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Comparison of various prognostic scores in variceal and non-variceal upper gastrointestinal bleeding: A prospective cohort study

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Abstract

Background and Aims

Various prognostic scores like Glasgow–Blatchford bleeding score (GBS), modified Glasgow–Blatchford bleeding score (mGBS), full Rockall score (FRS) including endoscopic findings, clinical Rockall score (CRS), and albumin, international normalized ratio (INR), mental status, systolic blood pressure, age >65 (AIMS65) are used for risk stratification in patients with upper gastrointestinal bleeding (UGIB). The utility of these scores in variceal UGIB (VUGIB) is not well defined. In this prospective study, we aimed to assess the performance of these scores in patients with non-variceal (NVUGIB) and VUGIB.

Methods

We included 1011 patients (during March 2017 and August 2018) including 439 with NVUGIB and 572 VUGIB. Performance of GBS, mGBS, FRS, CRS, and AIMS65 for various outcome measures was analyzed using the area under receiver operator characteristic curve (AUROC).

Results

The accuracy of prognostic scores in predicting the composite outcome including the need of hospital-based intervention and 42-day mortality was higher in NVUGIB as compared with VUGIB, AUROC: CRS: 0.641 vs. 0.537; FRS: 0.669 vs. 0.625; GBS: 0.719 vs. 0.587; mGBS: 0.711 vs. 0.594; AIMS65: 0.567 vs. 0.548. GBS and mGBS at a cut-off score of 1 had the highest negative predictive value, 91.7% and 91.3%, respectively, for predicting composite outcome in NVUGIB. Similarly, these scores had better accuracy for predicting 42-day rebleeding in NVUGIB as compared to VUGIB, AUROC: CRS: 0.680 vs. 0.537; FRS: 0.698 vs. 0.565; GBS: 0.661 vs. 0.543; mGBS: 0.627 vs. 0.540; AIMS65: 0.695 vs. 0.606.

Conclusion

The prognostic scores such as CRS, FRS, GBS, mGBS, and AIMS65 predict the need for hospital-based management, rebleeding, and mortality better among patients with NVUGIB than VUGIB.

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References

  1. Abougergi MS, Travis AC, Saltzman JR. The in-hospital mortality rate for upper GI hemorrhage has decreased over 2 decades in the United States: a nationwide analysis. Gastrointest Endosc. 2015;81:882–8.

    Article  PubMed  Google Scholar 

  2. Jairath V, Martel M, Logan RF, Barkun AN. Why do mortality rates for nonvariceal upper gastrointestinal bleeding differ around the world? A systematic review of cohort studies. Can J Gastroenterol. 2012;26:537–43.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Chalasani N, Kahi C, Francois F, et al. Improved patient survival after acute variceal bleeding: a multicenter, cohort study. Am J Gastroenterol. 2003;98:653–9.

    Article  PubMed  Google Scholar 

  4. Augustin S, Muntaner L, Altamirano JT, et al. Predicting early mortality after acute variceal hemorrhage based on classification and regression tree analysis. Clin Gastroenterol Hepatol. 2009;7:1347–54.

    Article  PubMed  Google Scholar 

  5. Rockall TA, Logan RF, Devlin HB, Northfield TC. Risk assessment after acute upper gastrointestinal haemorrhage. Gut. 1996;38:316–21.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. Tham TCK, James C, Kelly M. Predicting outcome of acute non-variceal upper gastrointestinal haemorrhage without endoscopy using the clinical Rockall score. Postgrad Med J. 2006;82:757–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Srirajaskanthan R, Conn R, Bulwer C, Irving P. The Glasgow Blatchford scoring system enables accurate risk stratification of patients with upper gastrointestinal haemorrhage. Int J Clin Pract. 2010;64:868–74.

    Article  CAS  PubMed  Google Scholar 

  8. Chandra S. AIMS65 score predicts short-term mortality but not the need for intervention in acute upper GI bleeding. Gastrointest Endosc. 2013;78:381–2.

    Article  PubMed  Google Scholar 

  9. 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;36:782–9.

    Article  CAS  PubMed  Google Scholar 

  10. Blatchford O, Murray WR, Blatchford M. A risk score to predict need for treatment for upper-gastrointestinal haemorrhage. Lancet. 2000;356:1318–21.

