Glasgow Blatchford Score Score Research Articles

Validation of an Electronic Health Record-Based Machine Learning Model Compared to Clinical Risk Scores for Gastrointestinal Bleeding

Background & AimsGuidelines recommend use of risk stratification scores for patients presenting with gastrointestinal bleeding (GIB) to identify very-low-risk patients eligible for discharge from emergency departments. Machine learning models may outperform existing scores and can be integrated within the electronic health record (EHR) to provide real-time risk assessment without manual data entry. We present the first EHR-based machine learning model for GIB. MethodsThe training cohort comprised 2,546 patients and internal validation of 850 patients presenting with overt GIB (hematemesis, melena, hematochezia) to emergency departments of 2 hospitals from 2014-2019. External validation was performed on 926 patients presenting to a different hospital with the same EHR from 2014-2019. The primary outcome was a composite of red-blood-cell transfusion, hemostatic intervention (endoscopic, interventional radiologic, or surgical), and 30-day all-cause mortality. We used structured data fields in the EHR available within 4 hours of presentation and compared performance of machine learning models to current guideline-recommended risk scores, Glasgow-Blatchford Score (GBS) and Oakland Score. Primary analysis was area under the receiver-operating-characteristic curve (AUC). Secondary analysis was specificity at 99% sensitivity to assess proportion of patients correctly identified as very-low-risk. ResultsThe machine learning model outperformed the GBS (AUC=0.92 vs. 0.89;p<0.001) and Oakland score (AUC=0.92 vs. 0.89;p<0.001). At the very-low-risk threshold of 99% sensitivity, the machine learning model identified more very-low-risk patients: 37.9% vs. 18.5% for GBS and 11.7% for Oakland score (p<0.001 for both comparisons). ConclusionsAn EHR-based machine learning model performs better than currently recommended clinical risk scores and identifies more very-low-risk patients eligible for discharge from the emergency department.

Diagnostic value of liver stiffness measurement combined with risk scores for esophagogastric variceal bleeding in patients with hepatitis B cirrhosis

PurposeTo assess the predictive value of liver stiffness measurement (LSM) and three bleeding risk scoring systems for esophagogastric varices bleeding (EGVB) in patients with hepatitis B cirrhosis during hospitalization. MethodsIn this study, 210 patients who had hepatitis B cirrhosis were selected as the subjects. They were categorized into two groups based on whether EGVB occurred during hospitalization: a bleeding group (70 cases) and a non-bleeding group (140 cases). Logistic regression was used to analyze the factors related to the occurrence of EGVB, and the diagnostic performance was evaluated using a receiver operating characteristic (ROC) curve. ResultsSignificant differences were observed between the two groups in systolic blood pressure, platelet count, albumin, urea nitrogen, LSM, pre-endoscopic Rockall score (PRS), Glasgow-Blatchford score (GBS), and AIMS65 score (P < 0.05). The correlation analysis showed that LSM had significant positive relationship with PRS, GBS and AIMS65 score. Logistic regression analysis revealed that LSM and GBS score were independent risk factors for EGVB occurrence during hospitalization. ROC curve analysis showed that the combined prediction model of LSM and GBS score had the best prediction performance for EGVB occurrence, with an ROC curve area of 0.811, which was significantly better than the three risk scoring systems (P < 0.05), but similar to the predicted value of LSM (P = 0.335). ConclusionsThe combination of LSM and GBS score can significantly improve the predictive efficacy of EGVB occurrence in patients with hepatitis B cirrhosis during hospitalization, which has important clinical significance for patients' prognosis.

Pre-Endoscopic Scores Predicting Low-Risk Patients with Upper Gastrointestinal Bleeding: A Systematic Review and Meta-Analysis.

