total bilirubin (TBIL), HDL-C, International normalized ratio, and hemoglobin), allowing accurate discrimination of 3 distinct prognostic subgroups with 1.7% (low risk), 12.3% (intermediate risk), and 56.9% (high risk) mortality. Its accuracy was significantly better than that of Child–Pugh, model of end-stage liver disease, albumin-bilirubin score, D’Amico model, Augustin model, AIMS65 score and Glasgow-Blatchford score. Baseline HDL-C values ≤ 0.54 mmol/L were associated with markedly lower 6-week survival. Comparable results were found in the validation set.ConclusionHDL-C is a potential indicator for the prognosis of patients with cirrhosis and acute gastrointestinal bleeding. The new algorithm based on HDL-C allowed an accurate predictive assessment of 6-week mortality after bleeding attack.

Diagnostic accuracy of AIMS-65 clinical scoring system in predicting outcome in patients with upper gastrointestinal bleeding presenting at Tertiary Care Hospital, Karachi.

Objectives: To determine the diagnostic accuracy of AIMS-65 clinical scoring system in patients with upper gastrointestinal bleeding by taking mortality as gold standard. Study Design: Cross Sectional study. Setting: Department of Gastroenterology, Liaquat National Hospital Karachi. Period: 6 months from 14th Nov 2018 to 14th May 2019. Material & Methods: All patients who fulfilled the inclusion criteria in the Department of Gastroenterology, Liaquat National Hospital, Karachi were included. After taking informed written consent clinical examination and lab investigations were done to determine the diagnostic accuracy of AIMS-65 clinical scoring system in patients with upper gastrointestinal bleeding by taking mortality as gold standard. Result: Total of 252 patients with UGIB were included. 183 (72.6%) were males & 69 (27.4%) were females, with the mean age was 35.10±7.065 years. The sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of AIMS 65 scoring system in predicting mortality within 30 days was (77.4%, 84.4, 56.9, 93.3 and 82.93%) in patients with UGIB. Conclusion: In conclusion AIMS 65 score has higher diagnostic accuracy in predicting 30-day mortality in patients with UGIB.

RISK STRATIFICATION OF ACUTE UPPER GI BLEEDING BY ROCKALL, GLASGOW BLATCHFORD AND AIMS 65 SCORES

Background: Prognostic scales should be used for early stratification of patients according to risk. Several risk scores have been developed, most of which include endoscopic findings. Objective: To compare three scores "Rockall, Blatchford and AIMS65 scores" to identify the most accurate score used in predicting unfavorable outcomes during patient hospitalization, and for about 1 week after discharge. Patients and methods: A prospective study was conducted on Egyptian patients presented by upper gastrointestinal bleeding, (UGIB) recruited from the emergency department (ED) of Nasser institute hospital for research and treatment, over a period from January 2019 to July 2019. Results: About half of cases had chronic liver disease. The most frequent clinical condition was Melena; present in about half of cases. Stigmata were in more than half of cases. Cases with need for interventional endoscopy had significant higher hepatic disease, severe comorbidities, melena, syncope, shock and worser laboratories& endoscopic findings. Conclusion: Risk stratification and decision to perform interventions including therapeutic endoscopy is often a subjective matter.

RISK STRATIFICATION OF ACUTE UPPER GI BLEEDING BY ROCKALL, GLASGOW BLATCHFORD AND AIMS 65 SCORES

Background: Prognostic scales should be used for early stratification of patients according to risk. Several risk have been developed, most of which include endoscopic findings. Objective: To compare three Rockall, Blatchford and AIMS65 scores to identify the most accurate score used in predicting unfavorable outcomes during patient hospitalization, and for about 1 week after discharge. Patients and methods: A prospective study was conducted on Egyptian patients presented by upper gastrointestinal bleeding, (UGIB) recruited from the emergency department (ED) of Nasser institute hospital for research and treatment, over a period from January 2019 to July 2019. Results: About half of cases had chronic liver disease. The most frequent clinical condition was Melena; present in about half of cases. Stigmata were in more than half of cases. Cases with need for interventional endoscopy had significant higher hepatic disease, severe comorbidities, melena, syncope, shock and worser laboratories& endoscopic findings. Conclusion: Risk stratification and decision to perform interventions including therapeutic endoscopy is often a subjective matter.

