Are Scoring Systems Useful in Predicting Mortality from Upper GI Bleeding in Geriatric Patients?

Area of Science:

• Geriatric Medicine
• Gastroenterology
• Clinical Epidemiology

Background:

• Upper gastrointestinal (GI) bleeding poses a significant risk to elderly patients with comorbidities.
• Determining mortality rates and predictive factors is crucial for managing this vulnerable population.

Purpose of the Study:

• To ascertain the in-hospital mortality rate of geriatric patients experiencing upper GI bleeding.
• To identify effective cut-off values for AIMS65 and Rockall scores in predicting high-risk patients.
• To evaluate the influence of oral anticoagulant and NSAID use on mortality.

Main Methods:

• A retrospective cohort study involving 64 geriatric patients (≥60 years) with comorbidities admitted for upper GI bleeding.
• Calculation of AIMS65 and Rockall scores for all participants.
• Statistical analysis including ROC analysis and Kaplan-Meier survival curves to assess score efficacy and medication impact.

Main Results:

• In-hospital mortality was 18.7%. Sepsis, malignancy, and heart failure were significant predictors of mortality.
• AIMS65 score ≥ 2 (AUC=0.920) and Rockall score ≥ 6 (AUC=0.822) demonstrated high sensitivity and effectiveness in predicting mortality.
• No significant association was found between mortality and the use of oral anticoagulants or NSAIDs.

Conclusions:

• Upper GI bleeding in elderly patients with comorbidities carries a high in-hospital mortality rate, primarily driven by sepsis, malignancy, and heart failure.
• AIMS65 and Rockall scores are valuable tools for predicting mortality, potentially enabling earlier interventions.
• The study highlights the need for multicenter validation due to the small, high-risk cohort.