Prospective Comparison of the 3 Most Commonly Used Scoring Systems in Patients with GI Bleeding

Yıl 2022, Cilt: 11 Sayı: 3, 426 - 433, 04.10.2022

Tufan Alatlı , Salih Kocaoğlu

https://doi.org/10.53424/balikesirsbd.1105016

Öz

Aim: This study aimed to determine the most appropriate scoring system for the emergency department to facilitate the management of patients with gastrointestinal bleeding. Materials and Methods: Data were collected prospectively September’21-March’22 period in the emergency department. A total of 117 adult patients with GI bleeding were included. Composite clinical outcomes consisted of a need for surgical or endoscopic intervention, rebleeding, intensive care unit admission, or in-hospital mortality. Results: The median age of patients was 75 years and 58.1% (n=68) of them were male. Of the patients, 21 were hospitalized in the intensive care unit and 85 in the ward (17.94-72.64%). All three scoring systems can determine the hospitalization place or discharge of patients with GI bleeding. A positive and significant correlation was found between Glasgow-Blatchford and AIMS-65 and length of hospitalization (p<0.05). In-hospital mortality developed in 15 (12.82%) of the patients. Rockall, Glasgow-Blatchford, and AIMS-65 scoring systems were found to be significant for mortality prediction (AUC= 0.745 - 0.777 - 0.851). Seventy-one (60.68%) of patients received ES transfusion, and the Rockall, Glasgow-Blatchford, and AIMS-65 scoring systems were found to be significant for the prediction of ES transfusion (AUC= 0.624 - 0.826 - 0.653). Rebleeding developed in 16 (13.67%) patients. Glasgow-Blatchford and AIMS-65 scoring systems were found to be significant for rebleeding (p= 0.03-0.04). The Rockall classification was found to be insignificant (p=0.57). Conclusion: All scoring systems were successful in terms of management of patients with GI bleeding and survey estimation. The AIMS-65 scoring system stands out only in terms of rebleeding prediction. For this reason and it is more practical, we recommend the AIMS-65 scoring system for the emergency department.

Anahtar Kelimeler

Gastrointestinal bleeding, scoring systems, emergency department, complications

Destekleyen Kurum

Yok

Proje Numarası

Yok

Teşekkür

The authors would like to thank colleagues in the department of emergency department.

GIS Kanamalı Hastalarda En Sık Kullanılan 3 Skorlama Sisteminin Prospektif Karşilaştırılmasi

Öz

Amaç: Bu çalışmanın amacı Gastrointestinal kanamalı hasta yönetimini kolaylaştırmak için acil servise en uygun skorlama sistemini saptamaktır. Gereç ve Yöntem: Veriler, acil serviste 6 aylık (22.09.2021-31.03.2022) bir süre boyunca ileriye dönük olarak toplandı. GI kanaması olan yetişkin 117 hasta dahil edildi. Bileşik klinik sonuçlar, cerrahi veya endoskopik müdahale ihtiyacı, tekrar kanama, yoğun bakım ünitesine yatış veya hastane içi ölümden oluşuyordu. Bulgular: Hastaların ortanca yaşı 75 olup, %58,1'i (n=68) erkekti. Hastaların 21’i yoğun bakım, 85’i servise yatırıldı (% 17,94-72,64). Her üç skorlama sistemide hastalarının yatış yeri veya taburculuğunu belirleyebilmektedir. Glasgow-Blatchford ve AIMS-65 ile yatış süresi arasında pozitif anlamlı bir ilişki bulunmuştur (p<0,05). Hastaların 15’inde (%12,82) hastane içi mortalite gelişmiştir, Rockall, Glasgow-Blatchford, AIMS-65 skorlama sistemleri mortalite tahmini yönünden anlamlı bulunmuştur (AUC= 0.745 – 0.777 – 0,851 ). Hastaların 71’ine (%60,68) ES transfüzyonu yapılmıştır ve Rockall, Glasgow-Blatchford, AIMS-65 skorlama sistemleri ES transfüzyonu tahmini açısından anlamlı saptanmıştır (AUC= 0.624 – 0.826 – 0,653). Hastalardan 16’sında (%13,67) rebleeding gelişmiştir. Glasgow-Blatchford ve AIMS-65 skorlamaları rebleeding için anlamlı (p= 0,03-0,04), Rockall sınıflaması ise anlamsız saptanmıştır (p=0,57). Sonuç: Tüm skorlama sistemleri GIS kanama hastalarının yönetimi ve survey tahmini açısından başarılıdır. Sadece rebleeding tahmini açısından AIMS-65 ön plana çıkmaktadır. Bu sebepten ve daha pratik olduğundan AS için biz AIMS-65 skorlama sistemini önermekteyiz.