    Article  CAS  PubMed  Google Scholar 

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

    Article  PubMed  PubMed Central  Google Scholar 

  12. Kim BJ, Park MK, Kim S-J, et al. Comparison of scoring systems for the prediction of outcomes in patients with nonvariceal upper gastrointestinal bleeding: a prospective study. Dig Dis Sci. 2009;54:2523–9.

    Article  PubMed  Google Scholar 

  13. Chen I-C, Hung M-S, Chiu T-F, Chen J-C, Hsiao C-T. Risk scoring systems to predict need for clinical intervention for patients with nonvariceal upper gastrointestinal tract bleeding. Am J Emerg Med. 2007;25:774–9.

    Article  PubMed  Google Scholar 

  14. Abraldes JG, Villanueva C, Bañares R, et al. Hepatic venous pressure gradient and prognosis in patients with acute variceal bleeding treated with pharmacologic and endoscopic therapy. J Hepatol. 2008;48:229–36.

    Article  PubMed  Google Scholar 

  15. D’Amico G, De Franchis R, Cooperative Study Group. Upper digestive bleeding in cirrhosis. Post-therapeutic outcome and prognostic indicators. Hepatology. 2003;38:599–612.

    Article  PubMed  Google Scholar 

  16. Reverter E, Tandon P, Augustin S, et al. A MELD-based model to determine risk of mortality among patients with acute variceal bleeding. Gastroenterology. 2014;146:412–9.

    Article  PubMed  Google Scholar 

  17. British Society of Gastroenterology Endoscopy Committee. Non-variceal upper gastrointestinal haemorrhage: guidelines. Gut. 2002;51Suppl 4:iv1–6.

  18. de Franchis R, Faculty BVI. Expanding consensus in portal hypertension: report of the Baveno VI consensus workshop: stratifying risk and individualizing care for portal hypertension. J Hepatol. 2015;63:743–52.

    Article  PubMed  Google Scholar 

  19. Thanapirom K, Ridtitid W, Rerknimitr R, et al. Prospective comparison of three risk scoring systems in non-variceal and variceal upper gastrointestinal bleeding. J Gastroenterol Hepatol. 2016;31:761–7.

    Article  PubMed  Google Scholar 

  20. Kalafateli M, Triantos CK, Nikolopoulou V, Burroughs A. Non-variceal gastrointestinal bleeding in patients with liver cirrhosis: a review. Dig Dis Sci. 2012;57:2743–54.

    Article  CAS  PubMed  Google Scholar 

  21. Saltzman JR, Tabak YP, Hyett BH, Sun X, Travis AC, Johannes RS. A simple risk score accurately predicts in-hospital mortality, length of stay, and cost in acute upper GI bleeding. Gastrointest Endosc. 2011;74:1215–24.

    Article  PubMed  Google Scholar 

  22. Romagnuolo J, Barkun AN, Enns R, Armstrong D, Gregor J. Simple clinical predictors may obviate urgent endoscopy in selected patients with nonvariceal upper gastrointestinal tract bleeding. Arch Intern Med. 2007;167:265–70.

    Article  PubMed  Google Scholar 

  23. Garcia-Tsao G, Abraldes JG, Berzigotti A, Bosch J. Portal hypertensive bleeding in cirrhosis: risk stratification, diagnosis, and management: 2016 practice guidance by the American Association for the Study of Liver Diseases. Hepatology. 2017;65:310–35.

    Article  Google Scholar 

  24. Jun C-H, Park C-H, Lee W-S, et al. Antibiotic prophylaxis using third-generation cephalosporins can reduce the risk of early rebleeding in the first acute gastroesophageal variceal hemorrhage: a prospective randomized study. J Korean Med Sci. 2006;21:883–90.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  25. Sung JJ, Chiu PC, Chan FKL, et al. Asia-Pacific working group consensus on non-variceal upper gastrointestinal bleeding: an update 2018. Gut. 2018;67:1757–68.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Laursen SB, Hansen JM, Schaffalitzky de Muckadell OB. The Glasgow Blatchford score is the most accurate assessment of patients with upper gastrointestinal hemorrhage. Clin Gastroenterol Hepatol. 2012;10:1130–5.

