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Comparison of various prognostic scores in variceal and non-variceal upper gastrointestinal bleeding: A prospective
Gyanranjan Rout1, Sanchit Sharma1, Deepak Gunjan1
1Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, 110 049, India.
Insights
Prognostic scores like Glasgow-Blatchford bleeding score (GBS) and modified Glasgow-Blatchford bleeding score (mGBS) are more accurate for predicting outcomes in non-variceal upper gastrointestinal bleeding (NVUGIB) than variceal UGIB (VUGIB). These scores are less reliable for VUGIB patients.
Area of Science:
- Gastroenterology
- Clinical Medicine
- Medical Prognostics
Background:
- Established prognostic scores (GBS, mGBS, FRS, CRS, AIMS65) are used for upper gastrointestinal bleeding (UGIB) risk stratification.
- The effectiveness of these scores in variceal UGIB (VUGIB) is not well-defined.
Purpose of the Study:
- To evaluate the performance of five prognostic scores in patients with non-variceal UGIB (NVUGIB) and VUGIB.
- To compare the accuracy of these scores in predicting clinical outcomes for NVUGIB versus VUGIB.
Main Methods:
- A prospective study included 1011 patients (439 NVUGIB, 572 VUGIB) from March 2017 to August 2018.
- The performance of GBS, mGBS, FRS, CRS, and AIMS65 was assessed using the area under the receiver operator characteristic curve (AUROC).
Main Results:
- Prognostic scores demonstrated higher accuracy in predicting composite outcomes (hospital intervention, 42-day mortality) in NVUGIB compared to VUGIB.
- GBS and mGBS showed the highest negative predictive value for composite outcomes in NVUGIB.
- These scores were also more accurate in predicting 42-day rebleeding in NVUGIB than in VUGIB.
Conclusions:
- Clinical Rockall score (CRS), full Rockall score (FRS), Glasgow-Blatchford bleeding score (GBS), modified Glasgow-Blatchford bleeding score (mGBS), and AIMS65 scores are more effective in predicting outcomes for NVUGIB patients.
- The predictive accuracy of these scores is significantly lower for patients with VUGIB.
Background And Aims:
Various prognostic scores like Glasgow-Blatchford bleeding score (GBS), modified Glasgow-Blatchford bleeding score (mGBS), full Rockall score (FRS) including endoscopic findings, clinical Rockall score (CRS), and albumin, international normalized ratio (INR), mental status, systolic blood pressure, age >65 (AIMS65) are used for risk stratification in patients with upper gastrointestinal bleeding (UGIB). The utility of these scores in variceal UGIB (VUGIB) is not well defined. In this prospective study, we aimed to assess the performance of these scores in patients with non-variceal (NVUGIB) and VUGIB.
Methods:
We included 1011 patients (during March 2017 and August 2018) including 439 with NVUGIB and 572 VUGIB. Performance of GBS, mGBS, FRS, CRS, and AIMS65 for various outcome measures was analyzed using the area under receiver operator characteristic curve (AUROC).
Results:
The accuracy of prognostic scores in predicting the composite outcome including the need of hospital-based intervention and 42-day mortality was higher in NVUGIB as compared with VUGIB, AUROC: CRS: 0.641 vs. 0.537; FRS: 0.669 vs. 0.625; GBS: 0.719 vs. 0.587; mGBS: 0.711 vs. 0.594; AIMS65: 0.567 vs. 0.548. GBS and mGBS at a cut-off score of 1 had the highest negative predictive value, 91.7% and 91.3%, respectively, for predicting composite outcome in NVUGIB. Similarly, these scores had better accuracy for predicting 42-day rebleeding in NVUGIB as compared to VUGIB, AUROC: CRS: 0.680 vs. 0.537; FRS: 0.698 vs. 0.565; GBS: 0.661 vs. 0.543; mGBS: 0.627 vs. 0.540; AIMS65: 0.695 vs. 0.606.
Conclusion:
The prognostic scores such as CRS, FRS, GBS, mGBS, and AIMS65 predict the need for hospital-based management, rebleeding, and mortality better among patients with NVUGIB than VUGIB.
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