Several risk scores have attempted to risk stratify patients with acute upper gastrointestinal bleeding (UGIB) who are at a lower risk of requiring hospital-based interventions or negative outcomes including death. This systematic review and meta-analysis aimed to compare predictive abilities of pre-endoscopic scores in prognosticating the absence of adverse events in patients with UGIB. We searched MEDLINE, EMBASE, Central, and ISI Web of knowledge from inception to February 2023. All fully published studies assessing a pre-endoscopic score in patients with UGIB were included. The primary outcome was a composite score for the need of a hospital-based intervention (endoscopic therapy, surgery, angiography, or blood transfusion). Secondary outcomes included: mortality, rebleeding, or the individual endpoints of the composite outcome. Both proportional and comparative analyses were performed. Thirty-eight studies were included from 2153 citations, (n = 36,215 patients). Few patients with a low Glasgow-Blatchford score (GBS) cutoff (0, ≤1 and ≤2) required hospital-based interventions (0.02 (0.01, 0.05), 0.04 (0.02, 0.09) and 0.03 (0.02, 0.07), respectively). The proportions of patients with clinical Rockall (CRS = 0) and ABC (≤3) scores requiring hospital-based intervention were 0.19 (0.15, 0.24) and 0.69 (0.62, 0.75), respectively. GBS (cutoffs 0, ≤1 and ≤2), CRS (cutoffs 0, ≤1 and ≤2), AIMS65 (cutoffs 0 and ≤1) and ABC (cutoffs ≤1 and ≤3) scores all were associated with few patients (0.01-0.04) dying. The proportion of patients suffering other secondary outcomes varied between scoring systems but, in general, was lowest for the GBS. GBS (using cutoffs 0, ≤1 and ≤2) showed excellent discriminative ability in predicting the need for hospital-based interventions (OR 0.02, (0.00, 0.16), 0.00 (0.00, 0.02) and 0.01 (0.00, 0.01), respectively). A CRS cutoff of 0 was less discriminative. For the other secondary outcomes, discriminative abilities varied between scores but, in general, the GBS (using cutoffs up to 2) was clinically useful for most outcomes. A GBS cut-off of one or less prognosticated low-risk patients the best. Expanding the GBS cut-off to 2 maintains prognostic accuracy while allowing more patients to be managed safely as outpatients. The evidence is limited by the number, homogeneity, quality, and generalizability of available data and subjectivity of deciding on clinical impact. Additional, comparative and, ideally, interventional studies are needed.

Age, blood tests and comorbidities and AIMS65 risk scores outperform Glasgow-Blatchford and pre-endoscopic Rockall score in patients with upper gastrointestinal bleeding.

Upper gastrointestinal (GI) bleeding is a life-threatening condition with high mortality rates. To compare the performance of pre-endoscopic risk scores in predicting the following primary outcomes: In-hospital mortality, intervention (endoscopic or surgical) and length of admission (≥ 7 d). We performed a retrospective analysis of 363 patients presenting with upper GI bleeding from December 2020 to January 2021. We calculated and compared the area under the receiver operating characteristics curves (AUROCs) of Glasgow-Blatchford score (GBS), pre-endoscopic Rockall score (PERS), albumin, international normalized ratio, altered mental status, systolic blood pressure, age older than 65 (AIMS65) and age, blood tests and comorbidities (ABC), including their optimal cut-off in variceal and non-variceal upper GI bleeding cohorts. We subsequently analyzed through a logistic binary regression model, if addition of lactate increased the score performance. All scores had discriminative ability in predicting in-hospital mortality irrespective of study group. AIMS65 score had the best performance in the variceal bleeding group (AUROC = 0.772; P < 0.001), and ABC score (AUROC = 0.775; P < 0.001) in the non-variceal bleeding group. However, ABC score, at a cut-off value of 5.5, was the best predictor (AUROC = 0.770, P = 0.001) of in-hospital mortality in both populations. PERS score was a good predictor for endoscopic treatment (AUC = 0.604; P = 0.046) in the variceal population, while GBS score, (AUROC = 0.722; P = 0.024), outperformed the other scores in predicting surgical intervention. Addition of lactate to AIMS65 score, increases by 5-fold the probability of in-hospital mortality (P < 0.05) and by 12-fold if added to GBS score (P < 0.003). No score proved to be a good predictor for length of admission. ABC score is the most accurate in predicting in-hospital mortality in both mixed and non-variceal bleeding population. PERS and GBS should be used to determine need for endoscopic and surgical intervention, respectively. Lactate can be used as an additional tool to risk scores for predicting in-hospital mortality.

