Glasgow-Blatchford Research Articles

A novel predictive model for Intensive Care Unit admission in Emergency Department patients with upper gastrointestinal bleeding

Acute upper gastrointestinal bleeding (UGIB) is a critical emergency. Conventional scoring models for patients with UGIB have limitations; thus, more suitable tools for the Emergency Department are necessary. We aimed to develop a new model that can identify significant predictors of Intensive Care Unit (ICU) admission in Emergency Department patients with UGIB and to compare its predictive accuracy with that of existing models. We retrospectively analyzed data from patients with UGIB treated between January 2020 and July 2022 at the Emergency Department of a single tertiary medical center. Using multivariable logistic regression and the area under the receiver operating characteristic curve (AUROC), we developed a new model to predict the probability of ICU admission. Among 433 patients, multiple logistic regression analysis identified sex, systolic blood pressure, diastolic blood pressure, hemoglobin level, platelet count, alanine transaminase level, and prothrombin time as significant predictors of ICU admission. Our model demonstrated superior predictive accuracy with an AUROC of 0.8539 (95% confidence interval [CI]: 0.8078–0.8999), outperforming the Glasgow–Blatchford score and AIMS65 score, which had AUROCs of 0.7598 (95% CI: 0.7067–0.8130) and 0.6930 (95% CI: 0.6324–0.7537), respectively. We implemented this model in a user-friendly calculator for clinical use. We identified key predictors of ICU admission that are crucial for hemodynamic stabilization in patients with UGIB. Our model, combined with this probability calculator, will enhance clinical decision-making and patient care for UGIB in emergency settings.

Comparative diagnostic utility of Rockall and Glasgow-Blatchford scores in non-variceal upper gastrointestinal bleeding: a systematic review and meta-analysis.

The Rockall score and Glasgow-Blatchford score (GBS) are two scoring systems validated in the evaluation of upper gastrointestinal bleeding (UGIB). However, no meta-analysis exists to summarize the current data and clarify the use of Rockall score and GBS focusing on non-variceal UGIB. We aimed to evaluate and compare the utility of the Rockall score and GBS in predicting clinical outcomes in non-variceal UGIB. We conducted a systematic review and meta-analysis, searching the MEDLINE and EMBASE databases for all peer-reviewed articles using the terms including 'Glasgow-Blatchford', 'Rockall', and 'gastrointestinal bleed' from their inception to 22 March 2023. Outcomes included mortality, rebleeding, need for blood transfusion, and need for surgical intervention. Seven studies with 755 participants with non-variceal bleeding were included in the analysis. Pooled analysis demonstrated no difference in the area under the receiver operating characteristic (AUROC) between GBS and Rockall score to predict mortality [weighted mean difference (WMD) = 0.01, 95% CI: -0.06 to 0.08] or rebleeding (WMD = 0.04, 95% CI: -0.03 to 0.11). GBS had a higher AUROC to predict the outcomes compared to Rockall score for the needs for transfusion (WMD = 0.09, 95% CI: 0.01-0.16) and surgical intervention (WMD = 0.21, 95% CI: 0.14-0.29). The GBS could be superior to the Rockall score in predicting the needs for transfusion and surgical intervention in non-variceal UGIB. However, both scores demonstrate low performance for predicting mortality or rebleeding.

Evaluation of Rockall and Blatchford Scores and Forrest Staging in Upper Gastrointestinal Bleeding

Objective: The study aimed to investigate the predictive value of Rockall and Blatchford scores and endoscopic Forrest staging in the need for transfusion and intensive care in upper gastrointestinal bleeding. Materials and Methods: This retrospective study was conducted on 294 patients with gastrointestinal bleeding who presented to the emergency department between January 1 and June 1, 2013. Results: The mean age of 294 patients was 58.73±21.30 years. The endoscopic diagnoses of the patients included peptic ulcer (43.5%, n=128), erosive gastritis (17.3%, n=51), and erosive bulbitis (12.6%, n=37). There was no statistically significant relationship between Forrest staging and Rockall and Blatchford scores (p=0.944, p=0.757). The need for blood transfusion was significantly more frequent in patients with a Rockall score of 5 and above and those with a high Blatchford score (p=0.004, p=0.001). Patients with a Rockall score of 5 and above were significantly more common among those referred to the intensive care unit (p=0.003). Conclusion: Pre-endoscopic Rockall and Blatchford scores and endoscopic Forrest staging can be used safely in predicting transfusion requirement, intensive care requirement, mortality risk, treatment and follow-up of patients with gastrointestinal bleeding, and thus may help to reduce health expenditures.