Comparison of various risk scores for the prognosis of hemorrhagic upper gastrointestinal mucosal disorder

BackgroundVarious risk scores have been proposed that are useful for the management of upper gastrointestinal bleeding (UGIB), which is an important disease in emergency medicine. Few studies have examined the usefulness of Charlson Comorbidity index (CCI) in this disease, which evaluates the patient’s general condition by scoring the patient’s underlying disease. There have been no studies investigating the efficacy of CCI compared to other risk scores in the management of UGIB requiring endoscopic hemostasis.MethodsIn addition to the Glasgow-Blatchford score, AIMS65 score, and Rockall score, we investigated the efficacy of the outcome prediction obtained by the original CCI and the updated CCI, scored only with respect to the underlying disease. We also examined the cutoff value when using the risk score. This retrospective study included 265 patients with hemorrhagic upper gastrointestinal mucosal lesions who underwent emergency endoscopic hemostasis during a 6-year period between 2011 and 2016 in our hospital.ResultsThe updated CCI and AIMS65 score correlated with prognosis in multivariate analysis (p = 0.002 and p = 0.003, respectively). In clinical practice, the prognosis might be worse if both updated CCI and AIMS65 score were 3 point or more.ConclusionIn addition to the AIMS65 score, the updated CCI can be a useful tool for managing upper gastrointestinal mucosal disorder bleeding that requires endoscopic hemostasis.

Prospective Comparison of the AIMS65 Score, Glasgow-Blatchford Score, and Rockall Score for Predicting Clinical Outcomes in Patients with Variceal and Nonvariceal Upper Gastrointestinal Bleeding.

Background/AimsThis study aimed to determine the performance of the AIMS65 score (AIMS65), Glasgow-Blatchford score (GBS), and Rockall score (RS) in predicting outcomes in patients with upper gastrointestinal bleeding (UGIB), and to compare the results between patients with nonvariceal UGIB (NVUGIB) and those with variceal UGIB (VUGIB). MethodsWe conducted a prospective observational study between March 2016 and December 2017. Receiver operating characteristic curve analysis was performed for all outcomes for comparison. The associations of all three scores with mortality were evaluated using multivariate logistic regression analysis. ResultsOf the total of 337 patients with UGIB, 267 patients (79.2%) had NVUGIB. AIMS65 was significantly associated (odds ratio [OR], 1.735; 95% confidence interval [CI], 1.148–2.620), RS was marginally associated (OR, 1.225; 95% CI, 0.973–1.543), but GBS was not associated (OR, 1.017; 95% CI, 0.890–1.163) with mortality risk in patients with UGIB. However, all three scores accurately predicted all other outcomes (all p<0.05) except rebleeding (p>0.05). Only AIMS65 precisely predicted mortality, the need for blood transfusion and the composite endpoint (all p<0.05) in patients with VUGIB. ConclusionsAIMS65 is superior to GBS and RS in predicting mortality in patients with UGIB, and also precisely predicts the need for blood transfusion and the composite endpoint in patients with VUGIB. No scoring system could satisfactorily predict rebleeding in all patients with UGIB.

