Evaluating the Performance of Four Risk Assessment Scores in Nonvariceal Upper Gastrointestinal Bleeding

Nonvariceal upper gastrointestinal bleeding (NVUGIB) continues to remain a life-threatening medical emergency, resulting in significant morbidity and mortality. Several scoring systems have been developed to predict outcomes, but the best risk stratification tool for emergency situations remains uncertain. This study examines four existing scoring systems: the blood urea nitrogen-to-serum albumin ratio (BAR), the international normalized ratio-to-albumin ratio (PTAR), the lactate-to-albumin ratio (LTA), and the National Early Warning Score (NEWS).

This retrospective, hospital-based study was conducted at the Johns Hopkins Aramco Healthcare (JHAH) facility in eastern Saudi Arabia from January 2020 to September 2023. Eligible participants were non-trauma UGIB patients aged 18 years or older. Cancer patients were excluded. Patient characteristics, vital signs, test results, comorbidities, disposition, and survival status at discharge were among the information collected from medical records. The four score systems were calculated and compared based on their predictive performance.

NEWS demonstrated the highest overall predictive performance, particularly for hospital admission (AUC 84%) and 90-day mortality (AUC 77.2%). Both NEWS and BAR were equally effective in predicting blood transfusion (AUC 71.7%). LTA showed the highest sensitivity for mortality prediction (75%), while PTAR provided moderate predictive value across all outcomes.

Among the four scoring systems evaluated, NEWS consistently outperformed others in predicting key clinical outcomes in NVUGIB, making it a reliable tool for initial risk stratification. BAR is also valuable for assessing transfusion needs, while LTA and PTAR may serve complementary roles depending on the clinical context.