Comparison of risk scores and shock index in hemodynamically stable patients presenting to the emergency department with nonvariceal upper gastrointestinal bleeding.

Abstract

Objective Risk assessment in nonvariceal upper gastrointestinal bleeding (UGIB) is not well validated and remains unclear in hemodynamically stable patients at emergency department admission. We compared the prognostic value of risk-scoring systems for predicting adverse outcomes in patients with nonvariceal UGIB and normotension.

Participants and methods A single-center prospective observational study was carried out. Patients with consecutive nonvariceal UGIB, presenting with normotension (systolic blood pressure >= 90 mmHg) to the emergency department, were included. We compared the areas under the curves (AUC) of Glasgow Blatchford score (GBS), the pre-endoscopy Rockall score, AIMS65, the shock index, and the modified shock index with respect to adverse outcomes defined as embolization, surgery, ICU admission, rebleeding, and in-hospital mortality.

Results In total, 1233 patients were included. Adverse outcomes occurred in 165 (13.4%) patients; in-hospital mortality was 1.2%. AUC of the GBS for adverse outcome was higher than that of the shock index, but not significantly different (0.647 vs. 0.569, P=0.23). AUC values of the modified shock index, AIMS65, and the pre-endoscopy Rockall score were 0.565, 0.593, and 0.533, respectively. The cut-off value of the GBS (>= 8) was associated with 85% sensitivity and 35% specificity for predicting adverse outcome.

Conclusion Pre-existing risk scores have shown suboptimal predictive ability for adverse events in normotensive patients with nonvariceal UGIB. The GBS (>= 8) might help to identify patients prone to adverse events; however, further studies with risk scores or new scores are needed because of the low accuracy of these scores.