ISG Task Force on Upper Gastrointestinal Bleeding (UGIB)-Comparison of Risk Scores in Nonvariceal Bleeding-A...

To compare the performance of the Glasgow Blatchford score (GBS) to the Total Rockall score (TRS) in predicting clinical interventions in Indian patients with acute nonvariceal upper gastrointestinal bleeding (ANVUGIB).

We prospectively studied ANVUGIB in 93 hospitals in India from October 2014 to September 2018. The etiological, clinical, and investigational details were recorded on a uniform structured proforma. The GBS and TRS were prospectively calculated for all patients. Clinical interventions were defined as blood transfusion, rebleed, and mortality with 30-day follow-up.

A total of 6450 patients with ANVUGIB were identified, followed up for 30 days and selected for analysis. Almost 5176 (80%) of the patients were male, and the mean age 50.7 ± 16.8 years (2-98 years). Blood transfusion was considered clinically necessary in 115 (1.7%) of the patients. Surgery and interventional radiology were required as rescue therapy in only 20 patients (0.3%) and 22 (0.3%) patients, respectively. The 30-day rebleeding and mortality occurred in 92 (1.4%) and in 184 (2.8%) patients, respectively. GBS was similar to TRS in predicting mortality (AUC 0.687 vs. 0.663) with cutoff values of 10.5 and 3.5 and predicting rebleeding with (AUC 0.637 vs. 0.630) cutoff values of 11.5 and 3.5, respectively. Outcomes were defined as 30-day mortality and rebleeding. Interventions were defined as transfusions, repeat endoscopy, surgery, or interventional radiology.

GBS was more accurate and had more desirable clinical characteristics in predicting the need for a transfusion for hospitalized patients than TRS. However, both GBS and TRS have poor to modest predictive capability for 30-day mortality and rebleeding. They do not, then, appear to be useful as screening tools to identify people at risk for those two outcomes in a hospital setting.