Full Rockall Score Research Articles

Comparative analysis of four upper gastrointestinal bleeding scoring systems for predicting multiple outcomes: an observational study in the emergency department

Objective: Numerous scoring systems have been developed to assess the risk associated with upper gastrointestinal bleeding (UGIB), and several studies have investigated their comparative accuracy in predicting patient outcomes. This study was undertaken to compare four well-known scoring systems, namely the pre-endoscopy Rockall score, full Rockall score, Glasgow-Blatchford Bleeding score (GBS), and AIMS65, with the aim of predicting five distinct outcomes in cases of non-variceal UGIB. Methods: This prospective observational study was conducted focusing on adult patients with UGIB presenting to the emergency department (ED). The primary endpoints of this study included in-hospital mortality, the need for re-endoscopy, the requirements for packed red blood cell (PRBC) transfusion, massive transfusion, and one-month rebleeding. Results: A total number of 320 patients were enrolled, with 44 (13·75%) in-hospital deaths. Based on the area under the curves (AUC), while certain scores outperformed others in specific outcome prediction, the AIMS65 scoring system demonstrated superior predictive capability for both in-hospital mortality (0.91) and massive transfusion (0.71). Regarding PRBC transfusion requirements, both AIMS65 and GBS exhibited similar predictive capacities (AUC=0.67 and 0.68, respectively). In terms of re-endoscopy and one-month rebleeding, the GBS scoring system displayed slightly better performance compared to the other systems (AUC=0.61 and 0.63, respectively). In the composite outcome, all scores had significant associations, and among them, the AIMS-65 score had the highest AUC (0.76). Conclusion: The AIMS65 scoring system was the most reliable tool for predicting in-hospital mortality and, to a lesser extent, massive transfusion requirements, while GBS and AIMS65 could be moderately and cautiously relied on for preparations regarding the need for PRBC transfusion.

Neutrophil-lymphocyte ratio predict outcome of upper gastrointestinal bleeding in emergency.

The neutrophil-lymphocyte ratio (NLR) is a simple marker of systemic inflammatory responses. The present study aims to evaluate the prognostic significance of the NLR on admission day in predicting outcomes for patients with upper gastrointestinal bleeding (UGIB), which is a prevalent medical emergency. 726 patients who were admitted to our clinic between January 2019 and December 2022 diagnosed with UGIB, and who underwent necessary examinations, were included in the study. The patients' Glasgow-Blatchford Score (GBS), Full Rockall Score (FRS), and NLR levels were calculated at the first admission. Outcomes were defined as in-hospital mortality, need for blood transfusion, surgical treatment and endoscopic therapy. Patients were categorized into four groups using NLR quartile levels to compare their clinical characteristics, Glasgow Blatchford Score, Full Rockall Score levels, and prognosis. Secondary, we modified FRS and GBS by adding NLR, respectively. We used area under the receiver operating characteristic curve (AUROC) to assess the accuracy of risk prediction for NLR, NLR-GBS, and NLR-FRS improved models. Of 726 patients, 6% died in hospital, 23.9% received endoscopic interventon, 4.8% received surgical treatment, and 46.4% received transfusion therapy. Multifactorial logistic regression showed that a high level of NLR was a risk factor for death in patients with UGIB (p = 0.028). NLR, GBS, FRS, NLR-GBS, and NLR-FRS have sufficient accuracy in predicting inpatient mortality, endoscopic treatment, and transfusion treatment, and the differences are statistically significant (p < 0.05). In the comprehensive prediction of adverse outcomes, NLR-GBS has the highest AUROC, and in predicting inpatient mortality, NLR-FRS has the highest AUROC. For UGIB patients, a high NLR was strongly associated with high risk UGIB. Combined testing with the GBS and FRS can achieve good predictive results, which is valuable in guiding the pre-screening and triage of emergency nursing care and clinical treatment to ensure that patients receive rapid and effective treatment and improve the quality of care.

