Development and Validation of a Scoring System to Predict Severe Acute Lower Gastrointestinal Bleeding in Vietnamese

Quach, Duc Trong; Nguyen, Nguyet Thi-My; Vo, Uyen Pham-Phuong; Le, Ly Thi-Kim; Vo, Cong Hong-Minh; Ho, Phat Tan; Nguyen, Tran; Bo, Phuong Kim; Nguyen, Nam Hoai; Vu, Khanh Truong; Dang, Manh Van; Dinh, Mai; Nguyen, Tuan Hung; Nguyen, Xung Van; Le, Suong; Tran, Chi Pham

doi:10.1007/s10620-020-06253-y

Cited by 16 publications

(25 citation statements)

References 21 publications

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“…Although comparatively less well established than in UGIB, risk stratification scores do exist for LGIB. Some have been developed to predict adverse outcomes, including the ABC score [19], Strate score [15], NOBLADS [20], Sengupta score [16], BLEED [17], Birmingham score [21], Severe Acute LGIB (SALGIB) [22] score, and the HAKA score [23]; whilst others have been developed to identify patients at low risk of adverse outcomes: Oakland score [24] and SHA 2 PE [25]. Additionally, scores developed for use in UGIB, such as the Glasgow-Blatchford bleeding score (GBS) [26] and Rockall score [27] have also been shown to have predictive ability in LGIB.…”

Section: Definition Epidemiology and Risk Factorsmentioning

confidence: 99%

Diagnosis and management of acute lower gastrointestinal bleeding: European Society of Gastrointestinal Endoscopy (ESGE) Guideline

et al. 2021

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Main Recommendations 1 ESGE recommends that the initial assessment of patients presenting with acute lower gastrointestinal bleeding should include: a history of co-morbidities and medications that promote bleeding; hemodynamic parameters; physical examination (including digital rectal examination); and laboratory markers. A risk score can be used to aid, but should not replace, clinician judgment.Strong recommendation, low quality evidence. 2 ESGE recommends that, in patients presenting with a self-limited bleed and no adverse clinical features, an Oakland score of ≤ 8 points can be used to guide the clinician decision to discharge the patient for outpatient investigation.Strong recommendation, moderate quality evidence. 3 ESGE recommends, in hemodynamically stable patients with acute lower gastrointestinal bleeding and no history of cardiovascular disease, a restrictive red blood cell transfusion strategy, with a hemoglobin threshold of ≤ 7 g/dL prompting red blood cell transfusion. A post-transfusion target hemoglobin concentration of 7–9 g/dL is desirable.Strong recommendation, low quality evidence. 4 ESGE recommends, in hemodynamically stable patients with acute lower gastrointestinal bleeding and a history of acute or chronic cardiovascular disease, a more liberal red blood cell transfusion strategy, with a hemoglobin threshold of ≤ 8 g/dL prompting red blood cell transfusion. A post-transfusion target hemoglobin concentration of ≥ 10 g/dL is desirable.Strong recommendation, low quality evidence. 5 ESGE recommends that, in patients with major acute lower gastrointestinal bleeding, colonoscopy should be performed sometime during their hospital stay because there is no high quality evidence that early colonoscopy influences patient outcomes.Strong recommendation, low quality of evidence. 6 ESGE recommends that patients with hemodynamic instability and suspected ongoing bleeding undergo computed tomography angiography before endoscopic or radiologic treatment to locate the site of bleeding.Strong recommendation, low quality evidence. 7 ESGE recommends withholding vitamin K antagonists in patients with major lower gastrointestinal bleeding and correcting their coagulopathy according to the severity of bleeding and their thrombotic risk. In patients with hemodynamic instability, we recommend administering intravenous vitamin K and four-factor prothrombin complex concentrate (PCC), or fresh frozen plasma if PCC is not available.Strong recommendation, low quality evidence. 8 ESGE recommends temporarily withholding direct oral anticoagulants at presentation in patients with major lower gastrointestinal bleeding.Strong recommendation, low quality evidence. 9 ESGE does not recommend withholding aspirin in patients taking low dose aspirin for secondary cardiovascular prevention. If withheld, low dose aspirin should be resumed, preferably within 5 days or even earlier if hemostasis is achieved or there is no further evidence of bleeding.Strong recommendation, moderate quality evidence. 10 ESGE does not recommend routinely discontinuing dual antiplatelet therapy (low dose aspirin and a P2Y12 receptor antagonist) before cardiology consultation. Continuation of the aspirin is recommended, whereas the P2Y12 receptor antagonist can be continued or temporarily interrupted according to the severity of bleeding and the ischemic risk. If interrupted, the P2Y12 receptor antagonist should be restarted within 5 days, if still indicated.Strong recommendation, low quality evidence.

