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External validation of scoring systems in risk stratification of upper gastrointestinal bleeding

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Abstract

Aim

The aim of this study was to externally validate the four commonly used scoring systems in the risk stratification of patients with upper gastrointestinal bleed (UGIB).

Methods

Patients of UGIB who underwent endoscopy within 24 h of presentation were stratified prospectively using the pre-endoscopy Rockall score (PRS) >0, complete Rockall score (CRS) >2, Glasgow Blatchford bleeding scores (GBS) >3, and modified GBS (m-GBS) >3 scores. Patients were followed up to 30 days. Prognostic accuracy of the scores was done by comparing areas under curve (AUC) in terms of overall risk stratification, re-bleeding, mortality, need for intervention, and length of hospitalization.

Results

One hundred and seventy-five patients were studied. All four scores performed better in the overall risk stratification on AUC [PRS = 0.566 (CI: 0.481–0.651; p-0.043)/CRS = 0.712 (CI: 0.634–0.790); p<0.001)/GBS = 0.810 (CI: 0.744–0.877; p->0.001); m-GBS = 0.802 (CI: 0.734–0.871; p<0.001)], whereas only CRS achieved significance in identifying re-bleed [AUC—0.679 (CI: 0.579–0.780; p = 0.003)]. All the scoring systems except PRS were found to be significantly better in detecting 30-day mortality with a high AUC (CRS = 0.798; p-0.042)/GBS = 0.833; p-0.023); m-GBS = 0.816; p-0.031). All four scores demonstrated significant accuracy in the risk stratification of non-variceal patients; however, only GBS and m-GBS were significant in variceal etiology. Higher cutoff scores achieved better sensitivity/specificity [RS > 0 (50/60.8), CRS > 1 (87.5/50.6), GBS > 7 (88.5/63.3), m-GBS > 7(82.3/72.6)] in the risk stratification.

Conclusion

GBS and m-GBS appear to be more valid in risk stratification of UGIB patients in this region. Higher cutoff values achieved better predictive accuracy.

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Authors and Affiliations

  1. Department of Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Dhanvantri Nagar, Gorimedu, Puducherry, 605 006, India

    Anna Cherian Anchu, Subair Mohsina, Sathasivam Sureshkumar & Vikram Kate

  2. Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Dhanvantri Nagar, Gorimedu, Puducherry, 605 006, India

    T. Mahalakshmy

Authors
  1. Anna Cherian Anchu
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  2. Subair Mohsina
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  3. Sathasivam Sureshkumar
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  4. T. Mahalakshmy
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  5. Vikram Kate
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Corresponding author

Correspondence to Vikram Kate.

Ethics declarations

Conflict of interest

ACA, SKM, SSM, TM, and VK declare that they have no conflict of interest.

Ethics statement

Institute ethics committee approved the study. The nature, methodology, and risks involved in the study were explained to the patient and informed consent was obtained. All the information collected was kept confidential and patient was given full freedom to withdraw at any point during the study. All provisions of the Declaration of Helsinki were followed in this study. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Institutional review board statement

The study was reviewed and approved by the JIPMER institute research committee and the institute ethics committee.

Informed consent statement

Informed consent was obtained from all individual participants included in the study.

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Anchu, A.C., Mohsina, S., Sureshkumar, S. et al. External validation of scoring systems in risk stratification of upper gastrointestinal bleeding. Indian J Gastroenterol 36, 105–112 (2017). https://doi.org/10.1007/s12664-017-0740-x

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  • DOI: https://doi.org/10.1007/s12664-017-0740-x

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