AIMS65 Outperforms Other Scoring Systems for Non-Variceal Upper Gastrointestinal Bleeding in Octogenarians: A Prospective Study

Background: The incidence and adverse clinical outcomes of nonvariceal upper gastrointestinal bleeding (NVUGIB) increase significantly with advanced age. Among those over 80 years of age (octogenarians), this risk becomes markedly pronounced. Our study aimed to assess the predictive ability of four recognized scoring systems for clinical outcomes in octogenarians presenting with NVUGIB. Methods: We compared the Clinical Rock all Score (CRS), Full Rockall Score (FRS), Glasgow Blatchford Score (GBS), and AIMS65 scores for their ability to forecast clinical outcomes. These outcomes encompassed: (1) the requirement for endoscopic intervention, (2) recurrence of bleeding, and (3) 30-day mortality. Results: The study sample comprised 107 octogenarians, including 58 males (54.2%), with a median age of 86 (range 82-89). Ten patients (9.3%) experienced recurrent bleeding, while 19 (17.8%) succumbed within 30 days. The AIMS65 score predicted 30-day mortality with an optimal cutoff value of 2.5, demonstrating 63% sensitivity and 86% specificity. In patients categorized as high-risk by the AIMS65 criteria, a cutoff value of 2 predicted 30-day mortality with 75% sensitivity and 68% specificity. Conclusions: The easily calculable pre-endoscopic AIMS65 score proves beneficial for predicting mortality among octogenarians with NVUGIB, thereby assisting clinical decision-making processes.

EARLY PREDICTORS OF OUTCOME IN BLEEDING OESPHAGEAL AND/OR GASTRIC VARICES IN THE EMERGENCY DEPARTMENT

Backgorund and Objective: Acute upper GIT bleeding is a life threatening emergency. Many scoring systems have been developed to evaluate patients with acute UGIB. The purpose of this study was to confirm value of Modified Blatchford scoring system, Full rockall score , AIM65 score &amp;lactate level as a predictor of outcome as regard patient’s mortality, their need for ICU, duration of hospitalization and need for endoscopic intervention in the emergency department. Patients an Methods: This study was performed on 100 patients who presented to the emergency department with acute UGIB in Alexandria main university hospital. All the study scores (GBS, AIMS65, PRS, and FRS) were able to predict the clinical outcomes in the UGIB patients. Results: GBS was the best performing risk score among the four scores for predicting all the clinical outcomes except the prediction of endoscopic intervention. Lactate was a sensitive predictor for ICU admission, hospital stay, rebleeding and mortality during first 48 hrs of admission in patients presenting with UGIB.

Prediction of in-hospital mortality after acute upper gastrointestinal bleeding: cross-validation of several risk scoring systems.

ObjectiveWe aimed to identify the clinical, biochemical, and endoscopic features associated with in-hospital mortality after acute upper gastrointestinal bleeding (AUGIB), focusing on cross-validation of the Glasgow-Blatchford score (GBS), full Rockall score (RS), and Cedars-Sinai Medical Center Predictive Index (CSMCPI) scoring systems.MethodsOur prospective cross-sectional study included 156 patients with AUGIB. Several statistical approaches were used to assess the predictive accuracy of the scoring systems.ResultsAll three scoring systems were able to accurately predict in-hospital mortality (area under the receiver operating characteristic curve [AUC] > 0.9); however, the multiple logistic model separated the presence of hemodynamic instability (state of shock) and the CSMCPI as the only significant predictive risk factors. In compliance with the overall results, the CSMCPI was consistently found to be superior to the other two systems (highest AUC, highest sensitivity and specificity, highest positive and negative predictive values, highest positive likelihood ratio, lowest negative likelihood ratio, and 1-unit increase in CSMCPI associated with 6.3 times higher odds of mortality), outperforming the GBS and full RS.ConclusionsWe suggest consideration of the CSMCPI as a readily available and reliable tool for accurately predicting in-hospital mortality after AUGIB, thus providing an essential backbone in clinical decision-making.