Acute upper gastrointestinal bleeding in southern Saudi Arabia: A retrospective observational study

Context: Upper gastrointestinal bleeding (UGIB) is a common life-threatening emergency that carries considerable mortality and morbidity; it remains a common cause for admission to hospitals worldwide. UGIB is classified as variceal bleeding and non-variceal bleeding because of distinct etiologies and management. Aims: To describe present clinical manifestations in southern Saudi Arabian UGIB patients, including both endoscopic and basic laboratory parameters, to assess the risk factors, and compare the predictive power and clinical usefulness of three risk scoring systems (AIMS65 score, Glasgow-Blatchford score, Rockall risk score) for the management of patients presenting with UGIB. Methods: This was a retrospective observational study. We included 283 patients admitted to the gastrointestinal unit at Abha city, southern Saudi Arabia, from November 2017 to October 2019. The study findings were the etiology of UGI bleeding, the endoscopic findings and clinical outcome of UGI bleeding. Results: Ages ranged from 18 to 97 years old with mean age of 54.5 ± 18.5 years. The majority of patients were males (72%; 203). Melina was the most common presenting symptom, in 66 (49.3%) patients. Diabetes mellitus was the most frequently recorded risk factor for UGIB (53.9%) followed by hypertension (44.9%), and aspirin use (35.7%). Endoscopic hemostatic treatment was applied in 70 patients (24.7%); 4.9% of patients re-bled, and 21 patients (7.4%) died during the study period. Conclusions: Comorbidities such as hypertension and diabetes, in addition to some medicines including ASA, steroids and NSAIDs were identified as risk factors of upper GIT bleeding among this study casesa list of risk factors for severe UGIB, leading to hospitalization and even death.

Prealbumin and D-dimer as Prognostic Indicators for Rebleeding in Patients with Nonvariceal Upper Gastrointestinal Bleeding.

Determining the risk stratification of nonvariceal upper gastrointestinal bleeding (NVUGIB) plays a vital role in treating upper gastrointestinal bleeding (UGIB). Traditional scores like Glasgow-Blatchford score (GBS), Rockall score (RS), and AIMS65 score have been widely utilized in UGIB practice, however exhibiting limited practical use due to relative lack of user-friendly characters. Prealbumin as a nutritional indicator and d-dimer as a fibrinolytic activity monitor, are generally used to evaluate the overall nutritional and fibrinolytic condition in UGIB patients. Here, we explored the predictive value of these two markers in NVUGIB for evaluating severity and prognosis including rebleeding and surgery intervention. One hundred and eighty-five patients suffering NVUGIB were enrolled. Their GBS, RS, and AIMS65 score, routine laboratory test results including prealbumin and d-dimer were determined after admission. Multivariate regression analysis was performed to define the independent predictors of rebleeding. ROC curves were generated to compare the suitability of prealbumin, d-dimer, and scores for rebleeding prediction. The NVUGIB patients with rebleeding exhibited higher scores, white blood cell counts, d-dimer, CRP, proportion of surgery intervention, and longer hospital stay, but lower hematocrit, hemoglobin, calcium, prealbumin, and fibrinogen than those without rebleeding. The multivariate regression analysis demonstrated that prealbumin and d-dimer were independent predictors for rebleeding. Values of prealbumin and d-dimer were correlated with hospital stay, ulcer degrees, and surgery demand. The ROC curve analyses showed that prealbumin and d-dimer exhibited superior prediction value over the scoring systems. Prealbumin and d-dimer are promising predictors for severity and prognosis in NVUGIB practice.

COMPARISON THE PNED SCORE WITH THE GB, AIMS65 SCORES FOR RISK STRATIFICATION IN PATIENTS WITH UPPER GASTROINTESTINAL BLEEDING