The Time of Endoscopy for Nonvariceal Upper Gastrointestinal Bleeding: An Observational Study

Objectives: In cases of nonvariceal upper gastrointestinal bleeding (NVUGIB), endoscopic intervention within the first 24 hours is widely recommended. However, data on the efficacy of urgent endoscopy are limited. Here, we used the Glasgow–Blatchford score to assess bleeding outcomes based on time-to-endoscopy.Methods: Prospectively collected multicenter data, which included 1554 patients with NVUGIB, were retrospectively reviewed between February 2011 and December 2013. Based on time-to-endoscopy, patients were grouped into the early (<24 hours) versus the delayed (≥24 hours) group and the urgent (<6 hours) versus the nonurgent (≥6 hours) group. The rates of re-bleeding, mortality, secondary intervention, transfusion, and morbidity aggravation were analyzed.Results: The mean time-to-endoscopy and median Glasgow–Blatchford score were 33.0±75.5 hours and 12 (range: 1–23), respectively. Univariate analyses revealed that in the delayed endoscopy group, the transfusion and re-bleeding rates were higher (hazard ratio [HR]: 1.257, 95% confidence interval [CI]: 1.026–1.540) and lower (HR: 0.610, 95% CI: 0.413–0.901), respectively. Multivariate analysis revealed that delayed endoscopy was a significant factor for lower re-bleeding rate (HR: 0.576, 95% CI: 0.387– 0.859), which was prominent in the low-risk group (HR: 0.417, 95% CI: 0.225–0.774). Multivariate analysis showed that when compared with the low-risk group, in-hospital comorbidity aggravation was more common in high-risk patients who underwent non-urgent endoscopy (HR: 2.957, 95% CI: 1.045–6.454).Conclusions: In low-risk patients, delayed endoscopy is sufficient for NVUGIB management. In high-risk patients, urgent endoscopy reduced comorbidity aggravation during hospital care.

ThP6.6 - Enhancing Management Strategies: Exploring the Expansion of Low-Risk Criteria in Glasgow-Blatchford Scoring for Acute Upper Gastrointestinal Bleeding – A Retrospective Cohort Study

Abstract Aims Glasgow-Blatchford Scoring (GBS) determines the need for further interventions in patients presenting with acute upper gastrointestinal bleeding (AUGIB). We aimed to study whether we can safely expand low-risk criteria to patients with GBS 2 and manage them as urgent outpatient. Methods A retrospective study of consecutive adult patients who had inpatient endoscopy for AUGIB in a single surgical unit from September 2021 to September 2022. Patient demographics, clinical and laboratory findings, GBS and endoscopic findings was analysed. Low-risk was defined as GBS 0-1 and high-risk as GBS ≥3. Results 150 patients were identified; 79 (58.7%) were male and median age of 63 years (IQR 53-76). Median total length-of-stay was 3.7 days (IQR 1.9=7.8). Similar to the low-risk group, patients with GBS 2 presented with lower range and frequency of symptoms as the high-risk group (p=0.0002). Severity correlated with admission haemoglobin (p=0.001) and urea count (p<0.0001) but not relevant comorbidities (p=0.560) and admission observations (p=0.456). The frequency of benign endoscopic findings in patients with GBS 2 were similar to the low-risk group with no malignant findings noted. This group also had similar rates of past and re-attendances for AUGIB and 30-day mortality of 0% to the low-risk group. Conclusion While our study has a small sample size, it suggests promising prospect that patients with GBS 2 may not need inpatient endoscopy. Future multi-centre studies are crucial to validate and strengthen this proposition. The potential advantages include decreased inpatient admissions, reduced healthcare costs, and alleviating pressures on emergency endoscopy unit.