Anahtar Kelimeler

Gastrointestinal Kanama, Skorlama Sistemi, Acil Servis, Komplikasyonlar

Proje Numarası

Yok

Kaynakça

• Referans1 Abougergi, M.S., Charpentier, J.P., Bethea, E., Rupawala, A., Kheder, J., Nompleggi, D., Liang, P., Travis, A.C.,& Saltzman, J.R. (2016). A prospective, multicenter study of the AIMS65 score compared with the Glasgow-Blatchford score in predicting upper gastrointestinal hemorrhage outcomes. J Clin Gastroenterol, 50(6):464-9.
• Referans2 Atkinson, R.J., & Hurlstone, D.P. (2008). Usefulness of prognostic indices in upper gastrointestinal bleeding. Best Pract Res Clin Gastroenterol, 22(2):233–42
• Referans3 Çay, F., & Çetinkaya, H.B. (2022). The usability of shock index and lactate in predicting mortality in multitrauma patients presenting to the emergency department. Anatolian Current Medical Journal, 4(2): 185-189
• Referans4 Gu, L., Xu, F., & Yuan, J. (2018). Comparison of AIMS65, Glasgow-Blatchford and Rockall scoring approaches in predicting the risk of in-hospital death among emergency hospitalized patients with upper gastrointestinal bleeding: a retrospective observational study in Nanjing, China. BMC Gastroenterol, 18(1):98. doi: 10.1186/s12876-018-0828-5.
• Referans5 Jung, D.H., Ko, B.S., Kim, Y.J., & Kim, W.Y. (2019). Comparison of risk scores and shock index in hemodynamically stable patients presenting to the emergency department with nonvariceal upper gastrointestinal bleeding. Eur J Gastroenterol Hepatol, 31(7):781-785.
• Referans6 Kim, M.S., Choi, J., & Shin, W.C. (2019). AIMS65 scoring system is comparable to Glasgow-Blatchford score or Rockall score for prediction of clinical outcomes for non-variceal upper gastrointestinal bleeding. BMC Gastroentero, 26;19(1):136.
• Referans7 Lewis, J.D., Bilker, W.B., Brensinger, C., Farrar, J.T., & Strom, B.L. (2002). Hospitalization and mortality rates from peptic ulcer disease and GI bleeding in the 1990s: relationship to sales of nonsteroidal antiinflammatory drugs and acid suppression medications. Am J Gastroenterol, 97:2540-2549.
• Referans8 Martínez-Cara, J.G., Jiménez-Rosales, R., Úbeda-Muñoz, M., de Hierro, M.L., de Teresa, J., & Redondo-Cerezo, E. (2016). Comparison of AIMS65, Glasgow-Blatchford score, and Rockall score in a European series of patients with upper gastrointestinal bleeding: performance when predicting in-hospital and delayed mortality. United European Gastroenterol J, 4(3):371-379. doi:10.1177/2050640615604779
• Referans9 Park, S.M., Yeum, S.C., Kim, B.W., Kim, J.S., Kim, J.H., Sim, E.H., Ji, J.S., & Choi, H. (2016). Comparison of AIMS65 Score and other scoring systems for predicting clinical outcomes in Koreans with nonvariceal upper gastrointestinal bleeding. Gut and Liver, 10(4): 526-531
• Referans10 Shafaghi, A., Gharibpoor, F., Mahdipour, Z., & Samadani, A.A. (2019). Comparison of three risk scores to predict outcomes in upper gastrointestinal bleeding; modifying Glasgow-Blatchford with albumin. Rom J Intern Med, 57(4):322-333. doi: 10.2478
• Referans11 Stanley, A.J., Dalton, H.R., Glasgow-Blatchford, O., Ashley, D., Mowat, C., Cahill, A., Gaya, D.R., Thompson, E., Warshow, U., Hare, N., Groome, M., Benson, & G., Murray, W. (2011). Multicentre comparison of the Glasgow-Blatchford and Rockall Scores in the prediction of clinical end-points after upper gastrointestinal haemorrhage. Aliment Pharmacol Ther, 34(4):470–5.
• Referans12 Stanley, A.J., Laine, L., Dalton, H.R., Ngu, J.H., Schultz, M., Abazi, R., Zakko, L., Thornton, S., Wilkinson, K., Khor, C.J., Murray, I.A., Laursen, S.B. (2017). International Gastrointestinal Bleeding Consortium. Comparison of risk scoring systems for patients presenting with upper gastrointestinal bleeding: international multicentre prospective study. BMJ, 4;356:i6432. doi: 10.1136/bmj.i6432.
• Referans13 Tang, Y., Shen, J., Zhang, F., Zhou, X., Tang, Z., & You, T. (2018). Comparison of four scoring systems used to predict mortality in patients with acute upper gastrointestinal bleeding in the emergency room. Am J Emerg Med, 36(1):27-32. doi: 10.1016/j.ajem.2017.06.053
• Referans14 Wang, C.H., Chen, Y.W., Young, Y.R., Young, C.J., & Chem, J.C. (2013). A prospective comparison of 3 scoring systems in upper gastrointestinal bleeding. American Journal of Emergency Medicine 31: 775–778
• Referans15 Zhong, M., Chen, W.J., Lu, X.Y., Qian, J., Zhu, C.Q. (2016). Comparison of three scoring systems in predicting clinical outcomes in patients with acute upper gastrointestinal bleeding: a prospective observational study. J Dig Dis, 17(12):820-828. doi: 10.1111/1751-2980.12433.