External validation of Glasgow-Blatchford, modified Glasgow-Blatchford and CANUKA scores to identify low-risk patients with upper gastrointestinal bleeding in emergency departments: a retrospective cohort study

BackgroundUpper gastrointestinal bleeding (UGIB) is a medical emergency with an approximate mortality of 10%, which results in a high hospitalisation rate. The Glasgow-Blatchford score (GBS) is recommended to identify low-risk...

A Novel Prediction Tool for Endoscopic Intervention in Patients with Acute Upper Gastro-Intestinal Bleeding.

(1) Background: Predicting which patients with upper gastro-intestinal bleeding (UGIB) will receive intervention during urgent endoscopy can allow for better triaging and resource utilization but remains sub-optimal. Using machine learning modelling we aimed to devise an improved endoscopic intervention predicting tool. (2) Methods: A retrospective cohort study of adult patients diagnosed with UGIB between 2012–2018 who underwent esophagogastroduodenoscopy (EGD) during hospitalization. We assessed the correlation between various parameters with endoscopic intervention and examined the prediction performance of the Glasgow-Blatchford score (GBS) and the pre-endoscopic Rockall score for endoscopic intervention. We also trained and tested a new machine learning-based model for the prediction of endoscopic intervention. (3) Results: A total of 883 patients were included. Risk factors for endoscopic intervention included cirrhosis (9.0% vs. 3.8%, p = 0.01), syncope at presentation (19.3% vs. 5.4%, p < 0.01), early EGD (6.8 h vs. 17.0 h, p < 0.01), pre-endoscopic administration of tranexamic acid (TXA) (43.4% vs. 31.0%, p < 0.01) and erythromycin (17.2% vs. 5.6%, p < 0.01). Higher GBS (11 vs. 9, p < 0.01) and pre-endoscopy Rockall score (4.7 vs. 4.1, p < 0.01) were significantly associated with endoscopic intervention; however, the predictive performance of the scores was low (AUC of 0.54, and 0.56, respectively). A combined machine learning-developed model demonstrated improved predictive ability (AUC 0.68) using parameters not included in standard GBS. (4) Conclusions: The GBS and pre-endoscopic Rockall score performed poorly in endoscopic intervention prediction. An improved predictive tool has been proposed here. Further studies are needed to examine if predicting this important triaging decision can be further optimized.

Scoring systems for predicting clinical outcomes in peptic ulcer bleeding.

Few studies have focused on assessing the usefulness of scoring systems such as the Rockall score (RS), Glasgow-Blatchford score (GBS), and AIMS65 score for risk stratification and prognosis prediction in peptic ulcer bleeding patients. This study aimed to assess scoring systems in predicting clinical outcomes of patients with peptic ulcer bleeding. A total of 682 peptic ulcer bleeding patients who underwent esophagogastroduodenoscopy between January 2013 and December 2017 were found eligible for this study. The area under the receiver-operating characteristic curve (AUROC) of each score was calculated for predicting rebleeding, hospitalization, blood transfusion, and mortality. The median age of patients was 64 (interquartile range, 56-75) years. Of the patients, 74.9% were men, and 373 underwent endoscopic intervention. The median RS, GBS, and AIMS65 scores were significantly higher in patients who underwent endoscopic intervention than in those who did not. The AUROC of RS for predicting rebleeding was significantly higher than that of GBS (P = .022) or AIMS65 (P < .001). GBS best predicted the need for blood transfusion than either pre-RS (P = .013) or AIMS65 (P = .001). AIMS65 score showed the highest AUROC for mortality (0.652 vs. 0.622 vs. 0.691). RS was significantly associated with rebleeding (odds ratio, 1.430; P < .001) and overall survival (hazard ratio, 1.217; P < .001). The RS, GBS, and AIMS65 scoring systems are acceptable tools for predicting clinical outcomes in peptic ulcer bleeding. RS is an independent prognostic factor of rebleeding and overall survival.

