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Predicting mortality and readmission in UGIB: a comparative study of rockall, glasgow-blatchford, and AIMS65 scores

Mehdi Nasr Isfahani1, Masoud Fallah2, Peyman Adibi Sedeh3

  • 1Department of Emergency Medicine, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran. m_nasr54@med.mui.ac.ir.

BMC Gastroenterology
|October 14, 2025
PubMed

Insights

The pre-endoscopic Rockall Score (pRS) best predicts mortality and readmission in upper gastrointestinal bleeding (UGIB) patients. This score aids in identifying high-risk individuals for better emergency management and discharge planning.

Area of Science:

  • Gastroenterology
  • Emergency Medicine
  • Clinical Risk Stratification

Background:

  • Upper gastrointestinal bleeding (UGIB) is a common emergency requiring accurate risk assessment.
  • Evaluating pre-endoscopic scoring systems is crucial for timely patient management.

Purpose of the Study:

  • To compare the predictive accuracy of the pre-endoscopic Rockall Score (pRS), Glasgow-Blatchford Score (GBS), and AIMS65 for 30-day mortality and hospital readmission in UGIB patients.
  • To assess the utility of these scoring systems in Iranian tertiary hospitals.

Main Methods:

  • A prospective observational study involving 290 adult UGIB patients.
  • Assessment using pRS, GBS, and AIMS65 at admission.
  • Statistical analysis including ROC curves and AUC comparisons to evaluate prognostic accuracy.

Main Results:

  • The pre-endoscopic Rockall Score (pRS) demonstrated the highest predictive accuracy for both mortality (AUROC=0.815) and readmission (AUROC=0.605).
  • High sensitivity and NPV were observed for all scores at low-risk thresholds, with pRS offering the best prognostic balance.
  • Shock, tachycardia, syncope, altered mental status, and severe comorbidities were significantly linked to adverse outcomes.

Conclusions:

  • The pre-endoscopic Rockall Score (pRS) is highly effective for identifying high-risk UGIB patients and guiding early management.
  • pRS's strong sensitivity and NPV support its use in discharge planning and risk stratification in emergency settings.
  • Further validation in diverse settings is recommended to optimize UGIB management strategies.
Abstract

Keywords:
30-day mortalityAIMS65Emergency departmentGlasgow-Blatchford scorePre-endoscopic rockall scorePrognostic scoring systemsReadmissionRisk stratificationTertiary referral hospitalsUpper gastrointestinal bleeding

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