Pre-Endoscopic Scores Predicting Low-Risk Patients with Upper Gastrointestinal Bleeding: A Systematic Review and...

Area of Science:

• Gastroenterology
• Clinical Medicine
• Evidence-Based Medicine

Background:

• Acute upper gastrointestinal bleeding (UGIB) management requires accurate risk stratification to identify patients needing interventions.
• Several pre-endoscopic risk scores aim to predict adverse outcomes in UGIB patients, but their comparative efficacy is unclear.

Purpose of the Study:

• To systematically review and compare the predictive abilities of pre-endoscopic risk scores for prognosticating the absence of adverse events in UGIB patients.
• To evaluate the accuracy of scores like Glasgow-Blatchford (GBS), clinical Rockall (CRS), AIMS65, and ABC in identifying low-risk UGIB patients.

Main Methods:

• A systematic review and meta-analysis of published studies assessing pre-endoscopic scores in UGIB patients.
• Searched MEDLINE, EMBASE, Central, and ISI Web of knowledge up to February 2023.
• Primary outcome: composite score for hospital-based interventions; Secondary outcomes: mortality, rebleeding.

Main Results:

• Thirty-eight studies with 36,215 patients were included.
• Low GBS cutoffs (0, ≤1, ≤2) were associated with very few hospital interventions (0.02-0.04).
• GBS demonstrated excellent discriminative ability for predicting the need for hospital-based interventions and was generally the most accurate for secondary outcomes.

Conclusions:

• A GBS cutoff of 1 or less best identifies low-risk UGIB patients.
• Expanding the GBS cutoff to 2 maintains prognostic accuracy and allows for safe outpatient management of more patients.
• Further comparative and interventional studies are needed due to limitations in data quality and generalizability.