Re-bleed and Mortality Amongst Patients Following Initial Endoscopy for Upper Gastrointestinal Bleeding: A Single-Center Nigeria Study.

Background and aimClinical and endoscopic parameters are predictive of patient outcome following acute upper gastrointestinal bleeding. The study aimed to investigate factors related to re-bleed and mortality following initial endoscopy among Nigerian patients with recent upper gastrointestinal bleeding (UGIB).MethodsThis is a cohort study of patients undergoing endoscopy for recent-onset UGIB at a referral endoscopy facility in Port Harcourt, Rivers State, Nigeria, from April 2014 to November 2020. Patients’ demographic and clinical data, American Society of Anesthesiologists (ASA) physical status, amount of blood transfusion, endoscopy results, and Rockall scores were retrieved from patients’ charts. The re-bleed and mortality rates were noted on follow-up by telephone. Statistical analysis was performed using SPSS version 20 (IMB Inc., Armonk, USA).ResultsA total of 560 patients had flexible video oesophagogastroduodenoscopy during the study period, and 46 (8.2%) of these were included in the study. Their age ranged from 28 years to 84 years (mean 58.6 ± 15.8 years) with 32 (69.6%) males and 14 (30.4%) females. Peptic ulcer disease (PUD) and gastritis/gastric erosions were the leading endoscopic diagnoses in 24 (52.2%) and 12 (26.1%) patients, respectively. Multiple comorbidities (p=0.021) and higher ASA score (mean 3.0; 95% confidence interval CI: 2.47-3.53; p=0.021) are associated with re-bleed, which was recorded in seven (15.2%) patients. Four (8.7%) cases of mortality were recorded in patients with a mean full Rockall score of 4.25 (95% CI: 1.52-6.97; p=0.021).ConclusionRe-bleed is more common in patients with multiple comorbidities, ASA score of three or more, and bleeding gastro-oesophageal varices at initial endoscopy. Mortality was significantly higher in patients with a full Rockall score of more than three.

Predicting The Mortality And Need Of Icu Admission By Using Various Scoring System In Patient Present With Hematemesis In Emergency Department.

BACKGROUNG: An overall annual incidence of acute upper gastrointestinal haemorrhage has been estimated to be 40-150 per 1,00,000 populations (1,2), leads to annual hospital admission rate of approximately 100 per 1,00,000 hospital admissions, and has significant associated morbidity and mortality, especially in the elderly. Gastrointestinal bleeding, which is most commonly arises from mucosal erosive disease accounts for up to 20,000 deaths annually. Various risk scoring systems have been recently developed to predict clinical Outcomes and need of ICU admission in patients with upper gastrointestinal bleeding (UGIB) or hematemesis. The two commonly used scoring systems include full Rockall score (RS) and the Glasgow Blatchford score (GBS). MATERIAL AND METHOD: An observational, study was conducted on 50 patients with obvious symptoms of UGIB in the emergency department of SVPIMSR, Ahmedabad. full Rockall score (RS) and the Glasgow-Blatchford score (GBS)were calculated. Data was collected from hospital iHiS system and analysed in epi info (version 7.3.2.1) CDC software. P <0.05 was considered statistically significant. RESULTS: A total of 50 patients with UGIB were included in the study of which 72% were male and 28% were female. The mean age of patients was 47.36±16.69 years. It was found that majority of patients (44%) were in the age group of 40-60 years. Mean frequency of hematemesis was significantly higher in non-survival patient in comparison with survival ones (3.1±1.1 versus 1.85±0.62, p=0.0004). In mortality prediction full Rockall score is better than GBS (p value 0.0769 versus 0.9612). Full RS system seems to be better than GBS in predicting mortality and need for ICU admission in patients presented with hematemesis.

AIMS65 predicts prognosis of patients with duodenal ulcer bleeding; a comparison with other risk-scoring systems.

