scholarly journals Clinical application of AIMS65 score to predict outcome in patients with acute upper gastrointestinal bleeding

2021 ◽  
Vol 2 (2) ◽  
pp. 77-81
Author(s):  
Kijan Maharjan ◽  
Rajesh Kumar Mandal ◽  
Sanjay Shrestha
Keyword(s):  
Blood Transfusion ◽  
Gastrointestinal Bleeding ◽  
Upper Gastrointestinal Bleeding ◽  
Endoscopic Therapy ◽  
Positive Association ◽  
Significant Positive Association ◽  
Cross Sectional ◽  
Icu Admission ◽  
Acute Upper Gastrointestinal Bleeding ◽  
Upper Gastrointestinal

BACKGROUND: Acute upper gastrointestinal bleeding (AUGIB) is a potentially life-threatening condition that requires rapid assessment in the emergency department. The current available scores are complex and have not been widely used in clinical practice. AIMS65 score is a simple score that can be used to risk stratify patients with AUGIB. METHODS: This was a descriptive cross-sectional study done at a single tertiary centre, NAMS, Bir Hospital among the patients presenting with AUGIB from August 2018 to January 2019. AIMS65 scores were calculated in patients presenting with acute UGIB by allotting 1 point each for albumin level < 3g/dl, INR > 1.5, alteration in mental status, systolic blood pressure ≤90 mm Hg, and age ≥65 years. Risk stratification was done during the initial 12 hours of hospital admission. RESULTS: A total of 84 patients consisting of 68 males and 16 females were enrolled in our study, with age ranging from 27 to 80 years. ICU admission, endoscopic therapy and blood transfusion were required in 22,44 and 49 patients respectively. In-patient mortality, the need for blood transfusion, endoscopic therapy or ICU admission were higher in those with AIMS65 score ≥ 2 showing statistically significant positive association (p=0.000). CONCLUSION: AIMS65 score is a simple non-endoscopic risk score that can be applied in patients of acute upper gastrointestinal bleeding to risk stratify and to predict in-patient mortality, the need for blood transfusion, endoscopic therapy or ICU admission.  

scholarly journals Management of non-variceal upper gastrointestinal bleeding: where are we in 2018?

2018 ◽  
Vol 10 (1) ◽  
pp. 35-42 ◽  
Author(s):  
Durayd Alzoubaidi ◽  
Laurence B Lovat ◽  
Rehan Haidry
Keyword(s):  
Gastrointestinal Bleeding ◽  
Upper Gastrointestinal Bleeding ◽  
Endoscopic Therapy ◽  
Positive Impact ◽  
Time Frame ◽  
Epinephrine Injection ◽  
Therapeutic Modalities ◽  
Acute Upper Gastrointestinal Bleeding ◽  
The Uk ◽  
Upper Gastrointestinal

Acute upper gastrointestinal bleeding (AUGIB) is one of the most common medical emergencies in the UK. Despite advancement in technology the management of AUGIB remains a challenge. The clinical community recognise the need for improvement in the treatment of these patients. AUGIB has a significant impact on resources. Endoscopic therapy is the gold standard treatment. The mortality in AUGIB is rarely related to the presenting bleed but significantly associated with concurrent comorbidities. The cost of blood transfusion in the management of patients with AUGIB is significant and misuse of blood products has been documented nationally. Risk stratification tools such as Glasgow-Blatchford Score, Rockall Score and the AIMS65 score have allowed clinicians to triage patients appropriately in order to deliver endoscopic therapy within a suitable time frame. Endoscopic therapeutic modalities such as epinephrine injection, heat thermocoagulation and mechanical clips have had a positive impact on patient’s management. However, in order to continue to improve patient’s outcomes, further developments are needed.

scholarly journals Timing of endoscopy for acute upper gastrointestinal bleeding: a territory-wide cohort study

Gut ◽  
2021 ◽  
pp. gutjnl-2020-323054
Author(s):  
Cosmos L T Guo ◽  
Sunny H Wong ◽  
Louis H S Lau ◽  
Rashid N S Lui ◽  
Joyce W Y Mak ◽  
...  
Keyword(s):  
Cohort Study ◽  
Gastrointestinal Bleeding ◽  
Upper Gastrointestinal Bleeding ◽  
Therapeutic Endoscopy ◽  
Public Hospitals ◽  
Icu Admission ◽  
Acute Upper Gastrointestinal Bleeding ◽  
Early Endoscopy ◽  
All Cause Mortality ◽  
Upper Gastrointestinal