Comparison of risk scoring systems for upper gastrointestinal bleeding in patients after renal transplantation: a retrospective observational study in Hunan, China

BackgroundUpper gastrointestinal bleeding (UGIB) is a common complication in renal transplant recipients. However, the risk stratification value of bleeding scoring systems in these patients is unclear, and data regarding risk factors are limited.MethodsClinical data of renal transplant recipients in The Third Xiangya hospital were collected. The predictive ability of Glasgow Blatchford score (GBS), pre-endoscopy Rockall score (pRS), and AIMS65 score were assessed by the area under the receiver operating characteristic curve (AUROC). Risk factors of UGIB were analyzed using binary logistic regression analysis.ResultsA total of 220 patients were enrolled, of which 55 with UGIB. Endoscopy improved the overall survival rate of patients. Glasgow Blatchford score (AUROC 0.868) performed best at predicting UGIB patients who need intervention or death, with a threshold of 10, sensitivity and specificity were 82.4% and 70%, respectively. In terms of predicting mortality, the GBS score was comparable with AIMS65 score (p = 0.30) and pRS score (p = 0.42). Viral hepatitis, intravenous hormone usage, low platelet count, and low albumin level were significant factors associated with UGIB.ConclusionsThe Glasgow Blatchford score (AUROC 0.868) was best at predicting the need for intervention or death. However, their ability to predict mortality was limited, with AUROC less than 0.8. Our study also identified four independent risk factors for renal transplant recipients with UGIB.

Prediction of the need for emergency endoscopic treatment for upper gastrointestinal bleeding and new score model: a retrospective study

BackgroundGastrointestinal bleeding is one of the major gastrointestinal diseases. In this study, our objective was to compare Glasgow-Blatchford score (GBS), AIMS65 score, MAP score, Modified GBS, and Iino score as outcome measures for upper gastrointestinal bleeding. In addition, we extracted factors associated with hemostatic procedures including endoscopy, and proposed a new robust score model.MethodsFrom January 2015 to December 2019, 675 patients with symptoms such as hematemesis who visited the National Hospital Organization Disaster Medical Center and underwent urgent upper endoscopy with diagnosis of suspected non-variceal upper gastrointestinal bleeding were retrospectively reviewed. We evaluated the GBS, AIMS65 score, MAP score, Modified GBS, and Iino score, and assessed the outcomes of patients requiring hemostatic treatments at the subsequent emergency endoscopy. We performed logistic regression analysis of factors related to endoscopic hemostasis and upper gastrointestinal bleeding, created a new score model, and evaluated the prediction of hemostatic treatment and mortality in the new score and the existing scores.ResultsThe factors associated with endoscopic treatment were hematemesis, heart rate, HB (hemoglobin), blood pressure, blood urea nitrogen (BUN). Based on these predictors and the partial regression coefficients, a new score named H3B2 (using the initial letters of hematemesis, heart rate, HB, blood pressure, and BUN) was generated. H3B2 score was slightly more discriminatory compared to GBS and Modified GBS (area under the receiver operating characteristic curves (AUROC): 0.73 versus 0.721 and 0.7128, respectively) in predicting hemostatic treatment in emergency endoscopy. The H3B2 score also showed satisfactory prediction accuracy for subsequent deaths (AUROC: 0.6857. P < 0.001).ConclusionsWe proposed a new score, the H3B2 score, consisting of simple and objective indices in cases of suspected upper gastrointestinal bleeding. The H3B2 score is useful in identifying high-risk patients with suspected upper gastrointestinal bleeding who require urgent hemostatic treatment including emergency endoscopy.

