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AIMS65 Score as a Predictor of Inhospital Outcomes in Patients with Chronic Liver Disease Presenting with Upper
Smriti Bharti1, Gagan Gunjan2, Pragya Pant3
1Department of Medicine, Sheikh Bhikhari Medical College and Hospital, Hazaribag, Jharkhand, India.
Insights
The AIMS65 score effectively predicts adverse outcomes in chronic liver disease patients with upper gastrointestinal bleeding. This score demonstrated superior mortality prediction compared to Child-Pugh and MELD scores in this patient group.
Area of Science:
- Hepatology
- Gastroenterology
- Clinical Medicine
Background:
- Upper gastrointestinal bleeding (UGIB) in patients with chronic liver disease (CLD) presents a significant risk, necessitating early prognostic assessment.
- The AIMS65 score is a potential tool for stratifying risk in these patients.
Purpose of the Study:
- To evaluate the prognostic accuracy of the AIMS65 score in predicting outcomes for patients with CLD and UGIB.
- To compare the predictive performance of the AIMS65 score against established scores like Child-Pugh and MELD.
Main Methods:
- A prospective observational study involving 131 adult CLD patients with UGIB.
- Patients were stratified based on AIMS65 scores (<3 vs. ≥3).
- Primary outcome was in-hospital mortality; secondary outcomes included ICU admission, rebleeding, and hospital stay duration.
Main Results:
- Patients with AIMS65 scores ≥3 exhibited significantly higher in-hospital mortality (31.3% vs. 4.7%), ICU admission rates (50.7% vs. 12.5%), rebleeding (40.3% vs. 7.8%), and longer hospital stays.
- The AIMS65 score demonstrated superior discrimination for in-hospital mortality (AUC=0.88) compared to Child-Pugh (AUC=0.84) and MELD (AUC=0.81) scores.
- Variceal bleeding was a common cause of UGIB in 68.0% of the cohort.
Conclusions:
- Elevated AIMS65 scores are strongly associated with adverse in-hospital outcomes in CLD patients experiencing UGIB.
- The AIMS65 score offers improved mortality prediction over Child-Pugh and MELD scores in this population.
- AIMS65 may serve as a valuable and practical bedside tool for risk stratification in CLD patients with UGIB.
Background:
Upper gastrointestinal bleeding (UGIB) in chronic liver disease (CLD) carries a high risk and requires early stratification. This study evaluated the prognostic value of the AIMS65 score in CLD patients with UGIB.
Methods:
This prospective observational study included 131 adult CLD patients with UGIB admitted over 18 months at Rajendra Institute of Medical Sciences, Ranchi. Patients were grouped as AIMS65 <3 and AIMS65 ≥3. The primary outcome was inhospital mortality; secondary outcomes were intensive care unit (ICU) admission, rebleeding, and length of hospital stay. Mortality prediction by AIMS65 was compared with Child-Pugh and model for end-stage liver disease (MELD) scores.
Results:
The median age was 54 years (interquartile range: 46-63), and 54.9% were male. Variceal bleeding was present in 68.0% of patients. Compared with AIMS65 <3, patients with AIMS65 ≥3 had higher inhospital mortality (31.3% vs. 4.7%), ICU admission (50.7% vs. 12.5%), rebleeding (40.3% vs. 7.8%), and longer hospital stay (13.5 ± 3.8 vs. 7.3 ± 2.1 days) (all P < 0.001). AIMS65 showed the highest discrimination for inhospital mortality (area under the curve: 0.88; 95% confidence interval [CI]: 0.80-0.95), compared with Child-Pugh (0.84; 95% CI: 0.75-0.92) and MELD (0.81; 95% CI: 0.72-0.90).
Conclusions:
Higher AIMS65 scores were associated with adverse inhospital outcomes in CLD patients with UGIB. AIMS65 showed better mortality discrimination than Child-Pugh and MELD in this cohort and may be a useful bedside risk stratification tool.