Duodenal ulcer bleeding has a higher risk of mortality than bleeding from other portions of the gastrointestinal tract. AIMS65 is an effective risk-scoring system to predict prognosis of upper gastrointestinal bleeding and can be easily calculated without endoscopic findings. In this study, we investigate the usefulness of AIMS65 to predict prognosis of patients with duodenal ulcer bleeding. Two hundred and fifty-five patients with endoscopically diagnosed duodenal ulcer bleeding at Kurashiki Central hospital from July 2007 to June 2017 were studied. We compared AIMS65, Glasgow Blatchford score (GBS), admission Rockall, and full Rockall scoring systems for predicting in-hospital mortality by calculating area under the receiver operating characteristic curve (AUROC). In-hospital mortality due to duodenal ulcer bleeding occurred in 17 (6.7%). Scores of all scoring systems were significantly higher in patients with in-hospital mortality than in patients without it. AUROC values for predicting in-hospital mortality was 0.83 in AIMS65, 0.74 in GBS, 0.76 in admission Rockall score, and 0.82 in full Rockall score, a statistically insignificant difference among the systems. In AIMS65, score more than or equal to 2 was an optimal value to predict in-hospital mortality, with sensitivities of 88.2% and specificities of 59.7%, respectively. AIMS65 predicted in-hospital mortality of patients with duodenal ulcer bleeding as accurately as did other scoring systems. Given its simplicity of calculation, AIMS65 may be a more clinically practical system in the management of bleeding duodenal ulcer patients.

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

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)

Comparison of the performance of risk scoring systems for tumor bleeding in patients with inoperable gastric cancer.

The Glasgow - Blatchford bleeding score (GBS) and admission and full Rockall scores are widely used risk scoring systems to stratify risk and determine the need for intervention in patients with upper gastrointestinal bleeding. We evaluated the performance of these risk scoring systems in patients with gastric cancer and tumor bleeding. This retrospective study included patients with inoperable gastric cancer who presented with tumor bleeding at the National Cancer Center, Korea, between 2001 and 2015. The GBS, and admission and full Rockall scores were calculated. Primary outcome was the performance of the risk scoring systems in predicting the need for urgent interventions (endoscopic therapy, transarterial embolization, and surgery). The risk factors associated with urgent intervention were analyzed. Of 357 patients with tumor bleeding, 118 (33.1 %; 116 endoscopic therapy, 2 trans-arterial embolization) required urgent intervention. The full Rockall score was better at predicting the need for urgent intervention (area under the receiver operating characteristic curve = 0.78; P < 0.001) than the GBS (0.56) and admission Rockall score (0.56). Hemostatic intervention was not performed in patients with a full Rockall score ≤ 6 (103 patients, 28.9 %). On multivariate analysis, endoscopic stigmata of recent hemorrhage of Forrest classes Ia - IIb were significant factors associated with urgent intervention. The full Rockall score was superior to the GBS and admission Rockall score in predicting the need for urgent intervention for tumor bleeding. Thus, endoscopic evaluation is required to determine the need for urgent intervention in patients with gastric cancer and tumor bleeding.

Comparison of various prognostic scores in variceal and non-variceal upper gastrointestinal bleeding: A prospective cohort study.

Various prognostic scores like Glasgow-Blatchford bleeding score (GBS), modified Glasgow-Blatchford bleeding score (mGBS), full Rockall score (FRS) including endoscopic findings, clinical Rockall score (CRS), and albumin, international normalized ratio (INR), mental status, systolic blood pressure, age >65 (AIMS65) are used for risk stratification in patients with upper gastrointestinal bleeding (UGIB). The utility of these scores in variceal UGIB (VUGIB) is not well defined. In this prospective study, we aimed to assess the performance of these scores in patients with non-variceal (NVUGIB) and VUGIB. We included 1011 patients (during March 2017 and August 2018) including 439 with NVUGIB and 572 VUGIB. Performance of GBS, mGBS, FRS, CRS, and AIMS65 for various outcome measures was analyzed using the area under receiver operator characteristic curve (AUROC). The accuracy of prognostic scores in predicting the composite outcome including the need of hospital-based intervention and 42-day mortality was higher in NVUGIB as compared with VUGIB, AUROC: CRS: 0.641 vs. 0.537; FRS: 0.669 vs. 0.625; GBS: 0.719 vs. 0.587; mGBS: 0.711 vs. 0.594; AIMS65: 0.567 vs. 0.548. GBS and mGBS at a cut-off score of 1 had the highest negative predictive value, 91.7% and 91.3%, respectively, for predicting composite outcome in NVUGIB. Similarly, these scores had better accuracy for predicting 42-day rebleeding in NVUGIB as compared to VUGIB, AUROC: CRS: 0.680 vs. 0.537; FRS: 0.698 vs. 0.565; GBS: 0.661 vs. 0.543; mGBS: 0.627 vs. 0.540; AIMS65: 0.695 vs. 0.606. The prognostic scores such as CRS, FRS, GBS, mGBS, and AIMS65 predict the need for hospital-based management, rebleeding, and mortality better among patients with NVUGIB than VUGIB.

