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©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
Age, blood tests and comorbidities and AIMS65 risk scores outperform Glasgow-Blatchford and pre-endoscopic Rockall score in patients with upper gastrointestinal bleeding
Bianca Codrina Morarasu, Victorita Sorodoc, Anca Haisan, Stefan Morarasu, Cristina Bologa, Raluca Ecaterina Haliga, Catalina Lionte, Emilia Adriana Marciuc, Mohammed Elsiddig, Diana Cimpoesu, Gabriel Mihail Dimofte, Laurentiu Sorodoc
Bianca Codrina Morarasu, Victorita Sorodoc, Cristina Bologa, Raluca Ecaterina Haliga, Catalina Lionte, Laurentiu Sorodoc, Department of Internal Medicine and Toxicology, Saint Spiridon University Regional Emergency Hospital, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, Iasi 700111, Romania
Anca Haisan, Diana Cimpoesu, Department of Emergency Medicine, Saint Spiridon University Regional Emergency Hospital, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, Iasi 700111, Romania
Stefan Morarasu, Gabriel Mihail Dimofte, Second Department of Surgical Oncology, Regional Institute of Oncology, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, Iasi 700111, Romania
Emilia Adriana Marciuc, Department of Radiology, Emergency Hospital “Prof. Dr. N. Oblu”, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, Iasi 700309, Romania
Mohammed Elsiddig, Department of Gatroenterology, Beaumont Hospital, Dublin D09V2N0, Ireland
Author contributions: Morarasu BC and Sorodoc V contributed equally to this work; Sorodoc L, Dimofte GM, Haisan A, and Morarasu S designed the research study; Haisan A and Marciuc EA performed the research; Bologa C, Haliga RE, and Lionte C contributed to the analytic tools; Morarasu BC, Sorodoc V, Haisan A, Cimpoesu D, and Elsiddig M analyzed the data and wrote the manuscript; and all authors have read and approve the final manuscript.
Institutional review board statement: The study was reviewed and approved by the ‘’Saint Spiridon’’ Institutional Review Board approved this study (approval No. 39/30.03.2022).
Conflict-of-interest statement: The authors declare no conflict of interest.
Data sharing statement: Technical appendix, statistical code, and dataset available from the corresponding author at victorita.sorodoc@umfiasi.ro.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
https://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Victorita Sorodoc, MD, PhD, Associate Professor, Department of Internal Medicine and Toxicology, Saint Spiridon University Regional Emergency Hospital, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, No. 1 BLD Independentei, Iasi 700111, Romania. victorita.sorodoc@umfiasi.ro
Received: March 28, 2023
Peer-review started: March 28, 2023
First decision: April 26, 2023
Revised: May 14, 2023
Accepted: May 30, 2023
Article in press: May 30, 2023
Published online: July 6, 2023
BACKGROUND
Upper gastrointestinal (GI) bleeding is a life-threatening condition with high mortality rates.
AIM
To compare the performance of pre-endoscopic risk scores in predicting the following primary outcomes: In-hospital mortality, intervention (endoscopic or surgical) and length of admission (≥ 7 d).
METHODS
We performed a retrospective analysis of 363 patients presenting with upper GI bleeding from December 2020 to January 2021. We calculated and compared the area under the receiver operating characteristics curves (AUROCs) of Glasgow-Blatchford score (GBS), pre-endoscopic Rockall score (PERS), albumin, international normalized ratio, altered mental status, systolic blood pressure, age older than 65 (AIMS65) and age, blood tests and comorbidities (ABC), including their optimal cut-off in variceal and non-variceal upper GI bleeding cohorts. We subsequently analyzed through a logistic binary regression model, if addition of lactate increased the score performance.
RESULTS
All scores had discriminative ability in predicting in-hospital mortality irrespective of study group. AIMS65 score had the best performance in the variceal bleeding group (AUROC = 0.772; P < 0.001), and ABC score (AUROC = 0.775; P < 0.001) in the non-variceal bleeding group. However, ABC score, at a cut-off value of 5.5, was the best predictor (AUROC = 0.770, P = 0.001) of in-hospital mortality in both populations. PERS score was a good predictor for endoscopic treatment (AUC = 0.604; P = 0.046) in the variceal population, while GBS score, (AUROC = 0.722; P = 0.024), outperformed the other scores in predicting surgical intervention. Addition of lactate to AIMS65 score, increases by 5-fold the probability of in-hospital mortality (P < 0.05) and by 12-fold if added to GBS score (P < 0.003). No score proved to be a good predictor for length of admission.
CONCLUSION
ABC score is the most accurate in predicting in-hospital mortality in both mixed and non-variceal bleeding population. PERS and GBS should be used to determine need for endoscopic and surgical intervention, respectively. Lactate can be used as an additional tool to risk scores for predicting in-hospital mortality.
Core Tip: Upper gastrointestinal (GI) bleeding is a life-threatening condition with high mortality rates. It represents one of the main reasons for presentation in the emergency department, having a major impact on both the patient and the clinician. This cohort study evaluates four of the mostly used pre-endoscopic risk scores by comparing them in two populations, variceal and non-variceal upper GI bleeding, highlighting which one should be preferably used depending on the investigated outcome.
