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Evaluation of Six Preendoscopy Scoring Systems to Predict Outcomes for Older Adults with Upper Gastrointestinal
Yajie Li1, Qin Lu2, Kexuan Wu2
1Department of Gerontology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu 210009, China.
Insights
The MAP(ASH) score effectively predicts outcomes in older adults with upper gastrointestinal bleeding (UGIB), while the ABC score is most accurate for mortality prediction. Other scores showed varying performance for different outcomes.
Area of Science:
- Gastroenterology
- Clinical Medicine
- Geriatrics
Background:
- Upper gastrointestinal bleeding (UGIB) is a significant health concern in older adults.
- Accurate prediction of UGIB outcomes is crucial for timely intervention and improved patient management.
- Several pre-endoscopic scoring systems exist, but their comparative efficacy in elderly populations is not well-established.
Purpose of the Study:
- To evaluate and compare the predictive accuracy of six pre-endoscopic scoring systems for various upper gastrointestinal bleeding outcomes in older adults.
- To identify the most effective scoring system for predicting mortality, intervention, rebleeding, and ICU admission in this demographic.
Main Methods:
- A retrospective study was conducted on 602 older adults (age ≥ 65) presenting with UGIB.
- Six scoring systems were assessed: ABC, AIMS65, Glasgow Blatchford score (GBS), MAP(ASH), pRS, and T-score.
- Area Under the Curve (AUC) was used to compare the predictive performance of each score for different outcomes.
Main Results:
- The MAP(ASH) score demonstrated the best performance in predicting the need for intervention and ICU admission.
- The ABC score showed the highest accuracy in predicting mortality.
- MAP(ASH), AIMS65, and ABC scores offered fair prediction for rebleeding, while GBS, T-score, and pRS performed poorly.
Conclusions:
- MAP(ASH) is a reliable tool for predicting multiple UGIB outcomes in older adults, including mortality, intervention, rebleeding, and ICU admission.
- ABC excels in predicting mortality, and GBS shows acceptable performance for ICU admission, mortality, and intervention.
- AIMS65 and T-score have moderate predictive value, whereas pRS may not be suitable for this patient group.
Objectives:
To compare the ability of six preendoscopic scoring systems (ABC, AIMS65, Glasgow Blatchford score (GBS), MAP(ASH), pRS, and T-score) to predict outcomes of upper gastrointestinal bleeding (UGIB) in older adults.
Methods:
This was a retrospective study of 602 older adults (age ≥ 65) presenting with UGIB at Zhongda Hospital Southeast University from January 2015 to June 2021. Six scoring systems were used to analyze all patients.
Results:
ABC had the largest area under the curve (AUC) (0.833; 95% confidence interval (CI): 0.801-0.862) and was significantly higher than pRS 0.696 (95% CI: 0.658-0.733, p < 0.01) and T-score 0.667 (95% CI: 0.628-0.704, p < 0.01) in predicting mortality. MAP(ASH) (0.783; 95% CI: 0.748-0.815) performs the best in predicting intervention and was similar to GBS, T-score, ABC, and AIMS65. The AUCs for MAP(ASH) (0.732; 95% CI: 0.698-0.770), AIMS65 (0.711; 95% CI: 0.672-0.746), and ABC (0.718; 95% CI: 0.680-0.754) were fair for rebleeding, while those of GBS (0.662; 95% CI: 0.617-0.694), T-score (0.641; 95% CI: 0.606-0.684), and pRS (0.609; 95% CI: 0.569-0.648) were performed poorly. MAP(ASH) performs the best in predicting ICU admission (0.784; 95% CI: 0.749-0.816). All the five scores were significantly higher than pRS (p < 0.05 for ABC, AIMS65 and T-score, p < 0.01 for GBS and MAP).
Conclusions:
Mortality, intervention, rebleeding, and ICU admission in UGIB for older adults can be predicted well using MAP(ASH). ABC is the most accurate for predicting mortality. Except for rebleeding, GBS has an acceptable performance in predicting ICU admission, mortality, and intervention. AIMS65 and T-score performed moderately, and pRS may not be suitable for the target cohort.
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