A Comparative Analysis of Risk Scoring Systems in Predicting Clinical Outcomes in Upper Gastrointestinal Bleed

BackgroundUpper gastrointestinal bleed (UGIB) is a life-threatening condition that presents as hematemesis (fresh blood), coffee-ground vomiting, or melena. Multiple scoring systems are developed to predict different clinical outcomes, which are important to managing UGIB and are essential to determining low and high-risk patients. The study aimed to compare the sensitivity and specificity of risk scoring systems and their optimum cut-off values in the assessment of UGIB.MethodsThe prospective cross-sectional study included patients (N = 81) with acute UGIB. Four different proposed scores [Glasgow-Blatchford score (GBS), AIMS65, pre-endoscopic Rockall, and full Rockall scoring system] were used for evaluating patients with UGIB. The optimum cut-off values of these risk scores were used to predict the clinical outcomes.ResultsThe AIMS65 score [Area Under the Receiver Operating Characteristic curve (AUROC): 0.91, cut-off: >1, sensitivity: 100%, specificity: 76.62%] and pre-Rockall were similar (AUROC: 0.91, cut-off: >0, sensitivity: 100%, specificity: 93.51%) at predicting mortality. The GBS (cut-off: >9, AUROC: 0.79, sensitivity: 69.23, specificity: 87.50) and AIMS65 scores (cut-off: >0, AUROC: 0.67, sensitivity: 72.31, specificity: 62.5) were good predictors of need for ICU care.ConclusionGBS was superior in predicting categorization into high risk and low risk, and endoscopic intervention, blood transfusion, and intensive care unit (ICU) care in UGIB patients. Pre-Rockall score and AIMS65 score were similar in predicting the mortality rate in UGIB.

S670 The Glasgow Blatchford Score (GBS) Is Associated With the Need for Endoscopic Intervention and Blood Transfusion in Patients With Upper Gastrointestinal Bleeding

Introduction: At an incidence of 48-160/100,000 individuals, upper gastrointestinal bleeding (UGIB) is the most common gastroenterological emergency, in the United States, accounting for 300,000 hospitalizations and $3.3 billion in healthcare spending, yearly. GBS, a quick tool that uses non-endoscopic criteria for clinical stratification of UGIB, allows for early diagnosis and outcome prediction, including need for intervention. The goals of this study are to determine the GBS scores of patients who underwent esophagogastroduodenoscopy (EGD) and if the need for endoscopic intervention and blood transfusion are related to GBS in patients with UGIB. Methods: This is a cross-sectional retrospective study that included patients ≥18 years, who were admitted for UGIB to McLaren Macomb Medical Center (MMMC) and underwent EGD between July, 2018 and July, 2020. The patient encounters of interest were identified using international classification of disease (ICD 10) procedure codes for EGD. Demographics and the need for intervention or blood transfusion, variables comprising GBS, and other explanatory variables were extracted. Frequencies, percentages, and student T-test were used when appropriate. A stepwise regression analysis was performed to determine predictors of GBS. SPSS version 25 was used to analyze the data. Statistical significance was set at a p< 0.05. Results: A total of 130 observations were included in this analysis. No patients were noted to have a GBS ≤2, indicating successful evidence-based allocation of resources, as a GBS ≤1 to ≤2 is associated with safe outpatient management. We found that GBS was statistically significantly related to the need for intervention, blood transfusion, and age group. Additionally, those who needed intervention and blood transfusion scored 1.493 [mean GBS 13.13±3.28 versus 10.62±3.83 (P=0.004)] and 3.486 [mean GBS 13.12±2.68 versus 9.16±3.83 (P=0.000)] higher, respectively. Also, those who are ≤60 years-old scored 1.77 [mean GBS 9.38±4.11 versus 11.7±3.57 (P=0.002)] less. Conclusion: Our study is among a few that investigated and found a mean GBS associated with need for intervention and blood transfusion. Even at higher GBS, we may be able to further stratify patients’ risk and predict need for intervention and blood transfusion. Further research is needed to investigate this nuance.Table 1.: Study Methodology Quality Assessment on Newcastle-Ottawa Scale.