    Article  PubMed  Google Scholar 

  27. Stanley AJ, Laine L, Dalton HR, et al. Comparison of risk scoring systems for patients presenting with upper gastrointestinal bleeding: international multicentre prospective study. BMJ. 2017;356:i6432.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Reed EA, Dalton H, Blatchford O, et al. Is the Glasgow Blatchford score useful in the risk assessment of patients presenting with variceal haemorrhage? Eur J Gastroenterol Hepatol. 2014;26:432–7.

    Article  PubMed  Google Scholar 

  29. Anand D, Gupta R, Dhar M, Ahuja V. Clinical and endoscopic profile of patients with upper gastrointestinal bleeding at tertiary care center of North India. J Dig Endosc. 2014;5:139–43.

  30. Mahajan P, Chandail VS. Etiological and endoscopic profile of middle aged and elderly patients with upper gastrointestinal bleeding in a tertiary care hospital in north India: A retrospective analysis. J Midlife Health. 2017;8:137-41.

  31. Lee HH, Park JM, Han S, et al. A simplified prognostic model to predict mortality in patients with acute variceal bleeding. Dig Liver Dis. 2018;50:247–53.

    Article  PubMed  Google Scholar 

  32. Wang F, Cui S, Wang F, et al. Different scoring systems to predict 6-week mortality in cirrhosis patients with acute variceal bleeding: a retrospective analysis of 202 patients. Scand J Gastroenterol. 2018;53:885–90.

    Article  PubMed  Google Scholar 

  33. Bryant RV, Kuo P, Williamson K, et al. Performance of the Glasgow–Blatchford score in predicting clinical outcomes and intervention in hospitalized patients with upper GI bleeding. Gastrointest Endosc. 2013;78:576–83.

    Article  PubMed  Google Scholar 

  34. Anchu AC, Mohsina S, Sureshkumar S, Mahalakshmy T, Kate V. External validation of scoring systems in risk stratification of upper gastrointestinal bleeding. Indian J Gastroenterol. 2017;36:105–12.

    Article  PubMed  Google Scholar 

  35. Sharma V, Jeyaraman P, Rana SS, et al. Utility of clinical and complete Rockall score in Indian patients with upper gastrointestinal bleeding. Trop Gastroenterol. 2017;37:276–82.

    Article  Google Scholar 

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Authors and Affiliations

Authors

Contributions

Gyanranjan Rout: acquisition of data; analysis and interpretation of data; drafting of the manuscript. I approved the final version of the manuscript.

Sanchit Sharma: acquisition of data, draft writing. I approved the final version of the manuscript.

Deepak Gunjan: acquisition of data, study concept. I approved the final version of the manuscript.

Saurabh Kedia: acquisition of data. I approved the final version of the manuscript.

Baibaswata Nayak: draft writing. I approved the final version of the manuscript.

Shalimar: draft writing, study concept, design, statistical analysis, critical revision of the manuscript. I approved the final version of the manuscript.

Corresponding author

Correspondence to Shalimar.

Ethics declarations

Conflict of interest

GR, SS, DG, SK, BN, and S declare that they have no conflict of interest.

Ethics statement

The study was performed in a manner to conform with the Helsinki Declaration of 1975, as revised in 2000 and 2008 concerning human and animal rights. The study protocol was approved by the institutional review board and ethics committee.

Informed consent

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

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The authors are solely responsible for the data and the content of the paper. In no way, the Honorary Editor-in-Chief, Editorial Board Members, or the printer/publishers are responsible for the results/findings and content of this article.

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None of the authors has any financial, professional, or personal conflicts that are relevant to the manuscript.

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Supplementary Fig.1

Receiver operating characteristic curves for different scores for predicting the 42-day mortality in patients with non-variceal bleeding (A) and variceal bleeding (B) (PNG 16 kb)

High resolution image (TIF 940 kb)

Supplementary Fig. 2

Receiver operating characteristic curves for different scores for predicting 42-day rebleeding in patients with non-variceal bleeding (A) and variceal bleeding (B) (PNG 14 kb)

High resolution image (TIF 940 kb)

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Rout, G., Sharma, S., Gunjan, D. et al. Comparison of various prognostic scores in variceal and non-variceal upper gastrointestinal bleeding: A prospective cohort study. Indian J Gastroenterol 38, 158–166 (2019). https://doi.org/10.1007/s12664-018-0928-8

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  • DOI: https://doi.org/10.1007/s12664-018-0928-8

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