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Prediction of the need for emergency endoscopic treatment for upper gastrointestinal bleeding and new score model: a
Yoshihiro Sasaki1,2, Tomoko Abe3, Norio Kawamura3
1Department of Gastroenterology, National Disaster Medical Center, 3256 Midoricho, Tachikawa-shi, Tokyo, 190-0014, Japan. EZL06015@nifty.ne.jp.
Insights
A new H3B2 score effectively predicts the need for urgent hemostatic treatment in upper gastrointestinal bleeding cases. This score aids in identifying high-risk patients requiring interventions like emergency endoscopy.
Area of Science:
- Gastroenterology
- Medical Diagnostics
- Clinical Scoring Systems
Background:
- Upper gastrointestinal bleeding is a significant medical concern.
- Existing scoring systems like GBS and AIMS65 have limitations in predicting outcomes.
- There is a need for improved tools to assess patients with suspected upper GI bleeding.
Purpose of the Study:
- To compare the efficacy of Glasgow-Blatchford score (GBS), AIMS65, MAP score, Modified GBS, and Iino score.
- To identify key factors associated with the need for endoscopic hemostatic procedures.
- To develop and validate a novel, robust scoring model for upper gastrointestinal bleeding.
Main Methods:
- Retrospective review of 675 patients with suspected non-variceal upper GI bleeding from January 2015 to December 2019.
- Evaluation of established scoring systems (GBS, AIMS65, MAP, Modified GBS, Iino) for outcome prediction.
- Logistic regression analysis to identify predictors of endoscopic hemostasis and mortality, leading to the creation of the H3B2 score.
Main Results:
- Key predictors for endoscopic treatment included hematemesis, heart rate, hemoglobin, blood pressure, and BUN.
- The novel H3B2 score demonstrated slightly superior discrimination for predicting hemostatic treatment compared to GBS and Modified GBS (AUROC 0.73 vs. 0.721 and 0.7128).
- The H3B2 score also showed satisfactory accuracy in predicting subsequent mortality (AUROC 0.6857).
Conclusions:
- The H3B2 score, derived from simple and objective indices, is proposed for suspected upper GI bleeding.
- This new score aids in identifying high-risk patients needing urgent hemostatic interventions.
- The H3B2 score offers a valuable tool for clinical decision-making in managing upper gastrointestinal bleeding.
Background:
Gastrointestinal bleeding is one of the major gastrointestinal diseases. In this study, our objective was to compare Glasgow-Blatchford score (GBS), AIMS65 score, MAP score, Modified GBS, and Iino score as outcome measures for upper gastrointestinal bleeding. In addition, we extracted factors associated with hemostatic procedures including endoscopy, and proposed a new robust score model.
Methods:
From January 2015 to December 2019, 675 patients with symptoms such as hematemesis who visited the National Hospital Organization Disaster Medical Center and underwent urgent upper endoscopy with diagnosis of suspected non-variceal upper gastrointestinal bleeding were retrospectively reviewed. We evaluated the GBS, AIMS65 score, MAP score, Modified GBS, and Iino score, and assessed the outcomes of patients requiring hemostatic treatments at the subsequent emergency endoscopy. We performed logistic regression analysis of factors related to endoscopic hemostasis and upper gastrointestinal bleeding, created a new score model, and evaluated the prediction of hemostatic treatment and mortality in the new score and the existing scores.
Results:
The factors associated with endoscopic treatment were hematemesis, heart rate, HB (hemoglobin), blood pressure, blood urea nitrogen (BUN). Based on these predictors and the partial regression coefficients, a new score named H3B2 (using the initial letters of hematemesis, heart rate, HB, blood pressure, and BUN) was generated. H3B2 score was slightly more discriminatory compared to GBS and Modified GBS (area under the receiver operating characteristic curves (AUROC): 0.73 versus 0.721 and 0.7128, respectively) in predicting hemostatic treatment in emergency endoscopy. The H3B2 score also showed satisfactory prediction accuracy for subsequent deaths (AUROC: 0.6857. P < 0.001).
Conclusions:
We proposed a new score, the H3B2 score, consisting of simple and objective indices in cases of suspected upper gastrointestinal bleeding. The H3B2 score is useful in identifying high-risk patients with suspected upper gastrointestinal bleeding who require urgent hemostatic treatment including emergency endoscopy.
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