Comparing the Performance of the ABC, AIMS65, GBS, and pRS Scores in Predicting 90-day Mortality Or Rebleeding Among Emergency Department Patients with Acute Upper Gastrointestinal Bleeding: A Prospective Multicenter Study.

Background and ObjectivesAcute upper gastrointestinal bleeding (UGIB) is a common problem that can cause significant morbidity and mortality. We aimed to compare the performance of the ABC score (ABC), the AIMS65 score (AIMS65), the Glasgow-Blatchford score (GBS), and the pre-endoscopic Rockall score (pRS) in predicting 90-day mortality or rebleeding among patients with acute UGIB.MethodsThis was a prospective multicenter study conducted at 20 tertiary hospitals in China. Data were collected between June 30, 2020 and February 10, 2021. An area under the receiver operating characteristic curve (AUC) analysis was used to compare the performance of the four scores in predicting 90-day mortality or rebleeding.ResultsAmong the 1072 patients included during the study period, the overall 90-day mortality rate was 10.91% (117/1072) and the rebleeding rate was 12.03% (129/1072). In predicting 90-day mortality, the ABC and pRS scores performed better with an AUC of 0.722 (95% CI 0.675–0.768; P<0.001) and 0.711 (95% CI 0.663–0.757; P<0.001), respectively, compared to the AIMS-65 (AUC, 0.672; 95% CI, 0.624–0.721; P<0.001) and GBS (AUC, 0.624; 95% CI, 0.569–0.679; P<0.001) scores. In predicting rebleeding in 90 days, the AUC of all scores did not exceed 0.70.ConclusionIn patients with acute UGIB, ABC and pRS performed better than AIMS-65 and GBS in predicting 90-day mortality. The performance of each score is not satisfactory in predicting rebleeding, however. Newer predictive models are needed to predict rebleeding after UGIB.

Comparison of complete rockall score, Glasgow–Blatchford score, and AIMS 65 score for predicting in-hospital mortality in patients presenting with upper gastrointestinal hemorrhage at a Tertiary Care Hospital in Southern India

Background: Multiple risk assessment scores are available to triage and stratify patients presenting with upper gastrointestinal (GI) hemorrhage. This study was conducted to compare the accuracy of complete Rockall score (CRS), Glasgow–Blatchford score (GBS), and AIMS65 score (AIMS65-albumin, INR >1.5, impaired mental status, systolic pressure <90 mm Hg, and age >65) in predicting in-hospital mortality in patients presenting with upper GI hemorrhage to the gastroenterology department at a tertiary care hospital in Southern India. The secondary objectives were to compare these three scores in predicting the need for blood transfusion, any intervention (endoscopic or radiological or surgical intervention), or rebleeding in patients presenting with upper GI hemorrhage. Materials and Methods: This was a retrospective analysis of prospectively recorded data which included 207 patients with acute upper GI hemorrhage admitted at a tertiary care hospital at Chennai over 2 years. Demographic, clinical, laboratory, and endoscopic parameters were recorded. CRS, GBS, and AIMS65 scores were calculated. Data regarding in-hospital mortality, need for blood transfusion, endoscopic intervention, radiological intervention, surgical intervention, and rebleeding were collected. Area under receiver operating characteristic curve (AUROC) was compared between the three scores in predicting in-hospital mortality, need for blood transfusion, intervention, and rebleeding. Results: AIMS 65 score >3 (AUROC 0.92) was a better predictor of in-hospital mortality than GBS (AUROC 0.77) and CRS (AUROC 0.69). AIMS65 was a better predictor of rebleeding (AUROC 0.804) than GBS (AUROC 0.676) or CRS (AUROC 0.623). GBS was a better predictor for need of blood transfusion (AUROC 0.785) than AIMS65 (AUROC 0.691) or CRS (AUROC 0.629). Conclusion: AIMS 65 score (>3) was a better predictor of in-hospital mortality than GBS or CRS in patients presenting with acute upper GI hemorrhage due to either variceal and nonvariceal etiology. AIMS 65 was also a better predictor of risk of rebleeding. GBS was a better predictor of need for blood transfusion and need for intervention.

