Comparison of risk scoring systems for the prediction of clinical outcomes in nonvariceal upper gastrointestinal bleeding: a prospective randomized study

Year 2023, Volume: 6 Issue: 3, 643 - 649, 31.05.2023

Muhammed Bahaddin Durak , Batuhan Başpınar , İbrahim Ethem Güven , İlhami Yüksel

https://doi.org/10.32322/jhsm.1270718

Abstract

Aim: Non-variceal upper gastrointestinal bleeding (UGIB) is a typical gastrointestinal emergency. Detection of high-risk patients is crucial to organize medical care accordingly. This study aims to compare risk assessment scores for their ability to predict prognosis in nonvariceal-UGIB.
Material and Method: Adult patients with nonvariceal-UGIB applied to the emergency department were recruited prospectively. Clinical and Complete Rockall score (RS), Glascow-Blatchford score (GBS), AIMS65, and T-Score were compared for endpoints: (1) need for endoscopic treatment, (2) hospitalization, (3) rebleeding, and (4) 30-day mortality.
Results: A total of 469 patients were included. While 133 (28.0%) patients were discharged within 24 hours, 336 (72.0%) were hospitalized. The median length of hospital stay was 6.6 (0.0-8.0) days. Endoscopic treatment and transfusion were required in 109 (23.0%) and 255 (54.0%) patients, respectively. Rebleeding was observed in 36 (8.0%) patients. The 30-day mortality rate was 11.0 %. Complete Rockall score was superior among all risk scores regarding the prediction of the need for endoscopic treatment (AUC: 0.707, p<0.001) and hospitalization (AUC: 0.678, p<0.001). AUC values of AIMS65, Clinical RS, Complete RS, GBS, and T-score were 0.688, 0.601, 0.634, 0.631, and 0.651, respectively (p>0.05). AIMS65 score (AUC: 0.810, p<0.05) was superior to the clinical RS and GBS at predicting 30-day mortality. However, there was no difference between the AIMS65 score and the other scores of areas under the curve (p> 0.05).
Conclusion: Complete RS and AIMS65 scores are valuable tools to determine UGIB-related endpoints (need for intervention, hospitalization, rebleeding, and mortality). Identifying high-risk patients using the risk scoring systems and performing endoscopy in this group may improve clinical outcomes, while their sensitivity is inadequate in the low-risk patients.

Keywords

Gastrointestinal hemorrhage, endoscopy, risk assessment, prognosis

Varis dışı üst gastrointestinal kanamada klinik sonuçların tahmininde risk puanlama sistemlerinin karşılaştırılması: prospektif randomize çalışma

Abstract

Giriş/Amaç: Varis dışı üst gastrointestinal kanama (UGIB) tipik bir gastrointestinal acil durumdur. Yüksek riskli hastaların tespiti ve medikal yaklaşımı buna göre belirlemek çok önemlidir. Bu çalışma, varis dışı-UGIB'de prognozu predikte etme açısından risk değerlendirme puanlarını karşılaştırmayı amaçlamaktadır.
Gereç ve Yöntemler: Acil servise varis dışı UGIB ile başvuran erişkin hastalar prospektif olarak çalışmaya alındı. Klinik ve Full Rockall skoru (RS), Glascow-Blatcford skoru (GBS), AIMS65 ve T-Skoru, (1) endoskopik tedavi ihtiyacı, (2) hospitalizasyon ihtiyacı, (3) tekrar kanama ve (4) 30 günlük mortalite açısından karşılaştırıldı.
Bulgular: Toplam 469 hasta dahil edildi. 133 (%28,0) hasta 24 saat içinde taburcu edilirken, 336 (%72,0) hasta hastaneye yatırıldı. Hastanede kalış süresi medyan 6,6 (0,0-8,0) gündü. Endoskopik tedavi ihtiyacı 109 (%23,0), transfüzyon ihtiyacı 255 (%54,0) hastada gerekti. 36 (%8,0) hastada tekrar kanama görüldü. 30 günlük mortalite oranı %11.0 idi. Endoskopik tedavi (AUC: 0.707, p<0.001) ve hastaneye yatış (EAA: 0.678, p<0.001) gereksinimini predikte etmede Total Rockall skoru tüm risk skorları arasında üstündü. AIMS65 skoru (EAA: 0.810, p<0.05), 30 günlük mortaliteyi öngörmede klinik RS ve GBS'den üstündü.
Sonuç: GBS ve AIMS65 skorları, UGIB ile ilişkili sonlanım noktalarını (endoskopik tedavi ihtiyacı, hastaneye yatış, tekrar kanama ve mortalite) belirlemek için değerli skorlama sistemleridir. Risk skorlama sistemlerini kullanarak yüksek riskli hastaların belirlenmesi ve bu grupta endoskopi yapılması klinik sonuçları iyileştirebilirken, düşük riskli hastalarda duyarlılıkları yetersizdir.

Keywords

Gastrointestinal hemoraji, Endoskopi, Risk değerlendirmesi, Prognoz

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