WP3.16 - Comparing Outcomes in Acute Upper Gastrointestinal Bleeding: Initial Presentation versus In-hospital Incidence - A Single-Centre Investigation

Abstract Aims Acute upper gastrointestinal bleeding (AUGIB) is a gastrointestinal emergency with varied patient outcomes. We aimed to compare the outcomes of patients whose primary admission presentation was AUGIB versus inpatients who subsequently developed AUGIB as a complication. Methods This was a retrospective study of all adult patients receiving endoscopy for AUGIB in a single surgical unit from September 2021 to September 2022. Patient demographics, laboratory results, medical history and clinical progress, 30 and 90-day mortality were compared. Results 145 patients were identified, 75 (51.7%) were male and median age was 65 years (IQR 53-75). 117 presented to hospital with AUGIB (group 1) and 28 developed AUGIB as an inpatient (group 2). Median length-of-stay was 3.3 vs 10 days, respectively (p=0.014). Group 2 were more likely to present with symptomatic anaemia (p=0.001), higher National Early Warning System scores (p<0.001), shock (p<0.001), higher Glasgow-Blatchford score (p<0.001) and require blood transfusions (p<0.001). Group 2 had higher ASA Scores (p<0.001) and higher 30-day and 90-day all-cause mortality. No statistical correlations were noted regarding the distribution of endoscopic diagnoses obtained between both groups.Group 1(n=117)Group 2(n=28)P-Value30-Day all-cause Mortality4 (3.4%)4 (14.3%)0.02490-Day all-cause Mortality9 (7.7%)8 (28.6)0.002 Conclusion Our results echo previous studies that patients who develop AUGIB whilst an inpatient have significantly poorer outcomes. Causation is likely multifactorial and warrants further study. It remains important to closely apply the AUGIB care bundle and early critical care input to optimize outcome.

Evaluation of Glaskow-Blatchford, Rockall Scores and Shock Index of Patients Admitted from the Emergency Department with A Diagnosis of Upper Gastrointestinal System Bleeding

Background: Risk scores and shock index used in upper gastrointestinal system (GSB) bleeding have an important place in determining the treatment and clinical course of the patient. The aim of this study is to evaluate the predicted success in mortality by analyzing shock indices together with Glasgow Blatchford Scoring (GBS) and Rockall Scoring (RS), whichare used in upper GI bleeding. Methods: This study was conducted with a retrospective analysis of patients who were hospitalized with a diagnosis of upper GI bleeding from the emergency department of a single-center secondary care health institution. For each patient, age, gender, treatment procedures performed in the emergency department or clinic, and endoscopy results were evaluated. Mortality and discharge status of the patients were compared with the scoring values. Result: 86 patients were evaluated in the study. The average age was 69.09±19.07 and the most applications were in the 61-79 age range (48.8%). The most common presenting complaints of the patients were bloody vomiting and black stools. On physical examination, melena was positive in 64% of the patients. 89.5% of the patients were treated in intensive care. The mortality rate was 10.5%. In patients with death, the shock index value was ≥0.75 in all patients and the average was 1.07. As a result of the study, it was seen that GBS, RS and shock index were successful in predicting mortality. Conclusion: Current scoring systems need to be developed in order to manage patients with upper GI bleeding, which is frequently seen in emergency departments today, more quickly and to reduce patient costs.

Prognostic Significance of the Hemoglobin-Albumin Ratio in Upper Gastrointestinal Bleeding

ABSTRACT Objective Upper gastrointestinal bleeding is a serious and life-threatening condition where monitoring and prognosis are crucial. This study aimed to compare the prognostic value of the hemoglobin-albumin ratio (HAR) with endoscopic risk scoring systems. Methods The medical records of 153 patients with upper gastrointestinal bleeding treated at our clinic between 2022 and 2024 were retrospectively reviewed. Endoscopic risk scoring systems, including the Rockall score (RS), Glasgow-Blatchford score (GBS), and Forrest classification, were calculated. The HAR score, consisting of hematologic parameters, was computed. The HAR score was compared with clinical findings and endoscopic scores using the Mann-Whitney U and Kruskal-Wallis tests. The relationships between the HAR values and numerical variables were examined using Spearman’s correlation coefficient. Results Of the patients, 122 (79.7%) were male and 31 (20.3%) were female. A duodenal ulcer was the most common endoscopic finding (43.7%). The mean GBS was 10.69±3.89, RS was 4.37±2.27, and HAR was 2.88±0.64. There was a low-level significant correlation between the HAR score and the Glasgow Blatchford score (r=-0.254, p=0.002). Low hemoglobin levels, a low HAR score, and a high GBS were associated with a poor prognosis. Conclusion In patients with upper gastrointestinal bleeding, a low HAR score is associated with a poor prognosis. The HAR score is an effective and reliable marker, similar to endoscopic scoring systems. This study revealed a correlation between a high GBS and a low HAR score. Due to its simplicity, rapid and easy calculation, and practicality, the HAR score can be used routinely in clinical practice.