Back ground: Upper gastrointestinal bleeding (UGIB) is a common cause of internal medical or surgical emergencies and often make the life-threatening risks to patients. The stratification of risk in triage the patients with UGIB is very critical for clinicians. PNED score is still a fairly new scale in Vietnam and currently no research that evaluated and compared it with the GB and AIMS65 scores in risk stratification of UGIB patients has been found. This study were aimed to (i) evaluate the accuracy, predictive value of the GB, AIMS65 and PNED scores and (ii) to compare the PNED score with the GB and AIMS65 scores in risk stratification of patients with upper gastrointestinal bleeding on admission to the Department of Gastroenterology at Cho Ray Hospital. Subjects and Research Methods: A prospective cohort study investigating all patients presenting with UGIB on admission and treatment at the Department of Gastroenterology in Cho Ray Hospital from March 15th, 2019 to August 30th, 2019. We calculated PNED, GB, AIM65 scores and compared the area under the ROC curve (AUC) to determine the predicted value of the scores. Results: One hundred and seventy-five patients were included. Median age of 59.51 ± 14.36, male/female ratio of 2.07/1, proportion of patients requiring blood transfusion intervention: 45.1%, hemostatic endoscopy: 30.3%, surgery: 0.57%, re-bleeding during hospitalization: 9.7%, overall mortality: 5.1%. About predicting required blood transfusion intervention of GB score was highest then PNED score and finally AIMS65 score with AUC respectively 67.1%; 63.1%; 56.4% (p&lt;0.001). About predicting endoscopic intervention of PNED score was highest then GB score and finally AIMS65 score with AUC respectively 62.2%; 55.1%; 52.7%. About predicting required medical intervention of PNED score was highest then GB score and finally AIMS65 score with AUC respectively 69.7%; 66.2%; 56.3%. About predicting required re-bleeding of PNED score was highest then GB score score with AUC respectively 80.8%; 62.1%. AUC of AIMS65 score of 48.5% has no value in predicting re-bleeding. About predicting the risk of mortality of AIMS65 score was highest then GB score score and finally PNED score with AUC respectively 77.3%; 73.5%; 61.3%. The PNED score with a cut-off ≥ 6, has a positive predictive value is high for the overall medical intervention (76.81%) compared with GB score (68.33%) has cut-off ≥ 9 and AIMS65 score (61.33%) has cut-off ≥ 2. Conclusion: The PNED score is superior to the GB and AIMS65 scores in predicting hemostatic interventions, general medical interventions and re-bleeding. Key words: Upper gastrointestinal bleeding, PNED score, GB score, AIM65 score

Predictors of mortality and endoscopic intervention in patients with upper gastrointestinal bleeding in the intensive care unit.

BackgroundThe outcomes of patients undergoing esophagogastroduodenoscopy (EGD) in the intensive care unit (ICU) for upper gastrointestinal bleeding (UGIB) are not well described. Our aims were to determine predictors of 30-day mortality and endoscopic intervention, and assess the utility of existing clinical-prediction tools for UGIB in this population.MethodsPatients hospitalized in an ICU between 2008 and 2015 who underwent EGD were identified using a validated, machine-learning algorithm. Logistic regression was used to determine factors associated with 30-day mortality and endoscopic intervention. Area under receiver-operating characteristics (AUROC) analysis was used to evaluate established UGIB scoring systems in predicting mortality and endoscopic intervention in patients who presented to the hospital with UGIB.ResultsA total of 606 patients underwent EGD for UGIB while admitted to an ICU. The median age of the cohort was 62 years and 55.9% were male. Multivariate analysis revealed that predictors associated with 30-day mortality included American Society of Anesthesiologists (ASA) class (odds ratio [OR] 4.1, 95% confidence interval [CI] 2.2–7.9), Charlson score (OR 1.2, 95% CI 1.0–1.3), and duration from hospital admission to EGD (OR 1.04, 95% CI 1.01–1.07). Rockall, Glasgow-Blatchford, and AIMS65 scores were poorly predictive of endoscopic intervention (AUROC: 0.521, 0.514, and 0.540, respectively) and in-hospital mortality (AUROC: 0.510, 0.568, and 0.506, respectively).ConclusionsPredictors associated with 30-day mortality include ASA classification, Charlson score, and duration in the hospital prior to EGD. Existing risk tools are poorly predictive of clinical outcomes, which highlights the need for a more accurate risk-stratification tool to predict the benefit of intervention within the ICU population.

Clinical outcomes of sedation during emergency endoscopic band ligation for variceal bleeding: Multicenter cohort study.