The Clinical Impact of Rockall and Glasgow-Blatchford Scores in Nonvariceal Upper Gastrointestinal Bleeding

Introduction: Risk stratification in patients with nonvariceal upper gastrointestinal bleeding (NVUGIB) is crucial for proper management. Rockall score (RS; pre-endoscopic and complete) and Glasgow-Blatchford score (GBS) are some of the most used scoring systems. This study aims to analyze these scores’ ability to predict various clinical outcomes and possible cutoff points to identify low- and high-risk patients. Secondarily, this study intents to evaluate the appropriateness of patients’ transfers to our facility, which provides a specialized emergency endoscopy service. Methods: This study was retrospectively conducted at Centro Hospitalar Universitário do Porto and included patients admitted to the Emergency Department with acute manifestations of NVUGIB between January 2016 and December 2018. Receiver operating characteristic (ROC) curves and corresponding areas under the curve (AUC) were calculated. Transferred patients from other institutions and nontransferred (directly admitted to this institution) patients were also compared. Results: Of a total of 420 patients, 23 (5.9%) died, 34 (8.4%) rebled, 217 (51.7%) received blood transfusion, 153 (36.3%) received endoscopic therapy, 22 (5.7%) had surgery, and 171 (42.3%) required hospitalization in the Intermediate or Intensive Care Unit. Regarding mortality prediction, both complete RS (AUC 0.756, p < 0.001) and pre-endoscopic RS (AUC 0.711, p = 0.001) showed good performance. In the prediction of rebleeding, only complete RS (AUC 0.735, p < 0.001) had discriminative ability. GBS had good performance in the prediction of transfusion (AUC 0.785, p < 0.001). No score showed discriminative capability in the prediction of other outcomes. Transferred and nontransferred patients had similar pre-endoscopic RS (3.41 vs. 3.34, p = 0.692) and GBS (13.29 vs. 12.29, p = 0.056). Only patients with GBS ≥6 were transferred to our facility. There were no adverse outcomes recorded in any group when GBS was ≤3. Discussion/Conclusion: Complete RS and pre-endoscopic RS are effective at predicting mortality, but only complete RS showed good performance at predicting rebleeding. GBS is better at predicting transfusion requirement. Our study suggests that a transfer can possibly be reconsidered if GBS is ≤3, although current recommendations only propose outpatient care when GBS is 0 or 1. Patients’ transfers were appropriate, considering the high GBS scores and the outcomes of these patients.

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 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.

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.

