Clinical Utility of Risk Scores in Variceal Bleeding

Abstract

BACKGROUND: Variceal bleeding remains important cause of upper gastrointestinal bleed. Various risk scores are used in risk stratification for non-variceal bleed. Their utility in variceal bleeding patients is not clear. This study aims to compare probability of these scores in predicting various outcomes in same population. OBJECTIVE: This study aims to compare probability of these scores in predicting various outcomes in same population. To study characteristics and validate AIMS65, Rockall, Glasgow Blatchford score(GBS), Progetto Nazionale Emorragia Digestiva (PNED) score in variceal Upper Gastrointestinal Bleed (UGIB) patients for predicting various outcomes in our population. METHODS: Three hundred subjects with UGIB were screened prospectively. Of these 141 patients with variceal bleeding were assessed with clinical, blood investigations and endoscopy and risk scores were calculated and compared to non-variceal cases. All cases were followed up for 30 days for mortality, rebleeding, requirement of blood transfusion and need of radiological or surgical intervention. RESULTS: Variceal bleeding (141) was more common than non variceal (134) and 25 had negative endoscopy. In variceal group, cirrhosis (85%) was most common etiology. Distribution of age and sex were similar in both groups. Presence of coffee coloured vomitus (P=0.002), painless bleed (P=0.001), edema (P=0.001), ascites (P=0.001), hemoglobin <7.5 gms (P<0.001), pH<7.35 (P<0.001), serum bicarbonate level <17.6 mmol/L (P<0.001), serum albumin<2.75 gms% (P<0.001), platelet count <1.2 lacs/µL (P<0.001), high INR 1.35 (P<0.001), BUN >25mmol/L (P<0.001), and ASA status (P<0.001), high lactate >2.85 mmol/L (P=0.001) were significant. However, no factor was found significant on multivariate analysis. Rockall was found to be significant in predicting mortality and rebleed. AIMS65 was also significant in predicting mortality. GBS was significant in predicting blood transfusion and need of intervention. PNED score was significant in all events except mortality. CONCLUSION: All four scores had lower predictive potential in predicting events in variceal bleed. However, AIMS65 & Rockall score were significant in predicting mortality, while GBS in predicting need of transfusion and intervention. PNED score was significant in all events except mortality.

Clinical results of patients with variceal bleeding and risk analysis of scoring systems

“…One study used the AIMS65, MELD, APACHE II, and Child-Pugh scores to predict mortality in cases of acute variceal hemorrhage in cirrhotic patients and showed that the AIMS65 score had the highest sensitivity and specificity [25]. A different study reported that the AIMS65 and Rockall scores were superior to the other assessed scoring systems in predicting mortality [26]. In our study, the AIMS65 and Rockall scoring systems were less reliable compared to other scoring systems.…”

Systematic review and meta-analysis of risk scores in prediction for the clinical outcomes in patients with acute variceal bleeding

“…Eleven out of 28 studies were prospective. Nine studies reported sensitivity and specificity values [ 19 , 21 , 26 , 27 , 32 , 34 , 36 , 38 , 42 ]. All studies presented AUCs and 95% CIs.…”

Construction and validation of a predictive model for the risk of rebleeding in patients with esophageal and gastric varices hemorrhage

“…Another study compared the risk of clinical adverse events using the GBS and RS scores in NVUGIB and VUGIB patients, demonstrating that GBS can only predicted rebleeding risk in the NVUGIB subgroup and had lower predictive ability for rebleeding risk in VUGIB patients [16]. A prospective study in Brazil analyzed the ability of RS, GBS, AIMS65 and PNED (Progetto Nazionale Emorragia Digestiva) to predict rebleeding risk in VUGIB patients, revealing that only RS and PNED could predict rebleeding risk within 30 days, but both had AUC values below 0.7 (0.662 vs. 0.652, respectively) [17]. These research ndings indicate that although these scoring systems exhibit some accuracy in predicting rebleeding risk in NVUGIB patients, none of them can accurately predict rebleeding risk in VUGIB patients.…”