Few studies have directly compared the efficacy of sedated- and un-sedated endoscopic variceal ligation (EVL) for acute variceal bleeding. We aimed to determine whether sedation during EVL in patients with variceal bleeding is safe and effective. We analyzed data from patients who underwent EVL for acute variceal bleeding according to sedation in six hospitals of Hallym University Medical Center. The primary endpoint was treatment failure, defined as a failure to control bleeding, death during EVL, or rebleeding within 5 days. Secondary endpoints included the procedure time, adverse events, and 30-day mortality. Of 1,300 patients who were included, only 430 (33.1%) received sedation during EVL. Propofol alone was used for sedation in 85% of sedated-EVLs. The mean procedure time in the sedation group was shorter than that of the non-sedation group (12.4 ± 9.5 min versus 13.8 ± 9.4 min, P = 0.010). The proportion of treatment failure did not differ between the groups (7.4% versus 9.1%, P = 0.374). In the multivariable analysis, an AIMS65 score ≥2 and blood transfusion within 72 hours were associated with treatment failure of EVL; however, the use of sedation was not (odds ratio [95% confidence interval (CI)] = 0.96 [0.60-1.51]). Adverse events during EVL and hepatic encephalopathy did not differ between the two groups. Sedation also did not affect the 30-day mortality (hazard ratio [95% CI] = 0.99 [0.66-1.47]). Sedation reduced the procedure time of EVL. Sedation is safe to use during EVL for variceal bleeding in patients with cirrhosis.

Second urgent endoscopy within 48-hour benefits cirrhosis patients with acute esophageal variceal bleeding.

Urgent endoscopy (UE) is important to the diagnosis and treatment of liver cirrhosis patients with esophageal variceal bleeding (EVB). It was reported that a second-look endoscopy may benefit acute upper gastrointestinal bleeding (UGIB) caused by peptic ulcer, while whether it could improve UGIB caused by liver cirrhosis associated EVB remains unclear. This study aimed to investigate the characteristics of second UE for liver cirrhosis with EVB and further examined the potential prognostic factors.Patients aged ≥18 years who underwent UE for EVB within 2 hours after the admission were included and divided into scheduled second-look group (n = 245) and uncontrolled bleeding group (n = 352) based on the indications for second UE within 48 hours after initial endoscopy. Demographic and clinical data were collected and analyzed. Univariate and multivariate analysis were used to identify the risk factors for prognosis. The value of different scoring system was compared.Statistical differences were found on history of bleeding and hepatocellular carcinoma, ascites, endoscopic type of bleeding, between scheduled second-look group and uncontrolled bleeding group. Univariate and multivariate logistic regression analysis confirmed that ascites, hemoglobin <60 g/L, AIMS65 score and failure to identify in initial UE were independent risk factors for bleeding uncontrolled after initial UE, and age, bilirubin level, initial unsatisfactory UE hemostasis, failure to identify bleeding on initial UE and tube/urgent TIPS suggested in initial UE were independent risk factors for 42-day mortality.A second-look UE could bring benefit for liver cirrhosis patients with EVB without increasing the complication rate.

Risk assessment of cirrhosis patients with esophageal and gastric variceal bleeding by three scoring systems