ObjectiveWhile it is recommended that patients presenting with acute upper gastrointestinal bleeding (AUGIB) should receive endoscopic intervention within 24 hours, the optimal timing is still uncertain. We aimed to assess whether endoscopy timing postadmission would affect outcomes.DesignWe conducted a retrospective, territory-wide, cohort study with healthcare data from all public hospitals in Hong Kong. Adult patients (age ≥18) that presented with AUGIB between 2013 and 2019 and received therapeutic endoscopy within 48 hours (n=6474) were recruited. Patients were classified based on endoscopic timing postadmission: urgent (t≤6), early (6<t≤24) and late (24<t≤48). Baseline characteristics were balanced with inverse probability of treatment weighting. 30-day all-cause mortality, repeated therapeutic endoscopy rate, intensive care unit (ICU) admission rate and other endpoints were compared.ResultsResults showed that urgent timing (n=1008) had worse outcomes compared with early endoscopy (n=3865), with higher 30-day all-cause mortality (p<0.001), repeat endoscopy rates (p<0.001) and ICU admission rates (p<0.001). Late endoscopy (n=1601) was associated with worse outcomes, with higher 30-day mortality (p=0.003), in-hospital mortality (p=0.022) and 30-day transfusion rates (p=0.018).ConclusionCompared with urgent and late endoscopy among patients who have received therapeutic endoscopies, early endoscopy was associated with superior outcomes especially among patients with non-variceal bleeding. This supports the notion that non-variceal AUGIB patients should receive endoscopy within 24 hours, but also emphasises the importance of prior resuscitation and pharmacotherapy.

scholarly journals Does Blood Urea Nitrogen Level Predict Severity and High-Risk Endoscopic Lesions in Patients with Nonvariceal Upper Gastrointestinal Bleeding?

2008 ◽  
Vol 22 (4) ◽  
pp. 399-403 ◽  
Author(s):  
Khalid Al-Naamani ◽  
Nabil Alzadjali ◽  
Alan N Barkun ◽  
Carlo A Fallone
Keyword(s):  
High Risk ◽  
Blood Transfusion ◽  
Gastrointestinal Bleeding ◽  
Blood Urea Nitrogen ◽  
Upper Gastrointestinal Bleeding ◽  
Univariate Analysis ◽  
Urea Nitrogen ◽  
Icu Admission ◽  
The Mean ◽  
Upper Gastrointestinal

BACKGROUND: Nonvariceal upper gastrointestinal bleeding (UGIB) is a serious medical condition requiring prompt resuscitation and early endoscopic therapy in those with high-risk endoscopic lesions (HRLs). There are little or no data correlating sole blood urea nitrogen (BUN) level with the severity of nonvariceal UGIB or the presence of HRLs in the adult population.OBJECTIVES: To determine if the BUN level on presentation correlates with parameters of severity of UGIB (need for blood transfusion or intensive care unit [ICU] admission) or to the subsequent finding of HRL, and in so doing identify patients who will require early endoscopic intervention.METHODS: The Canadian Registry of patients with Upper Gastrointestinal Bleeding undergoing Endoscopy was used to identify patients enrolled from the McGill University Health Centre (Montreal, Quebec) who presented with or developed acute nonvariceal UGIB while admitted. All comparisons were performed using Student’sttest or Wilcoxon’s signed rank test, as appropriate. Logistic regression modelling using a stepwise method was performed to identify independent predictors of severe nonvariceal UGIB and HRL.RESULTS: Two hundred nine patients were enrolled in the study. The mean age was 67±18 years and 59.8% were male. The mean BUN level was 13.4±9.4 mmol/L. Univariate analysis demonstrated that the BUN level was a significant predictor of ICU admission (BUN 14.7±10.4 mmol/L versus 12.0±8.0 mmol/L, P=0.035). However, when adjusted for systolic blood pressure, BUN level became a weaker predictor of ICU admission, just failing to achieve statistical significance (OR 1.03, 95% CI 1.00 to 1.06; P=0.08). Univariate analysis also demonstrated that BUN level was not a statistically significant predictor of blood transfusion requirement (BUN 14.1±10.6 mmol/L versus 13.6±8.6 mmol/L, P=0.508), nor of HRL (BUN 14.2±10.7 mmol/L versus 12.9±8.6 mmol/L, P=0.605).CONCLUSION: In patients with nonvariceal UGIB, the BUN level at initial presentation is a weak predictor of the severity of UGIB as defined by ICU admission, but is not helpful in identifying patients with a HRL.

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