Development, Validation, and Comparative Assessment of an International Scoring System to Determine Risk of Upper Gastrointestinal Bleeding

2019 ◽  
Vol 17 (6) ◽  
pp. 1121-1129.e2 ◽  
Author(s):  
Kathryn Oakland ◽  
Brennan C. Kahan ◽  
Leonardo Guizzetti ◽  
Myriam Martel ◽  
Robert V. Bryant ◽  
...  
Keyword(s):  
Gastrointestinal Bleeding ◽  
Scoring System ◽  
Upper Gastrointestinal Bleeding ◽  
Comparative Assessment ◽  
Upper Gastrointestinal

scholarly journals MAP(ASH): A new scoring system for the prediction of intervention and mortality in upper gastrointestinal bleeding

2019 ◽  
Vol 35 (1) ◽  
pp. 82-89 ◽  
Author(s):  
Eduardo Redondo‐Cerezo ◽  
Francisco Vadillo‐Calles ◽  
Adrian J Stanley ◽  
Stig Laursen ◽  
Loren Laine ◽  
...  
Keyword(s):  
Gastrointestinal Bleeding ◽  
Scoring System ◽  
Upper Gastrointestinal Bleeding ◽  
Upper Gastrointestinal ◽  
New Scoring

scholarly journals Validation of a New Risk Score System for Non-variceal Upper Gastrointestinal Bleeding

2020 ◽  
Author(s):  
Min Seong Kim ◽  
Hee Seok Moon ◽  
In Sun Kwon ◽  
Jae Ho Park ◽  
Ju Seok Kim ◽  
...  
Keyword(s):  
Mortality Rate ◽  
Gastrointestinal Bleeding ◽  
Hospital Stay ◽  
Roc Curve ◽  
Scoring System ◽  
Operating Characteristic ◽  
Upper Gastrointestinal Bleeding ◽  
Bleeding Score ◽  
Upper Gastrointestinal ◽  
New Scoring

Abstract Background: Recently, a new international bleeding score was developed to predict 30-day hospital mortality in patients with upper gastrointestinal bleeding (UGIB). However, the efficacy of this newly developed scoring system has not been extensively investigated. We aimed to validate a new scoring system for predicting 30-day mortality in patients with non-variceal UGIB and determine whether a higher score is associated with re-bleeding, length of hospital stay, and endoscopic failure.Methods: A retrospective study was performed on 905 patients with acute non-variceal UGIB who were examined in our hospital between January 2013 and December 2017. Baseline characteristics, endoscopic findings, re-bleeding, admission, and mortality were reviewed. The 30-day mortality rate of the new international bleeding risk score was calculated using the receiver operating characteristic curves and compared to the pre-endoscopy Rockall score, AIMS65, Glasgow Blatchford score, and Progetto Nazionale Emorragia Digestiva score. To verify the variable for the 30-day mortality of the new scoring system, we performed multivariate logistic regression using our data and further analyzed the score items.Results: The new international bleeding scoring system showed higher receiver operating characteristic (ROC) curve values in predicting mortality (area under ROC curve 0.958; [95% confidence interval (CI)]), compared with such as AIMS65 (AUROC, 0.832; 95%CI, 0.806-0.856; P<0.001), PNED (AUROC, 0.865; 95%CI, 0.841-0.886; P<0.001), Pre-RS (AUROC, 0.802; 95%CI, 0.774-0.827; P<0.001), and GBS (AUROC, 0.765; 95%CI, 0.736-0.793; P <0.001). Multivariate analysis was performed using our data and showed that the 30-day mortality rate was related to multiple comorbidities, blood urea nitrogen, creatinine, albumin, syncope at first visit, and endoscopic failure within 24 hours during the first admission. In addition, in the high-score group, relatively long hospital stay, re-bleeding, and endoscopic failure were observed.Conclusion: The new international bleeding score could predict 30-day mortality better than the other scoring systems. High-risk patients can be screened using this new scoring system to predict 30-day mortality. The use of this scoring system seems to improve the outcomes of non-variceal UGIB patients through proper management and intervention.

scholarly journals Validation of a New Risk Score System for Non-variceal Upper Gastrointestinal Bleeding

2019 ◽  
Author(s):  
Min Seong Kim ◽  
Hee Seok Moon ◽  
In Sun Kwon ◽  
Jae Ho Park ◽  
Ju Seok Kim ◽  
...  
Keyword(s):  
Mortality Rate ◽  
Gastrointestinal Bleeding ◽  
Roc Curve ◽  
Scoring System ◽  
Operating Characteristic ◽  
Upper Gastrointestinal Bleeding ◽  
Scoring Systems ◽  
Bleeding Score ◽  
Upper Gastrointestinal ◽  
New Scoring

