Prediction of in-hospital mortality after acute upper gastrointestinal bleeding: cross-validation of several risk scoring systems

Abstract

Objective We aimed to identify the clinical, biochemical, and endoscopic features associated with in-hospital mortality after acute upper gastrointestinal bleeding (AUGIB), focusing on cross-validation of the Glasgow-Blatchford score (GBS), full Rockall score (RS), and Cedars-Sinai Medical Center Predictive Index (CSMCPI) scoring systems. Methods Our prospective cross-sectional study included 156 patients with AUGIB. Several statistical approaches were used to assess the predictive accuracy of the scoring systems. Results All three scoring systems were able to accurately predict in-hospital mortality (area under the receiver operating characteristic curve [AUC] > 0.9); however, the multiple logistic model separated the presence of hemodynamic instability (state of shock) and the CSMCPI as the only significant predictive risk factors. In compliance with the overall results, the CSMCPI was consistently found to be superior to the other two systems (highest AUC, highest sensitivity and specificity, highest positive and negative predictive values, highest positive likelihood ratio, lowest negative likelihood ratio, and 1-unit increase in CSMCPI associated with 6.3 times higher odds of mortality), outperforming the GBS and full RS. Conclusions We suggest consideration of the CSMCPI as a readily available and reliable tool for accurately predicting in-hospital mortality after AUGIB, thus providing an essential backbone in clinical decision-making.

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

“…A multicenter study which assessed the accuracy of 5 scores (GBS, Pre-RS, full-RS, AIM65, and PNED) for both intervention and mortality found that GBS was superior in predicting intervention or death [ 34 ]. Another study which analyzed the performance of 3 scores (GBS, full Rockall score and CS) for the prediction of in-hospital mortality found that all scores had an AUC > 0.9 but CS was superior to RS and GBS [ 4 ].…”

“…Upper gastrointestinal bleeding (UGIB) represents a common cause of hospital admissions in the gastroenterology and intensive care unit (ICU), with mortality ranging from 3 to 15% [ 1 , 2 , 3 , 4 ]. In most cases, early treatment and early endoscopy during the first 24 h is recommended according to current guidelines.…”

“…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.…”

Prediction of Gastrointestinal Bleeding Hospitalization in Hemodialysis

“…Despite this, these models often include kidney failure and/or markers altered in kidney disease as inputs, and thus can yield convoluted insights in the dialysis population. 36-40 The appropriate identification and risk classification in patients with kidney failure remains a clinical challenge. The Glasgow Blatchford score (GBS) has been evaluated for predicting the need for admission and endoscopic intervention in kidney failure patients presenting to the hospital with a suspected GIB; this model was found to have reasonable performance (AUROC=0.63, sensitivity=81.2%, and specificity=42.3%) with a GBS cutoff score of ≥14.…”

Utilidad del tacto rectal para diagnosticar hemorragia digestiva en pacientes que acuden a emergencia del Hospital Arzobispo Loayza, en el periodo agosto 2022- diciembre 2023

“…A la actualidad de hace uso de scores debidamente validados que tienen utilidad en la toma de decisiones para el manejo del sangrado gastrointestinal (19)(20)(21), entre ellos y de amplio uso tenemos la escala Glasgow Blatchford, cuyo objetivo es identificar pacientes con hemorragia digestiva alta de alto o bajo riesgo de necesidad de manejo de este sangrado, con sensibilidad 99% y especificidad 32%, el punto de corte es 2; es decir pacientes con un puntaje <2 son de bajo riesgo y pueden ser dados de alta, en cambio pacientes con un puntaje > 2 son catalogados como de alto riesgo, y deben ser admitidos para manejo de la hemorragia digestiva. Dentro los parámetros de este score se encuentran urea sérica, hemoglobina, presión arterial, pulso, tacto rectal positivo para melena, este último con un puntaje de 1 pudiendo ser determinante para establecer el tratamiento endoscópico del sangrado gastrointestinal (22).…”