Comparisons of six endoscopy independent scoring systems for the prediction of clinical outcomes for elderly and younger patients with upper gastrointestinal bleeding

Abstract

Objectives To compare the predictive ability of six pre-endoscopic scoring systems (ABC, AIMS65, GBS, MAP(ASH), pRS, and T-score) for outcomes of upper gastrointestinal bleeding (UGIB) in elderly and younger patients. Methods A retrospective study of 1260 patients, including 530 elderly patients (age $$\ge$$ ≥ 65) and 730 younger patients (age < 65) presenting with UGIB, was performed at Zhongda Hospital Southeast University, from January 2015 to December 2020. Six scoring systems were used. Results ABC had the largest areas under the curve (AUCs) of 0.827 (0.792–0.858), and 0.958 (0.929–0.987) for elderly and younger groups for predicting mortality respectively. The differences of the AUCs for predicting the outcome of mortality and rebleeding between the two groups were significant for ABC and pRS (p < 0.01). For intervention prediction, significant differences were observed only for pRS [AUC 0.623 (0.578–0.669) vs. 0.699 (0.646–0.752)] (p < 0.05) between the two groups. For intensive care unit (ICU) admission, the AUC for MAP (ASH) [0.791 (0.718–0.865) vs. 0.891 (0.831–0.950)] and pRS [0.610 (0.514–0.706) vs. 0.891 (0.699–0.865)] were more effective for the younger group (p < 0.05 and p < 0.01, respectively). For comparison of scoring systems in the same cohort, ABC was significantly higher than pRS: AUC 0.710 (0.699–0.853, p < 0.05) and T-score 0.670 (0.628–0.710, p < 0.01) for predicting mortality in the elderly group. In the younger group, ABC was significantly higher than GBS and T-score (p < 0.01). MAP(ASH) performs the best in predicting intervention in both groups. Conclusions ABC and pRS are more accurate for predicting mortality and rebleeding in the younger cohort, and pRS may not be suitable for elderly patients. There was no difference between the two study populations for GBS, AIMS65, and T-score. Except for ICU admission, MAP(ASH) showed fair accuracy for both cohorts.

The Accuracy of Pre-Endoscopic Scores for Mortality Prediction in Patients with Upper GI Bleeding and No Endoscopy Performed

“…GBS and RS are complex and sometimes difficult to use in emergency settings due to their low accuracy. Thus, during the last 10 years, other scores have been proposed for predicting intervention, including the N-score [ 8 ], Iino score [ 7 , 9 ], and H3B2 [ 7 ], or for predicting mortality, such as the MAP score [ 10 , 11 ], INBS (International Bleeding Score), PNED (Progetto Nazionale Emmoragia Digestive) [ 12 ], and Harbinger score [ 13 ]. H3B2 was proposed in 2019 and is useful for the prediction of therapeutic interventions, including emergency endoscopy, with an accuracy superior to both GBS and modified GBS, and also with satisfactory accuracy in mortality prediction [ 7 ].…”

“…Iino or Hirosaki score was proposed in 2016 for predicting intervention in a study of 212 patients in Japan and demonstrated superiority to both clinical Rockall and AIM65 [ 14 ]. MAP score was proposed in 2020 for the prediction of both intervention and risk of death [ 10 ], and INBS (ABC score) was proposed in an international cohort study in order to better assess mortality risk [ 15 ] and subsequently validated in other studies as superior to preclinical Rockall, GBS, PNED and AIM65 [ 16 , 17 ].…”

“…Therefore, the patients with no endoscopy performed represent a heterogenous group, with few studies regarding both mortality and the role of risk (non-endoscopic) scores in the prognostic evaluation. The mortality risk in the subgroup of patients without endoscopy is poorly evaluated in the literature; most studies included only patients with UGIB with endoscopy performed, and the absence of endoscopy represents one of the exclusion criteria in studies evaluating the performance of risk scores [ 1 , 3 , 4 , 10 , 24 , 25 , 26 , 27 ]. In this setting, a study evaluating the accuracy of prognostic scores for mortality in a subgroup of patients without endoscopy and with no known etiology for bleeding can be useful in order to predict the risk of death.…”