Abstract Background Recently, a new international bleeding score was developed to predict 30-day hospital mortality in patients with upper gastrointestinal bleeding (UGIB). However, the efficacy of this newly developed scoring system has not been extensively investigated. We aimed to validate a new scoring system for predicting 30-day mortality in patients with non-variceal UGIB and determine whether a higher score is associated with re-bleeding, length of hospital stay and endoscopic failure.Methods A retrospective study was performed on 905 cases with acute non-varieal UGIB who were examined in our hospital between January 2013 and December 2017. Baseline characteristics, endoscopic findings, re-bleeding, admission, and mortality were reviewed. The 30-day mortality rate of the new international bleeding risk score was calculated using the receiver operating characteristic curves and compared to the pre-endoscopy Rockall score, AIMS65, Glasgow Blatchford score, and Progetto Nazionale Emorragia Digestiva score. To verify the variable for the 30-day mortality of the new scoring system, we performed multivariate logistic regression using our data and further analyzed the score items.Results Compared with other scoring systems, the new international bleeding scoring system showed higher receiver operating characteristic (ROC) curve values in predicting mortality. (area under ROC curve 0.832; [95% confidence interval (CI)]) Multivariate analysis was performed using our data, the 30-day mortality rate was related to multiple comorbidities, BUN, creatinine, albumin, syncope at first visit, and endoscopic failure at first admission within 24 hours. In addition, in the new high score group, relatively long hospital stays, re-bleeding, and endoscopic failure were observed.Conclusion The new international bleeding score could predict 30-day mortality better than the other scoring systems. High-risk patients can be screened using this new scoring system to predict 30-day mortality. The use of this scoring system seems to improve the outcomes of non-variceal UGIB patients through proper management and intervention.

scholarly journals Upper GI bleeding: Causes, morbidity and mortality in admitted patients at Tertiary Care Hospital of Karachi.

2019 ◽  
Vol 26 (11) ◽  
pp. 1916-1924
Author(s):  
Naresh Kumar Seetlani ◽  
Khalid Imran ◽  
Pooja Deepak ◽  
Fizza Tariq ◽  
Daniyal Mirza ◽  
...  
Keyword(s):  
Peptic Ulcer ◽  
Gastrointestinal Bleeding ◽  
Peptic Ulcer Disease ◽  
Scoring System ◽  
Upper Gastrointestinal Bleeding ◽  
Morbidity And Mortality ◽  
Mortality Data ◽  
Ulcer Disease ◽  
Variceal Bleed ◽  
Upper Gastrointestinal

Objectives: Acute upper gastrointestinal bleed is one of the most common emergencies. Despite advancement in the medical field, gastrointestinal bleeding still carries significant mortality and fiscal burden on healthcare system. At present, limited data is available on the predictors of morbidity and mortality associated with acute upper gastrointestinal bleeding in our part of the country. Study Design: Descriptive analytical study. Setting: Medical wards of Civil Hospital Karachi. Period: From January 2018 to June 2018. Material and Methods: 260 patients of 12 years and above with complaint of upper gastrointestinal bleeding. After hemodynamic stabilization, patients were referred to undergo esophago-gastro-duodenoscopy at the endoscopy suite of the hospital. Their personal data and endoscopic findings were recorded after obtaining a written consent. The patients were followed for 2 weeks to document the factors leading to their morbidity and mortality. We used Rockall scoring system to identify risk of patient mortality. Data collected was analyzed using SPSS 22·0. Results: The survey included 260 patients having males (62·3%) more than females (37·7%) with age ranging from 12 to 85 years. Among all, variceal bleed was accounted in 186 (71·5%) patients while remaining 74 (28·4%) patients had non-variceal bleed; peptic ulcer disease being the most common etiology. The overall mortality rate of our study was 5·76%. Some factors influencing mortality of the patients were age > 60 years, comorbid, use of NSAIDS, rebleeding, deranged laboratory tests at the time of presentation- anemia (hemoglobin of < 10 g\dl), grade 3 thrombocytopenia (platelet count of < 50 cells\dl), serum creatinine > 1·5 and serum INR of > 1·6. Additionally, a direct proportion was seen in between Rockall scoring system and patient mortality with a significant p-value (0·000). Conclusion: In this study, variceal bleeding was found as the predominant lesion of upper gastro-intestinal bleeding followed by peptic ulcer disease. Certain factors are found that are strongly related in deteriorating patient’s outcome. Along with it, Rockall score is also a good predictor of outcome of patients.

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