Comparison of risk assessment scores of upper gastrointestinal bleeding: Proposal for a simplified score

Risk stratification of patients with upper gastrointestinal bleeding (UGIB) is crucial for streamlining healthcare in resource-limited settings, thereby minimizing both morbidity and mortality. Our objective was to validate clinical outcomes of the pre-existing risk assessment scores as full Rockall score (FRS), Glasgow-Blatchford bleeding score (GBS), Progetto Nazionale Emorragia Digestiva (PNED) and AIMS65 (an acronym of albumin, International Normalized Ratio [INR], mental status, systolic blood pressure, age > 65 years) scores and a proposed acronymic A2BC score incorporating four variables as age, serum albumin, mean blood pressure and serum creatinine in our setting.

Prospective study over a three-year period of patients presenting with UGIB at the Department of Medical Gastroenterology, Medical College, Kolkata.

The mean age of the 535 subject population was 52.84 ± 17.13 years, with male predominance (n = 284, 53.08%) and a majority being non-variceal bleeders (n = 336, 62.8%). The median (IQR) of FRS, GBS, PNED, AIMS65 and A2BC scores with composite risk defined as the presence of one or more of the following: need for blood transfusion during hospitalization, therapeutic intervention in non-malignant NVUGIB, rebleeding and death both within 42 days were 4 (3-6), 14 (12-16), 6 (2-10), 1 (0-2) and 1 (0-2) in comparison to those without the risk 2 (2-3), 10 (8-11), 3 (0-4), 0 (0-0) and 0 (0-0), respectively, all of which were statistically significant (p < 0.001). The discriminant cut-offs of FRS, GBS, PNED, AIMS65 and A2BC scores to predict composite risk of the subjects were ≥ 2, ≥ 7, ≥ 1, ≥ 1 and ≥ 1, respectively, with accuracies of 64.85%, 68.97%, 68.59%, 73.83%, and 77.57% respectively.

Our study validates the commonly used prognostic scores in our context and encourages further studies on the newly formulated A2BC score.