Development and Validation of a Novel 1-year Mortality Risk Score That Includes the Use of Antithrombotic in Patients With Overt Gastrointestinal Bleeding

Abstract

Goals and Background: We aimed to develop a novel 1-year mortality risk-scoring system that includes use of antithrombotic (AT) drugs and to validate it against other scoring systems in patients with acute gastrointestinal bleeding (GIB). Study: We developed a risk-scoring system from prospectively collected data on patients admitted with GIB between January 2013 and August 2020, who had at least 1- year of follow-up. Independent predictors of 1-year mortality were determined after adjusting for the following confounders: the age-adjusted Charlson Comorbidity Index (CCI) (divided into 4 groups: CCI-0=0, CCI-1=1 to 3, CCI-2=4 to 6, CCI-3 ≥7), need for blood transfusion, GIB severity, need for endoscopic therapy, and type of AT. The risk score was based on independent predictors. Results: Five hundred seventy-six patients were included and 123 (21%) died at 1-year follow-up. Our risk -score was based on the following: CCI-2 (2 points), CCI-3 (4 points), need for blood transfusion (1 point), and no use of aspirin (1 point), as aspirin use was protective (maximum score=6). Patients with higher risk scores had higher mortality. The model had a better predictive accuracy [AUC=0.82, 95% confidence interval (0.78-0.86), P<0.0001] than the Rockall score for upper GIB (Area Under the Curve (AUC)=0.68, P<<0.0001), the Oakland score for lower GIB (AUC=0.69, p=0.004), or the Shock Index for all (AUC=0.54, P<0.0001). Conclusion: A simple and novel score that includes use of AT upon admission accurately predicts 1-year mortality in patients with GIB. This scoring system may help guide follow-up decisions and inform the prognosis of patients with GIB.

Impact of blood transfusion on mortality and rebleeding in gastrointestinal bleeding: an 8-year cohort from a tertiary care center

“…The studies on non-variceal UGIB showed inconsistent results [ 22 ]. Our study, which included patients with UGIB, LGIB and only a small proportion of patients with variceal hemorrhage, found that BT did not affect long-term mortality, but increased 1-year mortality 3-fold, even after adjustment for confounders [ 11 ].…”

“…Although these studies were limited by the fact that transfused patients are generally sicker than non-transfused ones, 2 recent studies that used propensity matching to compare transfused and non-transfused patients suggested that BT does indeed increase the risk of mortality and rebleeding [ 9 , 10 ]. Furthermore, in a prospective study of patients presenting with GIB, BT was found to be an independent predictor of 1-year mortality [ 11 ].…”