The prognostic significance of the risk scores at upper gastrointestinal bleeding.

Upper gastrointestinal system (GIS) bleeding is one of the most common causes of mortality and morbidity. The predictive values of pre-endoscopic Rockall score (PERS), full Rockall score (FRS), Glasgow-Blatchford score (GBS), pre-endoscopic Baylor score (PEBS), and full Baylor score (FBS) to predict bleeding at follow-up, endoscopic therapy, blood transfusion requirement, and death are investigated in our study. This study was retrospectively conducted in patients admitted to emergency department with upper GIS bleeding. Demographic and clinical characteristics of the patients were recorded. The relationships of the aforementioned scores with in-hospital termination, bleeding at follow-up, endoscopic therapy, blood transfusion requirement, and death were explored. The study included a total of 420 subjects, of which 269 (64%) were men. All scoring systems were able to predict transfusion need and GBS was superior to other scores (P < 0.0001). In terms of endoscopic treatment, it was determined that only PERS, FRS, and FBS were statistically significant in predicting ability and PERS >3, FRS >5 and FBS >10 patients needed endoscopic treatment. All scoring systems were able to predict rebleeding. In comparison of two groups for rebleeding, it was found that PEBS was better able to predict bleeding during follow-up than both FRS and FBS, and PERS was better able to predict bleeding during follow-up than both FRS and FBS. All scoring systems were able to predict mortality. FRS and PERS scores had a greater discriminatory power for predicting death than the rest of the scores (P < 0.001). All scoring systems were effective for predicting need for blood transfusion, rebleeding, and death. GBS had more predictive power for transfusion need, PERS and PEBS for rebleeding, and FRS for mortality. PERS, FRS, and FBS were found to be effective in predicting endoscopic treatment.

Clinical Outcomes of Patients with Non-ulcer and Non-variceal Upper Gastrointestinal Bleeding: A Prospective Multicenter Study of Risk Prediction Using a Scoring System.

Compared with ulcer bleeding (UB) in non-variceal upper gastrointestinal bleeding (NVUGIB), non-ulcer bleeding (NUB) is often considered to have a low risk of poor outcomes and is treated less intensively without any risk stratification. We conducted this study to assess the predictability of scoring systems for NUB and compare the outcomes of NUB and UB. A total of 1831 UGIB patients were registered in the database during the period from February 2011 to December 2013. Among them, 1424 patients with NVUGIB were divided into two groups: Group UB (1101 patients with peptic ulcer bleeding) and Group NUB (323 patients with non-peptic ulcer-related bleeding). The most common cause of bleeding in Group NUB was Mallory-Weiss tears (51.1%), followed by Dieulafoy lesions (18.9%). A receiver operating characteristic (ROC) analysis revealed that the pre-Rockall score [area under the ROC (AUROC) = 0.798; 95% CI 0.707-0.890] and full Rockall score (AUROC = 0.794; 95% CI 0.693-0.895) were relatively good at predicting overall mortality in NUB. Glasgow-Blatchford score (AUROC = 0.783; 95% CI 0.730-0.836) was the most closely correlated with the need for clinical intervention in NUB. Those who had Glasgow-Blatchford score of 0 did not require any interventions, including blood transfusions. There were no statistical differences in overall mortality (p = 0.387), bleeding-related mortality (p = 0.447), or the incidence of re-bleeding (p = 0.117) between the two groups. Scoring systems are useful to predict mortality and the need for clinical intervention in patients with NUB.

