Mortality prediction among ED patients with upper gastrointestinal bleeding: Comparison of NEWS-2 and conventional...

Upper gastrointestinal bleeding (UGIB) is a common, potentially life-threatening emergency. Early risk stratification is essential for effective triage and management. Although scores like AIMS65, Glasgow-Blatchford (GBS), and pre-endoscopic Rockall (PERS) are widely used, the roles of NEWS-2 and its lactate-enhanced version (NEWS-2 L) in UGIB have not been fully assessed.

To compare the prognostic performance of NEWS-2 and NEWS2-L with conventional scoring systems in predicting in-hospital mortality in UGIB patients presenting to the ED.

In this prospective observational study, adult patients admitted to the ED with clinically confirmed UGIB were enrolled. A total of 178 patients were included in the final analysis. For each patient, GBS, PERS, AIMS65, NEWS-2, and NEWS2-L scores were calculated at presentation. Receiver operating characteristic (ROC) curves were used to assess the predictive performance of each scoring system. Sensitivity (Sn), specificity (Sp), likelihood ratios (LR), and area under the curve (AUC) values were reported. Multivariate logistic regression was conducted to identify independent predictors of in-hospital mortality.

Mortality occurred in 20.2 % of patients. All scoring systems significantly predicted mortality. AIMS65 had the highest sensitivity and lowest negative LR, while NEWS-2 showed the highest specificity and strongest positive LR. NEWS2-L offered minimal improvement over NEWS-2. In multivariate analysis, AIMS65 and NEWS-2 remained independent predictors; lactate alone did not.

Among patients with upper gastrointestinal bleeding, AIMS65 and NEWS-2 were both useful for mortality prediction. The lactate-augmented NEWS2-L provided modest additional benefit.