595 The Glasgow-Blatchford Score: Pitfalls and Cost of Generalization

INTRODUCTION: Non-variceal acute upper gastrointestinal bleeding (NVAUGIB) is one of the most common causes of hospitalization worldwide. The Glasgow-Blatchford Score (GBS) was developed to identify subjects who would benefit from hemostatic endoscopic intervention (HEI), in this and other types of GIB. According to the literature, a GBS score &lt;2 identifies with up to 99% accuracy subjects who do not need emergent HEI. Experience at our center suggests that the average GBS of our patients with NVAUGIB is consistently &gt;2 and yet our rate of HEI is low. Therefore, the primary aim of this study was to accurately determine the rate of significant HEI in subjects with NVAUGIB with GBS &gt;2. The secondary aim was to determine the cost of esophagogastroduodenoscopy (EGD) in patients in whom no significant HEI was performed. METHODS: Medical records of subjects admitted for NVAUGIB who underwent EGD from January 2015 – December 2017 were reviewed. NVAUGIB was defined as the presence of any of the following: hematemesis, hematochezia, coffee ground emesis, + FOBT, melena, drop in Hgb &gt;2 g/dl and absence of varices on EGD. The GBS was calculated on the day of EGD on all subjects. Data obtained was compared using a Kolmogorov-Smirnov Test of Normality first to ensure normal distribution, then an independent T-test was used to evaluate for significance. EGD cost was obtained from the hospital administration. RESULTS: A total of 586 subjects underwent EGD for the evaluation of NVAUGIB, and their demographic characteristics are listed in Table 1. The mean GBS for subjects with ≤2 and &gt;2 were 1 and 8.8 respectively. Of those with a GBS &gt;2 (503/586), only 16.9% (85/503) underwent a HEI. On the other hand, only 1% (1/83) of those with GBS ≤2 (83/586), underwent HEI. Overall, subjects who received HEI (86) had higher GBS compared to those who didn't (9.29, SD 3.51) vs. (7.42, SD 4.06) (P ≤ 0.05). A total of 418 EGDs without HEI were performed in subjects with GBS &gt;2. The cost of a diagnostic EGD at our institution is approximately $2,866.00. Therefore, the cost of these procedures was approximately $1,200,000.00. CONCLUSION: In our population, a GBS cutoff of &gt;2 did not identify patients requiring HEI accurately as previously reported in the literature. The cost of performing non-therapeutic endoscopic evaluation in these subjects is alarming. Further research regarding the generalizability of the GBS is needed at this time.

P132: Real life management of patients presenting with upper gastrointestinal bleeding in a tertiary care emergency department - Are we delivering the standard of care?

Introduction: Upper gastrointestinal bleeding (UGIB) is a common Emergency Department (ED) presentation. Early endoscopic intervention, supported by Glasgow Blatchford Score (GBS) severity, has been shown to reduce re-bleeding rates and lower morbidity and mortality. However, emergent endoscopy is not necessary for all patients. Low-risk patients can be managed with outpatient follow-up. Other important management decisions such as blood transfusion (Hb &lt;70) and use of proton pump inhibitors (PPI) also warrant evaluation. The aim of this study was to compare the timing and appropriateness of endoscopy and blood transfusion and proton pump inhibitor (PPI) use in a tertiary care setting to the standard of care. Methods: A retrospective cohort study was conducted to examine the management of patients presenting with UGIB to the ED in 2016 using a standard chart review methodology. TANDEM and EDIS (Emergency Department Information System) databases were queried to identify patients using specified ICD 10 codes and the CEDIS (Canadian Emergency Department Information System) presenting complaints of vomiting blood or blood in stool/melena. Outcome measures included: patient characteristics, the GBS to determine appropriateness of endoscopic intervention, diagnoses, blood transfusion indications and utilization of oral or intravenous PPIs. Data were entered into a REDCap database and analyzed using standard non-parametric statistical tests. Results: A total of 200 patients, 59% male (118/200), mean age 59 years (range 18 - 92 years) were included. The median GBS was 9. 79% of patients (157/200) underwent endoscopy during the hospital visit: 30% of patients with GBS 0-3 (13/43) and 80% patients with GBS 4 (125/157) underwent endoscopy 24 hours. The two most common endoscopic diagnoses were peptic ulcers (39%, 61/157) and varices (18%, 28/157), while 14% (22/157) had a normal diagnosis or mild gastritis. 174/200 patients (87%) were given IV or oral PPI in the ED whereas the remaining 26 (13%) did not receive PPI in hospital. 46% of patients (89/194) received blood transfusion, but only 51% (45/89) were administered based on the 70 g/L threshold while in 40% (36/89) of patients the less restrictive threshold of 90 g/L was used. Conclusion: A majority of UGIB patients presenting to a tertiary hospital ED appropriately received endoscopy 24 hours based on a GBS score 4. PPI use was appropriate but a proportion of patients received inappropriate blood transfusions.