Different scoring systems to predict 6-week mortality in cirrhosis patients with acute variceal bleeding: a retrospective analysis of 202 patients

Objective: Determine the optimal scoring system for evaluation of 6-week bleeding-related mortality in liver cirrhosis patients with acute variceal bleeding (AVB). Prediction effects of six scoring systems, AIMS65 score, Glasgow-Blatchford (GBS) score, full Rockall (FRS) score, the model for end-stage liver disease (MELD), the MELD-Na model and the Child-Turcotte-Pugh (CTP) score were analyzed in this study.Methods: A total of 202 liver cirrhosis patients with AVB were enrolled between 1 January 2014, and 31 December 2014. All subjects were scored according to AIMS65, GBS, FRS, MELD, MELD-Na and CTP scoring systems on the first day of admission. The primary endpoint of the study was 6-week mortality. The prediction effect of these scoring systems for 6-week mortality was compared by ROC curve and the area under the curve (AUC).Results: The scores of nonsurvival group evaluated by the AIMS65, GBS, FRS, MELD, MELD-Na and CTP (2.6 ± 1.1, 12.9 ± 2.7, 6.6 ± 1.8, 26.9 ± 6.5, 31.6 ± 9.3, 9.6 ± 2.2, respectively) were higher than those of the survival group (1.2 ± 1.1, 10.2 ± 3.4, 5.1 ± 1.6, 21.0 ± 6.4, 22.8 ± 8.2, 7.7 ± 2.0, respectively) (p < .01). The values of AUC and Youden index of AIMS65 and MELD-Na scoring systems [(0.808, 0.453) and (0.781, 0.516), respectively] were superior to those of MELD (0.761, 0.454), CTP (0.748, 0.399), FRS (0.738, 0.358) and GBS scoring systems (0.726, 0.370).Conclusions: AIMS65 and MELD-Na scoring systems are recommended for evaluation of 6-week bleeding-related mortality in liver cirrhosis patients with AVB.

Previous Use of Antithrombotic Agents Reduces Mortality and Length of Hospital Stay in Patients With High-risk Upper Gastrointestinal Bleeding

Anti-thrombotic agents are risk factors for upper gastrointestinal bleeding (UGIB). However, few studies have evaluated their effects on patient outcomes. We assessed the effects of anti-thrombotic agents on outcomes of patients with high-risk UGIB. We performed a prospective study of 619 patients with acute UGIB (defined by hematemesis, coffee-ground vomit or melena) who required intervention and underwent endoscopy at 8centers in North America, Asia, and Europe, from March 2014 through March 2015. We collected data recorded on use of anti-thrombotic agents, clinical features, and laboratory test results to calculate AIMS65, Glasgow-Blatchford Score, and full Rockall scores. We also collected and analyzed data on co-morbidities, endoscopic findings, blood transfusion, interventional radiology results, surgeries, length of hospital stay, rebleeding, and mortality. Of the 619 patients who required endoscopic therapy, data on use of anti-thrombotic agents was available for 568; 253 of these patients (44%) used anti-thrombotic agents. Compared to patients not taking anti-thrombotic agents, patients treated with anti-thrombotics were older(P < .001), had a higher mean American Society of Anesthesiologists classification score (P< .0001), had a higher mean Rockall score (P < .0001), a higher mean AIMS65 score (P<.0001), and more frequently bled from ulcers (P < .001). There were no differences between groups in sex, systolic blood pressure, level of hemoglobin at hospital admission, frequency of malignancies, Glasgow-Blatchford Score, need for surgery or interventional radiology, number of rebleeding events, or requirement for transfusion. All-cause mortality was lower in patients who took anti-thrombotic drugs (11 deaths, 4%) than in patients who did not (37 deaths, 12%) (P=.002); this was due to lower bleeding-related mortality in patients taking anti-thrombotic drugs (3 deaths, 1%) than in patients who were not (19 deaths, 6%) (P= .003). Patients taking anti-thrombotic drugs had mean hospital stays of 6.9 days (95% CI, 2-23 days) compared to 7.9 days for non-users of anti-thrombotic agents (95% CI, 2-26 days) (P= .04). Despite being older, with higher American Society of Anesthesiologists classification, AIMS65, and Rockall scores, patients who have UGIB that requires endoscopic therapy and take anti-thrombotic drugs have lower mortality due to GI bleeding and shorter hospital stays, with similar rates of rebleeding, surgery, and transfusions, compared with those not taking anti-thrombotic drugs.

