Skip to main content

Advertisement

SpringerLink
Log in

Both Full Glasgow-Blatchford Score and Modified Glasgow-Blatchford Score Predict the Need for Intervention and Mortality in Patients with Acute Lower Gastrointestinal Bleeding

  • Original Article
  • Published:
Digestive Diseases and Sciences Aims and scope Submit manuscript

Abstract

Background

Glasgow-Blatchford score (GBS) has been developed for risk stratification in management of acute upper gastrointestinal (GI) bleeding. However, the performance of GBS in patients with lower GI bleeding is unknown.

Aim

To evaluate the performance of full or modified GBS and modified GBS in prediction of major clinical outcomes in patients with lower GI bleeding.

Methods

A retrospective study of patients admitted to a tertiary care center with either non-variceal upper GI bleeding or lower GI bleeding was conducted. The full and modified GBS were calculated for all patients. The primary outcome was a combined outcome of inpatient mortality, need for endoscopic, surgical, or radiologic procedure to control the bleed or treat the underlying source, and need for blood transfusion.

Results

A total of 1026 patients (562 cases for upper GI and 464 cases for lower GI) were included in the study. Hospital-based interventions and mortality were significantly higher in upper GI bleeding group. The performance of the full GBS in lower GI bleeding (area under the receiver operating curve (AUROC) 0.78, 95% CI 0.74–0.82) was comparable to full GBS in upper GI bleeding (AUROC 0.77, 95% CI 0.73–0.81) in predicting the primary outcome. Similarly, the performance of modified GBS in lower GI bleeding was shown to be comparable to modified GBS in upper GI bleeding (AUROC 0.78, 95% CI 0.74–0.83 vs. AUROC 0.76 95% CI 0.72–0.80).

Conclusion

In patients with lower GI bleeding, both full GBS and modified GBS can predict the need for hospital-based interventions and mortality.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Quirk DM, Barry MJ, Aserkoff B, Podolsky DK. Physician specialty and variations in the cost of treating patients with acute upper gastrointestinal bleeding. Gastroenterology. 1997;113:1443–1448.

    Article  CAS  Google Scholar 

  2. Johanson JF. Curbing the costs of GI bleeding. Am J Gastroenterol. 1998;93:1384–1385.

    Article  CAS  Google Scholar 

  3. Barkun AN, Bardou M, Kuipers EJ, et al. International consensus recommendations on the management of patients with nonvariceal upper gastrointestinal bleeding. Ann Intern Med. 2010;152:101–113.

    Article  Google Scholar 

  4. El-Tawil AM. Trends on gastrointestinal bleeding and mortality: where are we standing? World J Gastroenterol. 2012;18:1154–1158.

    Article  Google Scholar 

  5. Strate LL. Lower GI bleeding: epidemiology and diagnosis. Gastroenterol Clin North Am. 2005;34:643–664.

    Article  Google Scholar 

  6. Hreinsson JP, Kalaitzakis E, Gudmundsson S, Bjornsson ES. Upper gastrointestinal bleeding: incidence, etiology and outcomes in a population-based setting. Scand J Gastroenterol. 2013;48:439–447.

    Article  CAS  Google Scholar 

  7. Chung P KK. Epidemiology of Acute Gastrointestinal Bleeding. ed.^eds. Acute Gastrointestinal Bleeding City; Humana Press Inc.;2003:3-7.

  8. Kim SH, Yun JM, Chang CB, Piao H, Yu SJ, Shin DW. Prevalence of upper gastrointestinal bleeding risk factors among the general population and osteoarthritis patients. World J Gastroenterol. 2016;22:10643–10652.

    Article  Google Scholar 

  9. Rockall TA, Logan RF, Devlin HB, Northfield TC. Risk assessment after acute upper gastrointestinal haemorrhage. Gut. 1996;38:316–321.

    Article  CAS  Google Scholar 

  10. Blatchford O, Murray WR, Blatchford M. A risk score to predict need for treatment for upper-gastrointestinal haemorrhage. Lancet. 2000;356:1318–1321.

    Article  CAS  Google Scholar 

  11. Quach DT, Dao NH, Dinh MC, et al. The Performance of a Modified Glasgow Blatchford Score in Predicting Clinical Interventions in Patients with Acute Nonvariceal Upper Gastrointestinal Bleeding: A Vietnamese Prospective Multicenter Cohort Study. Gut Liver. 2016;10:375–381.

    Article  Google Scholar 

  12. Cheng DW, Lu YW, Teller T, Sekhon HK, Wu BU. A modified Glasgow Blatchford Score improves risk stratification in upper gastrointestinal bleed: a prospective comparison of scoring systems. Aliment Pharmacol Ther. 2012;36:782–789.