Validation of an Electronic Health Record–Based Machine Learning Model Compared With 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.

Prognostic scores for predicting clinical outcomes in upper gastrointestinal bleeding

Background and aimsThis study aimed to determine the performance of AIMS65, Rockall score, and Glasgow-Blatchford score (GBS) in patients presenting with upper gastrointestinal bleeding (UGIB) and to compare results between patients with nonvariceal UGIB (NVUGIB) and variceal UGIB (VUGIB).MethodsWe conducted a single-center prospective cohort study between December 2021 and December 2022. A total of 400 patients who met the inclusion criteria were included in the study, out of which 232 patients (58%) had NVUGIB and 168 patients (42%) had VUGIB. Receiver operating characteristic curve analysis was performed for all outcomes for comparison.ResultsOf the total of 400 patients with UGIB, 232 patients (58%) had NVUGIB, and 168 patients (42%) had VUGIB. The present study showed that GBS (AUROC 0.729, 95% CI: 0.598–0.859, p = 0.001) and RS (AUROC 0.693, 95% CI: 0.579–0.807, p = 0.005) but not AIMS65 (AUROC, 0.545, 95% CI: 0.412–0.679, p = 0.500) predicted in-hospital and overall 6-week mortality in patients with UGIB. All the three scores predicted need for blood transfusion and poor composite outcomes (p < 0.05). The need for endoscopic intervention was predicted by all the three scores in overall UGIB (OUGIB) patients (p < 0.05), only GBS and RS in NVUGIB patients (p < 0.05). Rebleeding was best predicated by RS in both OUGIB and NVUGIB patients (p < 0.05). None of the scores predicted the need for endoscopic intervention, rebleeding, need for surgical and radiological intervention, and composite outcomes in VUGIB patients (p > 0.05).ConclusionsGBS and RS were superior to AIMS65 in predicted in-hospital and overall 6-week mortality in all the three categories: OUGIB, NVUGIB, and VUGIB patients.

Gastrointestinal Bleeding in COVID-19 Infected Patients, and Management Outcomes.

Gastrointestinal bleeding in COVID-19-infection poses unique challenges to patients owing to the high risk of concomitant respiratory failure. However, endoscopic care providers are prone to transmission. This study aimed to understand the risk and management outcomes of gastrointestinal bleeding in COVID-19-infected patients. Data were abstracted from electronic patient medical records, using ICD 10 codes, and demographic and clinical data were collected, for COVID-19-infected patients who developed gastrointestinal (GI) bleeding. Complications related to COVID-19 infection and management outcomes of GI bleeding were studied. Statistically, descriptive analysis was used because of the small sample size. Eighteen COVID-19-infected patients developed episodes of GI bleeding, yielding a prevalence of 0.45%. Their mean age was 74.8 years, 55.5% were female, and 66.6% of patients (n=12) had upper GI bleeding symptoms, predominantly melena (55.5%), followed by coffee ground nasogastric aspirates (n=2). Only two patients (11.11%) had episodes of lower GI bleeding, and the remaining four patients (22.2%) had recurrent acute anemia requiring blood transfusion. The Glasgow-Blatchford score (GBS) at presentation ranged between 6 to 16 (mean 8.8) and seven patients (38.8%) underwent endoscopic evaluation for GI bleeding. The predominant comorbid conditions included hypertension (22.2%), diabetes mellitus (27.7%), chronic kidney disease (50%), ischemic heart disease (33%), atrial fibrillation (11.1%), and peripheral vascular disease (11.1%). The median hospitalization was 24.6 days (range: 3-54 days). The 30-day mortality rate in our cohort was 22.2%, (4/18) mainly noted in older patients aged> 60 years with comorbid conditions and severe COVID-19 infection. The prevalence of GI bleeding observed in our cohort was approximately 0.45%, significantly lower than the global prevalence observed, majority (66%) had upper GI bleeding. The exact reasons for the observed low prevalence of GI bleeding cannot be explained and will be the subject of future research.

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.