Application of four scoring systems on evaluation of the prognosis of acute nonvariceal upper gastrointestinal bleeding

Objective To evaluate the predictive value of Admission-Rockall Score (aRS), Full-Rockall Score (fRS), Glasgow-Blatchford Score (GBS) and AIMS65 scoring systems for rebleeding, mortality, transfusion and clinical intervention of patients with acute nonvariceal upper gastrointestinal bleeding (ANVUGIB). Methods A retrospective study was performed on the data of 294 ANVUGIB inpatients in the Department of Gastroenterology of Tianjin Medical University General Hospital from January 2015 to September 2016. Each patient was graded using the four scoring systems. The area under the receiver-operating characteristic curve (AUC) about rebleeding, mortality, blood transfusion and clinical intervention was calculated using each system. Results For predicting rebleeding, fRS (AUC=0.696) and GBS (AUC=0.697) were both superior to aRS (AUC=0.609, P 0.05). For predicting mortality, the AUC of aRS, fRS, GBS and AIMS65 were 0.755, 0.791, 0.818, and 0.780, respectively, and there were no significant differences (P>0.05). There were no significant differences in the predicting transfusion among four scoring systems, and the AUC was 0.625, 0.626, 0.697 and 0.658, respectively. Regarding clinical intervention treatment, fRS (AUC=0.661) was superior than that of aRS (AUC=0.520, P 0.05). Conclusion The four scoring systems are all with good predicting value on mortality of patients with ANVUGIB, while not on other aspects including rebleeding, transfusion and clinical intervention. fRS has a slightly better value on prediction of rebleeding and clinical intervention, and GBS is slightly better on prediction of rebleeding. Key words: Prognosis; Acute nonvariceal upper gastrointestinal bleeding; Scoring system

Utility of the Shock Index for Risk Stratification in Patients with Acute Upper Gastrointestinal Bleeding.

Patients with upper gastrointestinal bleeding (UGIB) frequently require hospitalization, and a small but significant percentage of these patients have adverse outcomes. Risk-scoring tools can help clinicians organize care and make predictions about outcomes. The shock index (heart rate divided by systolic blood pressure) has been used in multiple acute disorders and has the potential to identify patients with UGIB who are at risk for adverse outcomes. We retrospectively reviewed the electronic medical records of patients admitted with UGIB between January 1, 2012 and December 31, 2015. We collected information about patient demographics, presenting symptoms, underlying clinical disorders, endoscopic results, and outcomes. We calculated risk scores using the Glasgow-Blatchford score, the pre-endoscopy Rockall score, the full Rockall score, the AIMS65 (albumin, international normalized ratio, mental status, systolic blood pressure, age older than 65 years) score, and the shock index. This study included 214 admissions for acute UGIB. The mean age was 59.0 ± 15.9 years, 64.5% were men, the mean hemoglobin was 9.2 ± 3.1 g/dL, and the mean shock index was 0.78 ± 0.21 bpm/mm Hg. The mean shock index was significantly increased in patients requiring endoscopic therapy, admission to the intensive care unit, blood component transfusion, and red blood cell transfusion. Classification of patients by a shock index >0.7 preferentially selected patients with these adverse short-term outcomes. Among the scoring tools evaluated in this study, the shock index was the best predictor of the need for endoscopic therapy. The shock index is a good tool to identify patients with the potential for short-term adverse outcomes when they present with UGIB. It performs as well as other risk-scoring tools for GI bleeding and has the potential for serial use during hospitalization to identify changes in the clinical course.