    Article  CAS  Google Scholar 

  13. DeLong ER, DeLong DM, Clarke-Pearson DL. Comparing the areas under two or more correlated receiver operating characteristic curves: a nonparametric approach. Biometrics. 1988;44:837–845.

    Article  CAS  Google Scholar 

  14. Laine L, Jensen DM. Management of patients with ulcer bleeding Am J Gastroenterol. 2012;107:345–360. (quiz 361).

    CAS  PubMed  Google Scholar 

  15. Strate LL, Gralnek IM. ACG clinical guideline: management of patients with acute lower gastrointestinal bleeding. Am J Gastroenterol. 2016;111:459–474.

    Article  CAS  Google Scholar 

  16. Monteiro S, Goncalves TC, Magalhaes J, Cotter J. Upper gastrointestinal bleeding risk scores: who, when and why? World J Gastrointest Pathophysiol. 2016;7:86–96.

    Article  Google Scholar 

  17. Stanley AJ, Ashley D, Dalton HR, et al. Outpatient management of patients with low-risk upper-gastrointestinal haemorrhage: multicentre validation and prospective evaluation. Lancet. 2009;373:42–47.

    Article  CAS  Google Scholar 

  18. Girardin M, Bertolini D, Ditisheim S, et al. Use of Glasgow-Blatchford bleeding score reduces hospital stay duration and costs for patients with low-risk upper GI bleeding. Endosc Int Open. 2014;2:E74–E79.

    Article  Google Scholar 

  19. Strate LL, Ayanian JZ, Kotler G, Syngal S. Risk factors for mortality in lower intestinal bleeding. Clin Gastroenterol Hepatol. 2008;6:1004–1010. (quiz 1955-).

    Article  Google Scholar 

  20. Strate LL, Orav EJ, Syngal S. Early predictors of severity in acute lower intestinal tract bleeding. Arch Intern Med. 2003;163:838–843.

    Article  Google Scholar 

  21. Kwak MS, Cha JM, Han YJ, et al. The clinical outcomes of lower gastrointestinal bleeding are not better than those of upper gastrointestinal bleeding. J Korean Med Sci. 2016;31:1611–1616.

    Article  CAS  Google Scholar 

  22. Aoki T, Nagata N, Shimbo T, et al. Development and validation of a risk scoring system for severe acute lower gastrointestinal bleeding. Clin Gastroenterol Hepatol. 2016;14:1562–1570 e1562.

    Article  Google Scholar 

  23. Abusaada K, He X, Asad-Ur-Rahman F, et al. Predictors of the need for therapeutic intervention in older adult patients with a nonvariceal gastrointestinal bleed. South Med J. 2017;110:83–89.

    Article  Google Scholar 

  24. Laine L, Shah A. Randomized trial of urgent vs. elective colonoscopy in patients hospitalized with lower GI bleeding. Am J Gastroenterol. 2010;105:2636–2641. (quiz 2642).

    Article  Google Scholar 

  25. Witting MD, Magder L, Heins AE, Mattu A, Granja CA, Baumgarten M. ED predictors of upper gastrointestinal tract bleeding in patients without hematemesis. Am J Emerg Med. 2006;24:280–285.

    Article  Google Scholar 

Download references

Author information

Author notes

  1. Khalid Abusaada

    Present address: Internal Medicine Residency Program, Ocala Regional Medical Center, Ocala, FL, USA

  2. Asad Ur-Rahman

    Present address: Department of Gastroenterology, Cleveland Clinic Florida, Weston, FL, USA

Authors and Affiliations

  1. Internal Medicine Residency Program, Florida Hospital, Orlando, FL, USA

    Asad Ur-Rahman, Jian Guan, Sameen Khalid, Alvina Munaf, Mohammad Sharbatji, Evgeny Idrisov, Xiaoping He & Khalid Abusaada

  2. Internal Medicine Residency Program, Ocala Regional Medical Center, Ocala, FL, USA

    Archana Machavarapu

Authors
  1. Asad Ur-Rahman
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jian Guan
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Sameen Khalid
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Alvina Munaf
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Mohammad Sharbatji
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Evgeny Idrisov
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Xiaoping He
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Archana Machavarapu
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Khalid Abusaada
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jian Guan.

Ethics declarations

Conflict of interest

The authors have no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Ur-Rahman, A., Guan, J., Khalid, S. et al. Both Full Glasgow-Blatchford Score and Modified Glasgow-Blatchford Score Predict the Need for Intervention and Mortality in Patients with Acute Lower Gastrointestinal Bleeding. Dig Dis Sci 63, 3020–3025 (2018). https://doi.org/10.1007/s10620-018-5203-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10620-018-5203-4

Keywords

Search

Navigation