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A Comparison of the ABC and AIMS65 Scores in Predicting Outcomes in Patients with Acute Upper Gastrointestinal
Ali Sohail1, Uday Sankar Akash Vankayala2, Bivin George2
1Department of Internal Medicine, Staten Island University Hospital, Northwell Health, 475 Seaview Avenue, Staten Island, NY, 10305, USA. ASohail1@northwell.edu.
Insights
The ABC score is more accurate than AIMS65 for predicting mortality in upper gastrointestinal bleeding (UGIB) patients. This study supports using the ABC score for better risk stratification in clinical practice.
Area of Science:
- Clinical Medicine
- Gastroenterology
- Health Services Research
Background:
- Upper gastrointestinal bleeding (UGIB) is a critical medical emergency with high mortality rates.
- Accurate risk stratification is crucial for effective patient management and triage.
- Existing tools like ABC and AIMS65 scores need further comparative validation in diverse populations.
Purpose of the Study:
- To compare the predictive accuracy of the ABC score versus the AIMS65 score for in-hospital mortality in acute UGIB patients.
- To evaluate the performance of both scores in predicting secondary clinical outcomes.
Main Methods:
- A retrospective cohort study of 2,009 adult UGIB patients.
- Calculation of ABC and AIMS65 scores using EMR data.
- Statistical analysis using logistic regression and AUC to compare predictive accuracy.
Main Results:
- The ABC score showed significantly higher predictive accuracy for mortality (AUC 0.793) compared to AIMS65 (AUC 0.661).
- ABC score also demonstrated stronger correlations with secondary outcomes like hospital length of stay and ICU admission.
- The ABC score's superiority was consistent across different time periods, including the pandemic.
Conclusions:
- The ABC score is a superior tool for predicting in-hospital mortality in acute UGIB patients compared to AIMS65.
- Findings support the routine use of the ABC score for risk stratification in clinical practice.
- The ABC score offers consistent advantages across various outcomes and patient subgroups.
Background:
Upper gastrointestinal bleeding (UGIB) remains a significant clinical emergency with substantial mortality. Accurate risk stratification is essential for optimal patient triage and management. The ABC score (Age, Blood tests, Comorbidities) and AIMS65 score are prominent pre-endoscopy risk stratification tools, yet direct comparative studies within diverse United States healthcare populations remain limited.
Aims:
To compare the predictive accuracy of ABC and AIMS65 scores for in-hospital mortality and secondary clinical outcomes in patients with acute UGIB.
Methods:
This retrospective cohort study analyzed 2,009 adult patients admitted with acute UGIB across multiple Northwell Health hospitals between January 2019 and January 2024. Both ABC and AIMS65 scores were calculated for each patient using structured EMR data, ICD-10 diagnosis codes, and anesthesiology procedure documentation. Primary outcomes included in-hospital mortality and 30-day readmission. Secondary outcomes encompassed hospital length of stay, ICU admission, development of complications (shock, sepsis, acute kidney injury), vasopressor use, and need for mechanical ventilation. Univariable logistic regression models assessed predictive accuracy using area under the receiver operating characteristic curve (AUC), with bootstrap internal validation (10,000 resamples) confirming negligible optimism bias. DeLong's test compared discriminative abilities between scores. Sensitivity analyses evaluated score performance across pandemic periods and in a broader AIMS65-computable cohort.
Results:
Among 2,009 patients (56.1% male; median age 70 years), 97 (4.8%) experienced in-hospital mortality and 59 (2.9%) had 30-day readmission. The ABC score demonstrated significantly superior predictive accuracy for mortality compared to AIMS65 (AUC 0.793 vs. 0.661; p < 0.0001 by DeLong's test; optimism-corrected AUCs: 0.793 and 0.661, respectively). Each one-unit increase in ABC score corresponded to a 50.7% increase in mortality odds (OR 1.507; 95% CI: 1.386-1.638). Neither score significantly predicted 30-day readmission. ABC score showed stronger correlations with secondary outcomes including hospital length of stay (r = 0.47 vs. r = 0.33), ICU length of stay (r = 0.35 vs. r = 0.22), and vasopressor requirements (r = 0.30 vs. r = 0.21). ABC's superiority was consistent across pre-pandemic, peak pandemic, and post-peak subgroups. In the broader AIMS65-computable cohort (n = 6,766), AIMS65 demonstrated an AUC of 0.706, confirming that the cohort restriction modestly attenuated its discrimination but that ABC's advantage persisted.
Conclusions:
The ABC score demonstrates significantly superior predictive accuracy for in-hospital mortality compared to AIMS65 in patients with acute UGIB, with consistent advantages across secondary outcomes, pandemic periods, and cohort definitions. These findings support the preferential use of ABC score for risk stratification in clinical practice.