Comparison of risk scoring systems for patients presenting with upper gastrointestinal bleeding: international multicentre prospective study

Objective To compare the predictive accuracy and clinical utility of five risk scoring systems in the assessment of patients with upper gastrointestinal bleeding.Design International multicentre prospective study.Setting Six large hospitals...

Comparison of Glasgow-Blatchford score and full Rockall score systems to predict clinical outcomes in patients with upper gastrointestinal bleeding.

BackgroundVarious risk scoring systems have been recently developed to predict clinical outcomes in patients with upper gastrointestinal bleeding (UGIB). The two commonly used scoring systems include full Rockall score (RS) and the Glasgow-Blatchford score (GBS). Bleeding scores were assessed in terms of prediction of clinical outcomes in patients with UGIB.Patients and methodsTwo hundred patients (age >18 years) with obvious symptoms of UGIB in the emergency department of Rasoul Akram Hospital were enrolled. Full RS and GBS were calculated. We followed the patients for records of rebleeding and 1-month mortality. A receiver operating characteristic curve by using areas under the curve (AUCs) was used to statistically identify the best cutoff point.ResultsEighteen patients were excluded from the study due to failure to follow-up. Rebleeding and mortality rate were 9.34% (n=17) and 11.53% (n=21), respectively. Regarding 1-month mortality, full RS was better than GBS (AUC, 0.648 versus 0.582; P=0.021). GBS was more accurate in terms of detecting transfusion need (AUC, 0.757 versus 0.528; P=0.001), rebleeding rate (AUC, 0.722 versus 0.520; P=0.002), intensive care unit admission rate (AUC, 0.648 versus 0.582; P=0.021), and endoscopic intervention rate (AUC, 0.771 versus 0.650; P<0.001).ConclusionWe found the full RS system is better for 1-month mortality prediction while GBS system is better for prediction of other outcomes.

OC-036 International Assessment of Outcome of Upper GI Haemorrhage at Weekends: Abstract OC-036 Table 1

Introduction Weekend admissions have been associated with higher mortality. For upper gastrointestinal haemorrhage (UGIH) some studies show significantly increased mortality and less early endoscopy while the UK UGIH audit reported no difference. We studied whether out of hours (OOH) admissions were sicker and/or had higher mortality. Methods Prospective study over 12 months (from March 2014) from 2 UK and 2 international centres. Admission time, demographics, pulse, BP, lab results, endoscopy findings, further procedures and 30 d mortality were recorded. 3 pre-endoscopy scores (Glasgow Blatchford (GBS), AIMS65 and admission Rockall scores) and 2 post-endoscopy scores (PNED and full Rockall scores) were determined. Chi-squared, Fisher’s exact and Kruskal-Wallis tests were used as appropriate. A two-tailed significance level of 5% was used. Results 2118 pconsecutive atients, 60% male, median age 66 years were seen. There were no significant differences in mortality, need for endoscopic therapy, surgery/embolisation or rebleeding in both UK and non-UK centres. There were no differences in comorbidity, mean ASA 2.3, pulse or BP although weekday admissions had a lower Hb (110 g/l vs 118 g/l (weeknight) vs 117 g/l (weekend) p 2118 consecutive patients admitted March 2014-March 2015 from Glasgow (600), Truro (544), Odense (541) and Singapore (433). Data shown are mean [95% CI] or number (%). Conclusion There is no difference in mortality in patients admitted with UGIH OOH compared to weekday admissions. The severity of UGIH was not related to time of admission. Similar findings were noted in the 2 UK centres and internationally. Disclosure of Interest None Declared