Objective To compare the risk assessment capability of model for end-stage liver disease (MELD), glasgow-blatchford score (GBS), and the AIMS65 scoring system for liver cirrhosis patients with esophageal and gastric variceal bleeding (EGVB). Methods A retrospective analysis was made on data of 182 cirrhosis patients with EGVB admitted to the Department of Gastroenterology, General Hospital of Tianjin Medical University from January 1, 2015 to March 1, 2018. According to the MELD, GBS and AIMS65 scoring system, the corresponding scores of each were calculated to evaluate the ability of the three scoring systems to correctly classify EGVB as a high-risk patient . The receiver operating characteristic curve was drawn to compare the predictive value of three scoring systems for different clinical outcomes (blood transfusion, rebleeding, and death). The area under curve (AUC)>0.7 was believed to have higher accuracy. Results The clinical outcomes of 182 patients included blood transfusion in 113 (62.1%) cases, rebleeding in 31 (17.0%) cases, and death of 11 (6.0%) cases. The MELD score was 7-25, GBS was 3-16, and AIMS65 score was 0-3. There were 4 (2.2%) patients with MELD score < 9, 139 (76.4%) patients with AIMS65 score 0-1, including 68 patients with AIMS65 score of 0 and 71 patients with AIMS65 score of 1. The AUC of MELD, GBS and AIMS65 for predicting blood transfusion was 0.514 (95%CI: 0.439-0.589), 0.681 (95%CI: 0.608-0.748), and 0.669 (95%CI: 0.596-0.737), respectively. When predicting rebleeding, the AUC of MELD, GBS and AIMS65 was 0.525 (95%CI: 0.449-0.599), 0.528 (95%CI: 0.453-0.602) and 0.580 (95%CI: 0.505-0.652), respectively. When predicting in-hospital mortality, the AUC of MELD, GBS and AIMS65 was 0.642 (95%CI: 0.567-0.711), 0.581 (95%CI: 0.505-0.653) and 0.786 (95%CI: 0.719-0.843), respectively. AIMS65 was superior to MELD (P=0.083 6) and GBS (P=0.047 0). Conclusion GBS can correctly classify cirrhosis patients with EGVB as high-risk group , and is better than AIMS65 and MELD scoring system. MELD, GBS and AIMS65 all have poor accuracy in predicting blood transfusion and rebleeding, AIMS65 has a higher predictive value for death. Key words: Prognosis; Liver cirrhosis; Esophageal and gastric variceal bleeding; Scoring system

Comparison of the AIMS65 score with the Glasgow-Blatchford and Rockall scoring systems for the prediction of the risk of in-hospital death among patients with upper gastrointestinal bleeding.

the aim of this study was to compare the AIMS65, Glasgow-Blatchford score (GBS) and Rockall score for the prediction of the risk of in-hospital death among patients with upper gastrointestinal bleeding (UGIB). patients with UGIB admitted to the ZhongDa hospital from June 2015 to July 2017 were retrospectively collected. All patients were assessed by the AIMS65, GBS and Rockall score and the main outcomes were in-hospital mortality. Odds ratios (OR) and 95 % confidence interval (CI) were estimated to assess the association of the three scores with the risk of death using logistic regression models. Subsequently, their risk stratification accuracy were compared. Finally, their predictive power was compared using the area under the receiver operating characteristic curve (AUROC). of the 284 UGIB patients enrolled in the study, 51 (18.0 %) had variceal bleeding (VUGIB) and 10 patients (3.5 %) died. AIMS65 (OR = 5.14, 95 % CI = 2.48, 10.64), GBS (OR = 1.66, 95 % CI = 1.28, 2.15) and Rockall (OR = 2.72, 95 % CI = 1.76, 4.18) scores were positively associated with death risk among all patients. The AIMS65 score (high-risk group vs low-risk group: 11.9 % vs 0.0 %, p < 0.001) was effective to classify high-risk in-hospital deaths populations. The AIMS65 score was the best approach to predict in-hospital death among all UGIB patients (AUROC: AIMS65 0.955, GBS 0.882, Rockall 0.938), NVUGIB patients (AUROC = 0.969, 95 % CI = 0.937, 0.989) or VUGIB patients (AUROC = 0.885, 95 % CI = 0.765, 0.967). the AIMS65 score is the most convenient UGIB prognostic score to predict in-hospital mortality and may be more suitable for patients with NVUGIB.

