Comparative analysis of four upper gastrointestinal bleeding scoring systems for predicting multiple outcomes: an observational study in the emergency department

Najmeh Tohidi; Mitra Movahedi; Mohammad  Rezaei Zadeh Rukerd; Hanieh Mirkamali; Seyed Danial Alizadeh; Mohammad Javad Najafzadeh; Amin Honarmand; Mehran Ilaghi; Pouria Pourzand; Amirhossein Mirafzal

doi:10.18502/fem.v8i3.16331

Najmeh Tohidi Department of Emergency Medicine, Kerman University of Medical Sciences, Kerman, Iran.
Mitra Movahedi Department of Emergency Medicine, Kerman University of Medical Sciences, Kerman, Iran.
Mohammad Rezaei Zadeh Rukerd Gastroenterology and Hepatology Research Center, Institute of Basic and Clinical Physiology Sciences, Kerman University of Medical Sciences, Kerman, Iran.
Hanieh Mirkamali Student Research Committee, School of Medicine, Kerman University of Medical Sciences, Kerman, Iran.
Seyed Danial Alizadeh Faculty of Medicine, Kerman University of Medical Sciences, Kerman, Iran.
Mohammad Javad Najafzadeh Department of Orthopedic Surgery, Kerman University of Medical Sciences, Kerman, Iran.
Amin Honarmand Department of Emergency Medicine, Kerman University of Medical Sciences, Kerman, Iran.
Mehran Ilaghi Institute of Neuropharmacology, Kerman Neuroscience Research Center, Kerman University of Medical Sciences, Kerman, Iran.
Pouria Pourzand Department of Emergency Medicine, School of Medicine, University of Minnesota, Minneapolis, United States.
Amirhossein Mirafzal Department of Emergency Medicine, Kerman University of Medical Sciences, Kerman, Iran.

DOI: https://doi.org/10.18502/fem.v8i3.16331

Keywords: Outcomes; Prediction; Scoring Systems; Upper Gastrointestinal Bleeding

Abstract

Objective: Numerous scoring systems have been developed to assess the risk associated with upper gastrointestinal bleeding (UGIB), and several studies have investigated their comparative accuracy in predicting patient outcomes. This study was undertaken to compare four well-known scoring systems, namely the pre-endoscopy Rockall score, full Rockall score, Glasgow-Blatchford Bleeding score (GBS), and AIMS65, with the aim of predicting five distinct outcomes in cases of non-variceal UGIB.

Methods: This prospective observational study was conducted focusing on adult patients with UGIB presenting to the emergency department (ED). The primary endpoints of this study included in-hospital mortality, the need for re-endoscopy, the requirements for packed red blood cell (PRBC) transfusion, massive transfusion, and one-month rebleeding.

Results: A total number of 320 patients were enrolled, with 44 (13·75%) in-hospital deaths. Based on the area under the curves (AUC), while certain scores outperformed others in specific outcome prediction, the AIMS65 scoring system demonstrated superior predictive capability for both in-hospital mortality (0.91) and massive transfusion (0.71). Regarding PRBC transfusion requirements, both AIMS65 and GBS exhibited similar predictive capacities (AUC=0.67 and 0.68, respectively). In terms of re-endoscopy and one-month rebleeding, the GBS scoring system displayed slightly better performance compared to the other systems (AUC=0.61 and 0.63, respectively). In the composite outcome, all scores had significant associations, and among them, the AIMS-65 score had the highest AUC (0.76).

Conclusion: The AIMS65 scoring system was the most reliable tool for predicting in-hospital mortality and, to a lesser extent, massive transfusion requirements, while GBS and AIMS65 could be moderately and cautiously relied on for preparations regarding the need for PRBC transfusion.