Comparison of four scoring systems for risk stratification of upper gastrointestinal bleeding

Area of Science:

• Gastroenterology
• Clinical Medicine
• Medical Informatics

Background:

• Upper gastrointestinal bleeding (UGIB) is a significant cause of morbidity and mortality.
• Accurate prediction of clinical outcomes in UGIB patients is crucial for timely and effective management.
• Several scoring systems exist, but their comparative performance in predicting UGIB outcomes requires further evaluation.

Purpose of the Study:

• To compare the predictive performance of four scoring systems: Glasgow-Blatchford Bleeding Score (GBS), pre-endoscopic Rockall score (PRS), complete Rockall score (CRS), and Cedars-Sinai Medical Center Predictive Index (CSMCPI).
• To assess the accuracy of these scores in identifying high-risk patients, predicting rebleeding, and forecasting 30-day mortality in UGIB patients.

Main Methods:

• A prospective study involving 153 patients admitted with UGIB who underwent endoscopy within 24 hours.
• Prospective calculation of GBS, PRS, CRS, and CSMCPI for all included patients.
• Performance assessment of each score using receiver operating characteristic (ROC) curve analysis and area under the curve (AUC) values.

Main Results:

• The complete Rockall score (CRS) exhibited the highest AUC (0.991) for predicting high-risk patients.
• For predicting rebleeding, CRS achieved an AUC of 0.701.
• CRS also showed the highest AUC (0.823) for predicting 30-day mortality among the evaluated scores.

Conclusions:

• The complete Rockall score (CRS) demonstrates superior effectiveness in predicting high-risk status, rebleeding, and 30-day mortality in patients with upper gastrointestinal bleeding.
• CRS performance surpasses that of GBS, PRS, and CSMCPI in these critical outcome predictions.
• These findings support the utility of CRS as a valuable tool for risk stratification and management decisions in UGIB patients.