Comparison of Risk Scores for Lower Gastrointestinal Bleeding: A Systematic Review and Meta-analysis

Area of Science:

• Gastroenterology
• Clinical Epidemiology
• Medical Informatics

Background:

• Clinical prediction models, or risk scores, aid in stratifying patients with lower gastrointestinal bleeding (LGIB).
• The most accurate LGIB risk score for predicting patient outcomes remains undetermined.

Purpose of the Study:

• To systematically identify and compare the prognostic performance of available LGIB risk scores.

Main Methods:

• A systematic literature search was conducted across Ovid MEDLINE, Embase, and Cochrane Central Register of Controlled Trials (1990-2021).
• Included studies derived or validated LGIB risk scores for clinical outcome prediction.
• Data were extracted following PRISMA guidelines, and performance was assessed using diagnostic metrics, including area under the receiver operating characteristic curve (AUROC).

Main Results:

• Nine studies involving 12 cohorts and 4 risk scores (Oakland, Strate, NOBLADS, BLEED) were included in the meta-analysis.
• The Oakland score demonstrated the highest AUROC for predicting safe discharge (0.86) and major bleeding (0.93).
• For transfusion prediction, the Oakland score achieved an AUROC of 0.99, while the Strate score showed the highest AUROC for hemostasis prediction (0.82).

Conclusions:

• The Oakland score is the most discriminative for predicting safe discharge, major bleeding, and transfusion needs in LGIB patients.
• The Strate score is superior for predicting the requirement for hemostasis.
• These validated risk scores can inform clinical decision-making and patient management in LGIB.