Risk assessment in acute non-variceal upper GI bleeding: the AIMS65 score in comparison with the Glasgow–Blatchford score in a Scottish population

Abstract

Introduction The early use of risk stratification scores is recommended for patients presenting with acute non-variceal upper gastrointestinal (GI) bleeds (ANVGIB). AIMS65 is a novel, recently derived scoring system, which has been proposed as an alternative to the more established Glasgow-Blatchford score (GBS). Objective To validate the AIMS65 scoring system in a predominantly Caucasian population from Scotland and compare it with the GBS. Design Retrospective study of patients presenting to a district general hospital in Scotland with a suspected diagnosis of ANVGIB who underwent inpatient upper GI endoscopy between March 2008 and March 2013. Outcomes The primary outcome measure was 30-day mortality. Secondary outcome measures were requirement for endoscopic intervention, endoscopy refractory bleeding, blood transfusion, rebleeding and admission to high dependency unit (HDU) and intensive care unit (ICU). The area under the receiver operating characteristic (AUROC) curve was calculated for each score. Results 328 patients were included. Of these 65.9% (n=216) were men and 34.1% (n=112) women. The mean age was 65.2 years and 30-day mortality 5.2%. AIMS65 was superior to the GBS in predicting mortality, with an AUROC of 0.87 versus 0.70 ( p<0.05). The GBS was superior for blood transfusion (AUROC 0.84 vs 0.62, p<0.05) and admission to HDU (AUROC 0.73 vs 0.62, p<0.05). There were no significant differences between the scores with respect to requirement for endoscopic intervention,

Recent advances in the management of peptic ulcer bleeding

“…The AIMS65 score has been advocated as an even simpler score requiring scoring only on a 5-point score for each of the following factors: albumin of less than 30 g/l, international normalised ratio (>1.5), Glasgow coma scale score of less than 14, systolic blood pressure of less than 90 mmHg, and age of more than 65. Although the AIMS65 can reliably predict mortality, it appears less accurate than the GBS in determining the need for interventions such as blood transfusion or admission to critical care 15 , 16 .…”

Advances in the Therapy of Bleeding Peptic Ulcer

“…Although the AIMS65 can reliably predict mortality, it appears less accurate than the GBS in determining the need for interventions such as blood transfusion or admission to critical care. 15,17 A further score, the Progetto Nazionale Emorragia Digestive score (PNED) system which relies on a rather cumbersome multipart scoring utilising age, the presence of cancer, renal failure, American Society of Anaesthesiologists (ASA) grade, cirrhosis, rebleeding and failure of endoscopic therapy has been proposed. A large prospective study of over 3000 patients confirmed that the GBS clearly performed best in identifying the lowest risk patients and also in predicting important interventions such as endoscopic therapy or blood transfusion.…”

“…Although the AIMS65 can reliably predict mortality, it appears less accurate than the GBS in determining the need for interventions such as blood transfusion or admission to critical care. 15,17…”

Highlights from this issue

“…However, criticism of the GBS has arisen from its complexity. Palmer and colleagues,1 in this edition of Frontline Gastroenterology (FG) have compared the GBS with a simpler non-endoscopic score, the AIMS65. This 5-point score was found to be superior to GBS in predicting 30-day mortality, but not transfusion requirement.…”