A217 EVALUATING PREDICTIVE SCORING AND OUTCOMES OF PATIENTS DISCHARGED HOME FROM THE EMERGENCY DEPARTMENT WITH UPPER GASTROINTESTINGAL BLEEDING

Abstract Background Upper gastrointestinal bleed (UGIB) is a common emergency department (ED) presentation. The Glasgow-Blatchford Bleeding Score (GBS) is a validated tool for predicting UGIBs requiring admission for endoscopic evaluation. Utilization of GBS in Northern Ontario EDs may help risk stratify UGIB to decrease return to care. Aims This study aimed to evaluate factors and outcomes of patients discharged from the ED with suspected UGIB. Methods A total of 1,139 charts were identified with an ICD-10 ED diagnosis of gastrointestinal hemorrhage from 2016-2022. Of these, 92 charts met inclusion criteria. Patients admitted to hospital from the index ED visit, who were below the age of 18 years at the time of presentation, or with clinically suspected lower gastrointestinal hemorrhage were excluded. Patient were further grouped by place of residence if their primary address was within Thunder Bay city limits or not. Results There were 48 males (52%) with a median age of 58.7 (IQR 32.2) at presentation with UGIB to ED. The median (IQR) Charlson Comorbidity Index (CCI) and GBS were 3 (5) and 3 (6), respectively. The odds ratio for returning to the ED and being admitted for UGIB within sixty days was 4.07 times greater for patients from the region compared to Thunder Bay residents (95% CI 1.28–12.97). GBS was found to be significantly greater (p=0.048, Mann-Whitney U-Test) among seven patients who underwent emergent endoscopy from the ED and were discharged home. In univariate K-M survival analysis, the mean survival time to hospital admission at sixty days was 45 days among those with a presenting GBS score of ampersand:003E3, compared to 57 days when GBS was 3 or less (pampersand:003C0.005, log rank Mantel-Cox). After adjustment for age, sex, place of residence, and CCI, there was a 17% increase in the expected hazard for hospital admission at sixty days for each point increase in GBS (95% CI 1.03–1.34). Similarly, the expected hazard for follow-up hospital admission was 2.95 times higher (95% CI 1.11–7.85) in patients living outside Thunder Bay travelling to seek care. There were no statistically significant hazards identified between age, sex, or CCI and hospital admission (Cox proportional hazards model, p=0.001). Of patients admitted to hospital within sixty days of ED discharge (n=17), the median length of stay was five days with 56% requiring blood transfusion and 83% receiving endoscopy. Conclusions Higher GBS scores and residence outside of Thunder Bay increase the likelihood of revisit and admission to hospital for UGIB following ED discharge. Future research will aim to compare outcomes among larger urban centers. Funding Agencies NOAMA

Inferior vena cava collapsibility index and stroke volume as predictors of blood transfusion in upper gastrointestinal bleeding in the emergency department.

This study investigates the effectiveness of bedside ultrasonography in predicting blood transfusion requirements in patients with upper gastrointestinal bleeding (UGIB). It focuses on evaluating the inferior vena cava (IVC) diameter, IVC collapsibility index (CI), and stroke volume (SV) as ultrasonographic measures. A hundred adult patients enrolled in this prospective clinical study. The patients were divided into two groups (group 1: only saline administered group, group 2: saline and blood administered group). IVC diameter, IVC CI, and SV were measured at the time of admission and after treatment. At the initial admission, group 1 exhibited an IVC CI of 20.4% and an SV of 65.0mL, whereas group 2 displayed an IVC CI of 26.6% and an SV of 58.0mL. Upon analyzing the relationship between the Glasgow-Blatchford score (GBS) and SV, we identified a significant negative correlation (r=-0.7350; P<0.001). Similarly, a weak negative correlation was observed between the Rockall score (RS) and SV (r=-0.4718; P<0.001). It is worth noting that patients with UGIB require blood transfusion if their SV falls below 62.5mL, with an area under the curve (AUC) of 89.1% and a 95% confidence interval (CI) ranging from 82.8% to 95.4%. IVC CI and SV can be used as parameters to predict the need for blood transfusion in the ED in patients with UGIB.

Development and validation of machine learning models to predict the need for haemostatic therapy in acute upper gastrointestinal bleeding.

