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Development and Validation of a Novel 1-year Mortality Risk Score That Includes the Use of Antithrombotic in Patients
Tarek Nammour1, Lara El Jamal1, Mohammad N Hosni1
1Division of Gastroenterology and Hepatology.
Insights
A new scoring system accurately predicts 1-year mortality in patients with gastrointestinal bleeding (GIB), incorporating antithrombotic (AT) drug use. This tool aids in guiding patient follow-up and prognosis.
Area of Science:
- Gastroenterology
- Internal Medicine
- Cardiology
Background:
- Acute gastrointestinal bleeding (GIB) poses a significant mortality risk.
- Existing scoring systems may not fully capture mortality predictors, particularly antithrombotic (AT) drug use.
Purpose of the Study:
- To develop and validate a novel 1-year mortality risk-scoring system for acute GIB patients.
- To evaluate the system's performance against established scores, incorporating AT drug status.
Main Methods:
- A risk-scoring system was developed using prospectively collected data from 576 GIB patients with 1-year follow-up.
- Independent predictors of 1-year mortality were identified, adjusting for confounders like age-adjusted Charlson Comorbidity Index (CCI), blood transfusion, GIB severity, endoscopic therapy, and AT type.
Main Results:
- The novel score, based on CCI, blood transfusion, and aspirin use, showed higher predictive accuracy (AUC=0.82) than Rockall (AUC=0.68), Oakland (AUC=0.69), and Shock Index (AUC=0.54).
- Higher scores correlated with increased 1-year mortality, with 21% of patients dying within the follow-up period.
Conclusions:
- A simple, novel risk score accurately predicts 1-year mortality in GIB patients, including AT drug use.
- This scoring system can assist in clinical decision-making for follow-up and prognosis in GIB management.
Goals And Background:
We aimed to develop a novel 1-year mortality risk-scoring system that includes use of antithrombotic (AT) drugs and to validate it against other scoring systems in patients with acute gastrointestinal bleeding (GIB).
Study:
We developed a risk-scoring system from prospectively collected data on patients admitted with GIB between January 2013 and August 2020, who had at least 1- year of follow-up. Independent predictors of 1-year mortality were determined after adjusting for the following confounders: the age-adjusted Charlson Comorbidity Index (CCI) (divided into 4 groups: CCI-0=0, CCI-1=1 to 3, CCI-2=4 to 6, CCI-3 ≥7), need for blood transfusion, GIB severity, need for endoscopic therapy, and type of AT. The risk score was based on independent predictors.
Results:
Five hundred seventy-six patients were included and 123 (21%) died at 1-year follow-up. Our risk -score was based on the following: CCI-2 (2 points), CCI-3 (4 points), need for blood transfusion (1 point), and no use of aspirin (1 point), as aspirin use was protective (maximum score=6). Patients with higher risk scores had higher mortality. The model had a better predictive accuracy [AUC=0.82, 95% confidence interval (0.78-0.86), P <0.0001] than the Rockall score for upper GIB (Area Under the Curve (AUC)=0.68, P <<0.0001), the Oakland score for lower GIB (AUC=0.69, p =0.004), or the Shock Index for all (AUC=0.54, P <0.0001).
Conclusion:
A simple and novel score that includes use of AT upon admission accurately predicts 1-year mortality in patients with GIB. This scoring system may help guide follow-up decisions and inform the prognosis of patients with GIB.
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