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Utility of the CANUKA Scoring System in the Risk Assessment of Upper GI Bleeding
Sara Goff1, Emily Friedman1, Butros Toro1
1Gastroenterology Section.
Insights
The Canada-United Kingdom-Adelaide (CANUKA) score shows promise in predicting adverse outcomes and mortality for patients with upper gastrointestinal bleeding (UGIB) undergoing endoscopy. A score of 10 or higher indicates increased risk.
Area of Science:
- Gastroenterology
- Clinical Outcomes Research
- Medical Scoring Systems
Background:
- The Canada-United Kingdom-Adelaide (CANUKA) score was initially developed to identify patients with upper gastrointestinal bleeding (UGIB) suitable for emergency department discharge.
- Its utility in predicting adverse outcomes for inpatients undergoing endoscopy for UGIB requires further investigation.
Purpose of the Study:
- To evaluate the effectiveness of the CANUKA score in predicting adverse outcomes and in-hospital mortality in patients admitted with UGIB who undergo endoscopy.
- To establish a specific CANUKA score threshold for predicting these adverse events.
- To compare the predictive performance of the CANUKA score against existing scoring systems.
Main Methods:
- A retrospective analysis of 641 patients admitted for UGIB between January 1, 2018, and June 30, 2019, who underwent upper endoscopy.
- Patients were assigned a CANUKA score, and its predictive accuracy for adverse outcomes and mortality was assessed.
- Comparison of the area under the receiver operating characteristic curve (AUC) with established scoring systems.
Main Results:
- A CANUKA score of 10 or higher was significantly associated with adverse outcomes (unadjusted OR, 3.08).
- No adverse outcomes were observed in patients with a CANUKA score below 4, and no deaths occurred with a score below 6.
- In-hospital mortality was 2.1% for patients with a CANUKA score <10, compared to 6.8% for those with a score ≥10 (P=0.008).
- The AIMS65 score demonstrated the highest AUC (0.809) for predicting mortality.
Conclusions:
- The CANUKA score demonstrates potential as a predictor of adverse outcomes and mortality in hospitalized UGIB patients undergoing endoscopy.
- Further prospective, multicenter studies are necessary to validate the clinical utility of the CANUKA score.
Background:
The Canada-United Kingdom-Adelaide (CANUKA) score was developed to stratify patients who experience upper gastrointestinal bleeding (UGIB) to predict who could be discharged from the emergency department. Our aim was to determine if the CANUKA score could be utilized for UGIB in-patients undergoing endoscopy in predicting adverse outcomes. We additionally sought to establish a CANUKA score cut point to predict adverse outcomes and in-hospital mortality and compare this to established scoring systems.
Methods:
Between January 1, 2018 to June 30, 2019 all patients who underwent upper endoscopy after admission for UGIB were identified. We assigned a CANUKA score and compared the area under the receiver operating curve to established scoring systems.
Results:
Our data set included 641 patients, with a mean age of 59.5±14.5 years. A CANUKA score ≥10 was associated with an adverse outcome [unadjusted odds ratio, 3.08 (1.79, 5.27)]. No patients experienced an adverse outcome with a CANUKA score <4. No patients died with a CANUKA score <6. Those with a CANUKA score of <10 had an in-hospital mortality of 2.1% compared with 6.8% for those with a score ≥10 ( P =0.008). AIMS65 had the best area under the receiver operating characteristic curve (0.809) for predicting mortality.
Conclusions:
The CANUKA score may serve utility as a predictor of adverse outcomes and mortality in patients admitted with UGIB undergoing endoscopy. Future studies, ideally prospective and multicenter, will be needed to validate its clinical utility.
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