Acute upper gastrointestinal bleeding (AUGIB) is a major cause of morbidity and mortality. This presentation however is not universally high risk as only 20-30% of bleeds require urgent haemostatic therapy. Nevertheless, the current standard of care is for all patients admitted to an inpatient bed to undergo endoscopy within 24 h for risk stratification which is invasive, costly and difficult to achieve in routine clinical practice. To develop novel non-endoscopic machine learning models for AUGIB to predict the need for haemostatic therapy by endoscopic, radiological or surgical intervention. A retrospective cohort study. We analysed data from patients admitted with AUGIB to hospitals from 2015 to 2020 (n = 970). Machine learning models were internally validated to predict the need for haemostatic therapy. The performance of the models was compared to the Glasgow-Blatchford score (GBS) using the area under receiver operating characteristic (AUROC) curves. The random forest classifier [AUROC 0.84 (0.80-0.87)] had the best performance and was superior to the GBS [AUROC 0.75 (0.72-0.78), p < 0.001] in predicting the need for haemostatic therapy in patients with AUGIB. A GBS cut-off of ⩾12 was associated with an accuracy, sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of 0.74, 0.49, 0.81, 0.41 and 0.85, respectively. The Random Forrest model performed better with an accuracy, sensitivity, specificity, PPV and NPV of 0.82, 0.54, 0.90, 0.60 and 0.88, respectively. We developed and validated a machine learning algorithm with high accuracy and specificity in predicting the need for haemostatic therapy in AUGIB. This could be used to risk stratify high-risk patients to urgent endoscopy.

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.

The Role of Endoscopy-Independent Gastrointestinal Bleeding Scores in Predicting 30-day Mortality in Aged Over 65

Introduction: The aim of this study was to assess the power of clinical findings and scoring systems to predict mortality in patients over 65 years of age with non-variceal upper gastrointestinal bleeding. Materials and Method: Data on demographic profiles and risk estimation scores were retrospectively extracted from electronic hospital medical records and other electronic databases using a standard data extraction form. The AIMS65, pre-Rockall, modified Glasgow-Blatchford, T, and Baylor bleeding scores were calculated to estimate the 30-day mortality risk. The inclusion criteria were patients aged 65 and over who presented with active bleeding symptoms and had been diagnosed with acute upper gastrointestinal bleeding by the gastroenterology department. Results: The mean age was 75.23 years, and 23.6% of the patients died within 30 days. The 30-day mortality was associated with albumin levels, malignancy, and intensive care unit hospitalization. An inverse relationship was found between the albumin level and mortality, whereas the presence of cancer and the need for intensive care were associated with 2.8-fold and 2.2-fold increases in the risk of death, respectively. The AIMS65 score (AUC: 0.794) had the highest discriminative ability to predict 30-day mortality among all risk scores. Conclusion: Albumin levels, malignancy presence, and ICU admission were indicators of mortality risk in elderly patients with upper gastrointestinal bleeding. Calculating all the scores, excluding the Baylor Bleeding score, is beneficial for assessing the risk of mortality associated with upper gastrointestinal bleeding. The AIMS65 score demonstrates the highest discriminative ability. However, using these risk-scoring systems necessitates additional data. Keywords: Gastrointestinal Hemorrhage; Mortality; Aged.

Assessment of Hemorrhagic Risk in Maintenance Hemodialysis Population using Different Clinical Tools

BACKGROUND: End stage kidney disease (ESKD) patients receiving maintenance hemodialysis (HD) face an elevated bleeding risk. There are the factors such as body mass index (BMI), comorbidities, and medications such as antiplatelet, anticoagulants, and nonsteroidal anti-inflammatory drugs that increase the bleeding risk. The validity of bleeding risk assessment tools in the ESKD population needs to be studied. MATERIALS AND METHODS: This was a prospective, observational study in a HD unit at a tertiary care teaching hospital in Ajman. Sixty adult patients on regular maintenance HD sessions were included in the study. Severity of bleeding was categorized based on the World Health Organization (WHO) classification. Each patient’s risk of bleeding was assessed monthly using 9 different bleeding risk assessment tools (HASBLED, ATRIA, HEMORR2HAGES, ORBIT, IMPROVE, OBRI, S2TOP-BLEED, intracranial-B2 LEED3S, and Glasgow Blatchford Score for gastrointestinal bleeding) for 6 months’ period. Patients were categorized into low- and high-risk groups according to their risk scores. The predictive power of risk assessment tools was assessed by calculating its sensitivity and specificity. Receiver operating characteristic (ROC) curve was plotted, and the area under the curve was estimated for each risk assessment tool. Logistic regression model was also done using the SPSS software version 29. RESULTS: The mean age of the study group was 56 years, and the average BMI was 27 kg/m2. A total of 20 bleeding events were reported among ten patients (16.7%). The WHO category 1 and WHO category 2 bleeding were observed in 15 and 5 bleeding events, respectively. None had category 3 or 4 bleeding. Bleeding risk was found to be associated with ethnicity and obesity but not to other patient demographic factors or medication use. Based on sensitivity, specificity, positive predictive value, negative predictive value, and the area under the ROC curve, HEMORR2HAGES score showed better prediction of bleeding risk compared to the other tools used. CONCLUSION: In conclusion, most of the risk assessment tools showed poor predictive value in the maintenance HD population. Existing bleeding risk tools may not be helpful in dialysis patients. A more valid bleeding risk tool needs to be developed for the ESKD patient population.