Comparison of AIMS65, Glasgow-Blatchford, and pre-endoscopy Rockall scoring systems for risk stratification in Egyptian patients with upper gastrointestinal bleeding

Background Upper gastrointestinal bleeding (UGIB) is a serious medical emergency. Many scoring systems have been developed to predict bleeding outcomes for patients with UGIB. Recently, the guidelines recommend use of risk scores in UGIB to facilitate accurate triage and assist in clinical decisions. The aim of this study was to compare the AIMS65 with the Glasgow–Blatchford score (GBS) and the pre-endoscopy Rockall score (PRS) for risk stratification among Egyptian patients with UGIB. Patients and methods This prospective study involved 74 adult patients with UGIB. Clinical data, biochemical data, transfusion requirements, endoscopic interventions, and duration of hospitalization were collected. AIMS65, GBS, and PRS scores were calculated for each patient. The ability of these scores to predict clinical outcomes was determined. Results In receiver operating characteristic curve analysis, AIMS65 and GBS were better than PRS when predicting in-hospital mortality (0.95 vs 0.88 vs 0.83). However, the three scoring systems were similar in the prediction of the need for blood transfusion (0.74 vs 0.77 vs 0.69). They had less predictive values regarding endoscopic intervention (0.59 vs 0.57 vs 0.65) and duration of hospitalization (0.57 vs 0.57 vs 0.65). AIMS65 less than or equal to 2 can predict low-risk patients with sensitivity of 100% but with low specificity of 31%. AIMS65 score less than or equal to 2 with hemoglobin greater than 8 g/dl and no history of Chronic Liver Disease was able to detect the low-risk patients with specificity of 82% and 100% sensitivity. Conclusion Among Egyptian patients with UGIB, AIMS65 is comparable to GBS and better than pre-endoscopic Rockall score in detecting in-hospital mortality. The three scoring systems are similar in detecting the need for blood transfusion but they had less predictive values regarding endoscopic intervention and duration of hospitalization. In addition, AIMS65 score less than or equal to 2 with hemoglobin greater than 8 g/dl and no history of CLD can detect the low-risk patients who can be managed as outpatient and do endoscopy in scheduled time with specificity of 82% and 100% sensitivity. This finding needs more studies on a large number of patients to validate our assumption.

Prediction of adverse outcomes using non-endoscopic scoring systems in patients over 80 years of age who present with the upper gastrointestinal bleeding in the emergency department.

The emergency department (ED) admission rate for elderly patients with non-variceal upper gastrointestinal bleeding (UGIB) is increasing. The AIMS65 and Glasgow-Blatchford score (GBS) are two distinct scoring systems proposed to predict in-hospital and post-discharge mortality, length of stay (LOS), and health-related costs in these patients. The objective of the present study is to evaluate the accuracy of these scoring systems, in conjunction with the Charlson comorbidity index (CCI), to predict 30-day mortality and LOS in UGIB patients who are 80 years of age or older METHODS: A retrospective analysis was undertaken of 182 patients with non-variceal UGIB who were admitted to the ED of Canakkale Onsekiz Mart University Hospital. The AIMS65, GBS, and CCI scores were calculated and adverse patient outcomes were assessed. The mean age of patients was 85.59±4.33 years, and 90 (49.5%) of the patients were males. The AIMS65 was superior to the GBS (area under the receiver operating characteristic curve [AUROC] 0.877 vs. 0.695, respectively) and CCI (AUROC 0.877 vs. 0.526, respectively) in predicting the 30-day mortality. All three scores performed poorly in predicting the LOS in hospital. The cutoff threshold that maximized sensitivity and specificity for mortality was three for the AIMS65 score (sensitivity, 0.87; specificity, 0.80; negative predictive values [NPV], 0.977; positive predictive values [PPV], 0.392), 14 for GBS (sensitivity, 0.83; specificity, 0.51; NPV, 0.923; PPV, 0.367), and 5 for CCI (sensitivity, 0.91; specificity, 0.22; NPV, 0.946; PPV, 0.145). The AIMS65 is a simple, accurate, and non-endoscopic scoring system that can be performed easily in ED settings. It is superior to GBS and CCI in predicting 30-day mortality in elderly patients with UGIB.