Modified Glasgow-Blatchford Bleeding Score as an Alternative Predictors of Severity for Non-Variceal Upper Gastrointestinal Bleeding

BACKGROUND: Upper gastrointestinal bleeding (UGIB) is a frequent cause of emergency hospital admissions. Despite the dependency of most risk scoring systems for this disorder, the Glasgow-Blatchford bleeding score (GBS) is based on simple variables. This research intended for investigate the accuracy of a modified GBS (mGBS) to predict the severity of non-variceal UGIB.METHODS: Study conducted in Emergency Department of Dr. Saiful Anwar Hospital, Malang, from November 2012 to April 2013. Endoscopy performed between 12-24 hours after the patient stabilized. Sixty patients diagnosed were included. The accuracy of the mGBS in predicting the severity of non-variceal UGIB was compared with the full GBS using receiver operating characteristic (ROC) curve. The severity based on high risk in mGBS score compared by Forrest classification.RESULTS: For prediction of the severity of non-variceal UGIB, the GBS (AUC 0.947, 95% CI 0.87-1.03) had a slightly than the mGBS (AUC 0.943, 95% CI 0.86-1.02, p<0.01). Compared to the GBS, the mGBS was more specific (63% and 97%, respectively) but less sensitive (96% and 84%, respectively).CONCLUSION: The mGBS is an alternative diagnostic tool in predicting the severity of non-variceal UGIB.KEYWORDS: non variceal-UGIB, GBS, modified GBS

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

10.21203/rs.2.14578/v1 ◽

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.

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Faculty Opinions recommendation of Comparison of risk scoring systems for patients presenting with upper gastrointestinal bleeding: international multicentre prospective study.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.727169850.793536692 ◽

2017 ◽

Author(s):

Ian Beales

Keyword(s):

Gastrointestinal Bleeding ◽

Prospective Study ◽

Upper Gastrointestinal Bleeding ◽

Scoring Systems ◽

Risk Scoring ◽

Upper Gastrointestinal ◽

Multicentre Prospective Study

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790 International, Multicentre Prospective Study Comparing Risk Scoring Systems for Patients Presenting With Upper Gastrointestinal Bleeding

Gastroenterology ◽

10.1016/s0016-5085(16)30645-x ◽

2016 ◽

Vol 150 (4) ◽

pp. S164

Author(s):

Stig B. Laursen ◽

Loren Laine ◽

Harry Dalton ◽

Rozeta Abazi ◽

Jing Hieng Ngu ◽

...

Keyword(s):

Gastrointestinal Bleeding ◽

Prospective Study ◽

Upper Gastrointestinal Bleeding ◽

Scoring Systems ◽

Risk Scoring ◽

Upper Gastrointestinal ◽

Multicentre Prospective Study

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Prediction model of emergency mortality risk in patients with acute upper gastrointestinal bleeding: a retrospective study

PeerJ ◽

10.7717/peerj.11656 ◽

2021 ◽

Vol 9 ◽

pp. e11656

Author(s):

Lan Chen ◽

Han Zheng ◽

Saibin Wang

Keyword(s):

Emergency Department ◽

Gastrointestinal Bleeding ◽

Upper Gastrointestinal Bleeding ◽

Area Under The Curve ◽

Decision Curve Analysis ◽

Acute Upper Gastrointestinal Bleeding ◽

Bleeding Score ◽

Selection Operator ◽

Upper Gastrointestinal ◽

D Dimer

Background Upper gastrointestinal bleeding is a common presentation in emergency departments and carries significant morbidity worldwide. It is paramount that treating physicians have access to tools that can effectively evaluate the patient risk, allowing quick and effective treatments to ultimately improve their prognosis. This study aims to establish a mortality risk assessment model for patients with acute upper gastrointestinal bleeding at an emergency department. Methods A total of 991 patients presenting with acute upper gastrointestinal bleeding between July 2016 and June 2019 were enrolled in this retrospective single-center cohort study. Patient demographics, parameters assessed at admission, laboratory test, and clinical interventions were extracted. We used the least absolute shrinkage and selection operator regression to identify predictors for establishing a nomogram for death in the emergency department or within 24 h after leaving the emergency department and a corresponding nomogram. The area under the curve of the model was calculated. A bootstrap resampling method was used to internal validation, and decision curve analysis was applied for evaluate the clinical utility of the model. We also compared our predictive model with other prognostic models, such as AIMS65, Glasgow-Blatchford bleeding score, modified Glasgow-Blatchford bleeding score, and Pre-Endoscopic Rockall Score. Results Among 991 patients, 41 (4.14%) died in the emergency department or within 24 h after leaving the emergency department. Five non-zero coefficient variables (transfusion of plasma, D-dimer, albumin, potassium, age) were filtered by the least absolute shrinkage and selection operator regression analysis and used to establish a predictive model. The area under the curve for the model was 0.847 (95% confidence interval [0.794–0.900]), which is higher than that of previous models for mortality of patients with acute upper gastrointestinal bleeding. The decision curve analysis indicated the clinical usefulness of the model. Conclusions The nomogram based on transfusion of plasma, D-dimer, albumin, potassium, and age effectively assessed the prognosis of patients with acute upper gastrointestinal bleeding presenting at the emergency department.

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Semiautomated Glasgow-Blatchford Bleeding Score helps direct bed placement for patients with upper gastrointestinal bleeding

BMJ Open Gastroenterology ◽

10.1136/bmjgast-2020-000479 ◽

2020 ◽

Vol 7 (1) ◽

pp. e000479

Author(s):

Drew B Schembre ◽

Robson E Ely ◽

Janice M Connolly ◽

Kunjali T Padhya ◽

Rohit Sharda ◽

...

Keyword(s):

Intensive Care ◽

High Risk ◽

Length Of Stay ◽

Gastrointestinal Bleeding ◽

Transfusion Requirement ◽

Upper Gastrointestinal Bleeding ◽

Low Risk ◽

Risk Patients ◽

Bleeding Score ◽

Upper Gastrointestinal

ObjectiveThe Glasgow-Blatchford Bleeding Score (GBS) was designed to identify patients with upper gastrointestinal bleeding (UGIB) who do not require hospitalisation. It may also help stratify patients unlikely to benefit from intensive care.DesignWe reviewed patients assigned a GBS in the emergency room (ER) via a semiautomated calculator. Patients with a score ≤7 (low risk) were directed to an unmonitored bed (UMB), while those with a score of ≥8 (high risk) were considered for MB placement. Conformity with guidelines and subsequent transfers to MB were reviewed, along with transfusion requirement, rebleeding, length of stay, need for intervention and death.ResultsOver 34 months, 1037 patients received a GBS in the ER. 745 had an UGIB. 235 (32%) of these patients had a GBS ≤7. 29 (12%) low-risk patients were admitted to MBs. Four low-risk patients admitted to UMB required transfer to MB within the first 48 hours. Low-risk patients admitted to UMBs were no more likely to die, rebleed, need transfusion or require more endoscopic, radiographic or surgical procedures than those admitted to MBs. No low-risk patient died from GIB. Patients with GBS ≥8 were more likely to rebleed, require transfusion and interventions to control bleeding but not to die.ConclusionA semiautomated GBS calculator can be incorporated into an ER workflow. Patients with a GBS ≤7 are unlikely to need MB care for UGIB. Further studies are warranted to determine an ideal scoring system for MB admission.

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

10.21203/rs.2.14578/v2 ◽

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.

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