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Section: Definition Epidemiology and Risk Factorsmentioning

confidence: 99%

Diagnosis and management of acute lower gastrointestinal bleeding: European Society of Gastrointestinal Endoscopy (ESGE) Guideline

et al. 2021

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“…To date, there have been no validation studies of the two scores in Asian populations. In Vietnam, we have recently developed and validated a local scoring system, the severe acute lower gastrointestinal (SALGIB) score, to predict severe ALGIB ( Table 1 ) [ 10 ]. This score is simpler and easier compared to the two above-mentioned scores and has demonstrated good performance.…”

Section: Introductionmentioning

confidence: 99%

An External Validation Study of the Oakland and Glasgow-Blatchford Scores for Predicting Adverse Outcomes of Acute Lower Gastrointestinal Bleeding in an Asian Population

Quach

Nguyen

et al. 2021

Gastroenterology Research and Practice

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Aims. This study is aimed at (1) validating the performance of Oakland and Glasgow-Blatchford (GBS) scores and (2) comparing these scores with the SALGIB score in predicting adverse outcomes of acute lower gastrointestinal bleeding (ALGIB) in a Vietnamese population. Methods. A multicenter cohort study was conducted on ALGIB patients admitted to seven hospitals across Vietnam. The adverse outcomes of ALGIB consisted of blood transfusion; endoscopic, radiologic, or surgical interventions; severe bleeding; and in-hospital death. The Oakland and GBS scores were calculated, and their performance was compared with that of SALGIB, a locally developed prediction score for adverse outcomes of ALGIB in Vietnamese, based on the data at admission. The accuracy of these scores was measured using the area under the receiver operating characteristic curve (AUC) and compared by the chi-squared test. Results. There were 414 patients with a median age of 60 (48–71). The rates of blood transfusion, hemostatic intervention, severe bleeding, and in-hospital death were 26.8%, 15.2%, 16.4, and 1.4%, respectively. The SALGIB score had comparable performance with the Oakland score (AUC: 0.81 and 0.81, respectively; p = 0.631 ) and outperformed the GBS score (AUC: 0.81 and 0.76, respectively; p = 0.002 ) for predicting the presence of any adverse outcomes of ALGIB. All of the three scores had acceptable and comparable performance for in-hospital death but poor performance for hemostatic intervention. The Oakland score had the best performance for predicting severe bleeding. Conclusions. The Oakland and SALGIB scores had excellent and comparable performance and outperformed the GBS score for predicting adverse outcomes of ALGIB in Vietnamese.

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“…6 The clinical predictive factors of severe colonic bleeding include aspirin use, at least two comorbid illnesses, pulse rate greater than 100/minute, and systolic blood pressure less than 110 mm Hg. 7,8 The over mortality of colonic bleeding is "2.4 to 3.9%." Predictors of higher mortality include age >70 years, intestinal ischemia, and two or more comorbidities.…”

Section: Triaging Of Lgi Bleedingmentioning

confidence: 99%

“…The clinical predictive factors of severe colonic bleeding include aspirin use, at least two comorbid illnesses, pulse rate greater than 100/minute, and systolic blood pressure less than 110 mm Hg. 7 8 The over mortality of colonic bleeding is “2.4 to 3.9%.” Predictors of higher mortality include age >70 years, intestinal ischemia, and two or more comorbidities. 9 10 11 Other studies have also revealed the risk factors for poor LGI bleeding outcome and include hemodynamic instability at presentation, ongoing bleeding, comorbidities, older age, requirement of blood transfusion, and concomitant medications such as nonsteroidal anti-inflammatory drugs (NSAIDs), antiplatelets, and anticoagulants.…”

Section: Triaging Of Lgi Bleedingmentioning

confidence: 99%

Lower Gastrointestinal Bleeding

Jagtap

Reddy

Tandan

2022

Journal of Digestive Endoscopy

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Lower gastrointestinal (LGI) bleeding indicates bleeding from colon or anorectum. Typically, patients with LGI bleeding present with bright red blood per rectum or hematochezia, although rarely they can present with melena as well. Alternatively, LGI bleeding is also defined as bleeding from a source within potential reach of a colonoscope, that is, colon and terminal ileum. LGI bleedings have more favorable outcomes than upper GI (UGI) bleeding and less common than UGI bleeding. Any patient presenting with GI bleeding should undergo a detailed history and physical examination for clues that may suggest source and possible etiology. Colonoscopy remains the most widely used and preferred instrument of choice for both diagnosis and therapy. This review will discuss in brief the causes, triaging, and role of colonoscopy in the management of LGI bleeding.

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Development and Validation of a Scoring System to Predict Severe Acute Lower Gastrointestinal Bleeding in Vietnamese

Cited by 16 publications

References 21 publications

Diagnosis and management of acute lower gastrointestinal bleeding: European Society of Gastrointestinal Endoscopy (ESGE) Guideline

Diagnosis and management of acute lower gastrointestinal bleeding: European Society of Gastrointestinal Endoscopy (ESGE) Guideline

An External Validation Study of the Oakland and Glasgow-Blatchford Scores for Predicting Adverse Outcomes of Acute Lower Gastrointestinal Bleeding in an Asian Population

Lower Gastrointestinal Bleeding

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