Comparison of scoring systems for predicting clinical outcomes of acute lower gastrointestinal bleeding: A prospective cohort study.

This study aimed to determine the performance of the Oakland, Glasgow-Blatchford, and AIMS65 scores in predicting the clinical outcomes of acute lower gastrointestinal bleeding (LGIB). This prospective cohort study was conducted from July 2020 to July 2021. Patients admitted with acute lower gastrointestinal bleeding were enrolled. The Oakland, Glasgow-Blatchford, and AIMS65 scores were calculated. The primary outcome was validating the performance of the scores in predicting severe LGIB; secondary outcomes were comparing the performance of the scores in predicting the need for blood transfusion, hemostatic interventions, in-hospital rebleeding, and mortality. Receiver operating characteristic curves were calculated for all outcomes. The associations between all three scores and the primary outcomes were calculated using multivariate logistic regression analysis. Patients with acute LGIB (n=150) were enrolled (88 [58.7%] men and mean age: 63.6±17.3years). The rates of severe LGIB, need for blood transfusion, hemostatic intervention, in-hospital rebleeding, and in-hospital mortality were 54.7%, 79.3%, 10.7%, and 3.3%, respectively. The Oakland and Glasgow-Blatchford scores had comparable performance in predicting severe LGIB, need for blood transfusion, and mortality, outperforming the AIMS65 score. All scores were suboptimal for predicting hemostatic interventions and rebleeding. Our results demonstrate the predictive performances of the Oakland score and the GBS are excellent and comparable for severe LGIB, the need for blood transfusion, and in-hospital mortality in patients with acute LGIB. Thus, GBS could be considered as an alternative predictive score for stratification of the patients with acute LGIB.

Diagnostic Accuracy of Harbinger Score by Comparing It with Glasgow Blatchford (GBS) for Prediction of Early Endoscopic Intervention Need in Patients with Upper Gastrointestinal Bleed (UGIB)

Accurate risk assessment techniques are crucial to aid in clinical decision-making on the need for early endoscopic intervention in patients with upper GI bleed. The Glasgow-Blatchford Score and the Harbinger Score are two popular scoring systems; however, it is uncertain how accurate their comparative diagnostic abilities are. Objective: To evaluate and compare the diagnostic precision of the Harbinger Score and the Glasgow-Blachford Score in determining the need for early endoscopic intervention among patients experiencing upper gastrointestinal bleeding (UGIB). Methods: 278 UGIB patients who came to the Department of Gastroenterology, Liaqat National Hospital, Karachi, between July 2022 and June 2023 were enrolled. Demographic, clinical information and scores for Harbinger and Glasgow-Blatchford rating systems were derived for each patient. Outcome measure was the requirement for early endoscopic intervention. Diagnostic accuracy was determined and contrasted for both scoring systems. Results: 192 (69.06%) were male, 86 (30.93%) female. Age ranged from 16 to 80 years, with a mean of 65.5±16.4. 117 patients (42.08%) presented with dyspepsia and heartburn and syncope in 6 (2.15%). Mortality AUC was 0.761 for GBS and 0.532 for Harbinger score, p-value &lt;0.002. Both Harbinger and GBS scored &gt;14 and 1. GBS specificity was 88% and Harbinger 54%, while susceptibility was 80% (90% CI: 35.9-95.8) for both scores. The intensive care AUC was 0.769 for GBS and 0.531 for Harbinger score, with a p-value &lt;0.002. Conclusions: According to this study, Harbinger score had better sensitivity than GBS for predicting upper GI bleeding.