A unified prognostic tool for predicting critical outcomes in gastrointestinal bleeding

Gastrointestinal bleeding (GIB) is a common cause of emergency department admission and is associated with substantial morbidity and mortality. Early risk stratification remains challenging, particularly before endoscopic evaluation. This study aims to develop a novel, unified pre-endoscopic scoring system to predict early clinical deterioration in both upper and lower GIB. In this retrospective study, 403 patients with GIB admitted between 2018 and 2020 were screened, of whom 390 had complete data and were included. Clinical, laboratory, and hemodynamic parameters were extracted to derive a prognostic score predicting critical deterioration within 48 hours of admission. The primary outcome included mortality within 48 hours, intensive care unit admission, transfusion of >4 units of packed red blood cells, or need for surgery. Independent predictors identified by multivariable logistic regression were incorporated into a weighted scoring system. Discriminatory performance was assessed using the area under the receiver operating characteristic curve. Of 390 patients, 79 (20.3%) met criteria for critical deterioration. Independent predictors included age >70 years, male sex, a study-defined weighted comorbidity score ≥2, systolic blood pressure <90 mm Hg, hemoglobin < 7 g/dL, and loss of consciousness. Corresponding weighted points ranged from 2 to 4 per factor, yielding a total possible score of 0 to 17. The scoring system demonstrated excellent predictive performance (area under the receiver operating characteristic curve: 0.939), with high sensitivity and specificity across multiple cutoff points. The proposed scoring system is simple, rapid, and highly accurate for predicting early deterioration in GIB. It may serve as a practical tool for emergency department triage, early decision-making, and resource allocation. Prospective multicenter studies are warranted to validate its clinical utility.