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Comparison of Pre-Endoscopic C-WATCH Score with Established Risk Assessment Tools in Patients with Upper
Gabriel Allo1, Martin Bürger1, Johannes Gillessen1
1Department of Gastroenterology and Hepatology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.
Insights
The Cologne-WATCH (C-WATCH) score shows comparable performance to established risk scores for assessing upper gastrointestinal bleeding (UGIB) patients. This study found no significant differences in predicting outcomes like mortality and complications between C-WATCH and other scores.
Area of Science:
- Gastroenterology
- Clinical Risk Stratification
- Medical Informatics
Background:
- Guidelines recommend risk scores for early assessment of upper gastrointestinal bleeding (UGIB).
- This study evaluated the Cologne-WATCH (C-WATCH) score against established scores: Glasgow-Blatchford score (GBS), Rockall score (RS), and pre-endoscopic RS (p-RS).
Purpose of the Study:
- To compare the efficacy of the C-WATCH score with GBS, RS, and p-RS in predicting outcomes for UGIB patients.
- To assess the predictive value of these risk scores for 30-day mortality, complications, and need for intervention.
Main Methods:
- Retrospective analysis of 252 UGIB patients from January to December 2017.
- Evaluation of risk scores using Area Under the Receiver Operating Characteristic Curve (AUROC) for 30-day mortality, complications, and intervention needs.
- Subgroup analysis for on-admission and in-hospital UGIB cases.
Main Results:
- The Rockall score (RS) demonstrated superior performance in predicting complications compared to pre-endoscopic scores.
- No significant differences were found between pre-endoscopic scores, except GBS outperformed p-RS in predicting intervention needs.
- C-WATCH score showed similar predictive capabilities for mortality, complications, and intervention needs compared to established scores.
Conclusions:
- The C-WATCH score is a viable alternative, performing comparably to established pre-endoscopic risk scores for UGIB patient assessment.
- No significant differences were observed between C-WATCH and other scores in predicting relevant patient-related endpoints across subgroups.
Introduction:
Use of risk scores for early assessment of patients with upper gastrointestinal bleeding (UGIB) is recommended by various guidelines. We compared Cologne-WATCH (C-WATCH) score with Glasgow-Blatchford score (GBS), Rockall score (RS), and pre-endoscopic RS (p-RS).
Methods:
Patients with UGIB between January and December 2017 were retrospectively analyzed for 30-day mortality and composite endpoints risk of complications and need for intervention using areas under the receiver-operating characteristics curve (AUROC). Subgroup analysis was conducted for patients with UGIB on admission and in-hospital UGIB.
Results:
A total of 252 patients were identified (67.5% men, mean age 63.8 ± 14.9 years). In-hospital UGIB occurred in 49.6%. AUROCs for 30-day mortality, risk of complications, and need for intervention (not applicable to RS) were 0.684 (95% confidence interval [CI]: 0.606-0.763), 0.665 (95% CI: 0.594-0.735), and 0.694 (95% CI: 0.612-0.775) for C-WATCH score, 0.724 (95% CI: 0.653-0.796) and 0.751 (95% CI: 0.687-0.815) for RS, 0.652 (95% CI: 0.57-0.735), 0.653 (95% CI: 0.579-0.727), and 0.673 (95% CI: 0.602-0.745) for p-RS and 0.652 (95% CI: 0.572-0.732), 0.663 (95% CI: 0.592-0.734), and 0.752 (95% CI: 0.683-0.821) for GBS. RS outperformed pre-endoscopic scores in predicting risk of complications, while there were no significant differences between pre-endoscopic scores except GBS outperforming p-RS in predicting need for intervention. The subgroup analysis obtained similar results. Positive predictive values for patients with estimated low risk for all three endpoints (C-WATCH score ≤1, RS ≤2, p-RS <1, and GBS ≤1) were 89%, 69%, 78%, and 92%.
Conclusion:
C-WATCH score performed similar to the established pre-endoscopic risk scores in patients with UGIB regarding relevant patient-related endpoints with no significant differences between both the subgroups.
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