Comparison of Risk Scoring Systems in Hospitalised Patients who Develop Upper Gastrointestinal Bleeding. Issue 1 (2nd January 2021) - Mules, Thomas C.
Abstract: Background: The utility of risk scoring systems has not been validated in hospitalised patients who develop upper gastrointestinal bleeding (UGIB). This study's aim is to compare the accuracy of different risk scoring systems in these patients. Methods: Consecutive hospitalised patients who developed UGIB were included. Patients who had onset of UGIB less than 24 hours from the time of admission were excluded. UGIB risk assessment scores (Glasgow Blatchford, AIMS65, ABC, full Rockall, admission Rockall and PNED scores) were calculated and their abilities to predict predefined clinical endpoints: 30‐day mortality, endoscopic intervention and a composite endpoint (30‐day mortality or endoscopic intervention) were compared using area under the receiver operating curve (AUROC). Results: A total of 229 patients were included. Forty‐six (20%) required endoscopic intervention and 35 (15%) died within 30 days. The ABC score accurately predicted 30‐day mortality (AUROC 0.85) compared to PNED score (AUROC 0.80, P = 0.22), full Rockall score (AUROC 0.75, P < 0.05), Glasgow Blatchford score (AUROC 0.71, P < 0.05) and AIMS65 score (AUROC 0.70, P < 0.05). Patients with an ABC score ≤ 3 had a 30‐day mortality rate of 1.6%, compared to 7.5% and 42% for scores of 4‐7 and ≥ 8 respectively. None of the scores accurately predicted the need for endoscopic intervention and the composite endpoint (30‐day mortality or need for endoscopic intervention) (all scores AUROC < 0.8). Conclusions: In conclusion, the ABC score was most accurate at predicting mortality in hospitalised patients who develop UGIB making it clinically useful in all patients with UGIB.