Brief Article
Copyright ©2013 Baishideng Publishing Group Co., Limited. All rights reserved.
World J Gastroenterol. Jun 14, 2013; 19(22): 3466-3472
Published online Jun 14, 2013. doi: 10.3748/wjg.v19.i22.3466
Rockall score in predicting outcomes of elderly patients with acute upper gastrointestinal bleeding
Chang-Yuan Wang, Jian Qin, Jing Wang, Chang-Yi Sun, Tao Cao, Dan-Dan Zhu
Chang-Yuan Wang, Jian Qin, Jing Wang, Chang-Yi Sun, Tao Cao, Dan-Dan Zhu, Department of Emergency, Xuanwu Hospital of Capital Medical University, Beijing 100053, China
Author contributions: Wang CY designed the research and wrote the manuscript; Qin J designed the research and advised on the manuscript preparation; Sun CY and Wang J advised on the manuscript preparation; Cao T and Zhu DD collected data.
Correspondence to: Dr. Jian Qin, Department of Emergency, Xuanwu Hospital of Capital Medical University, No. 45 Changchun Street, Beijing 100053, China. jinse73@163.com
Telephone: +86-10-83198301 Fax: +86-10-83198382
Received: March 7, 2013
Revised: March 27, 2013
Accepted: April 3, 2013
Published online: June 14, 2013
Abstract

AIM: To validate the clinical Rockall score in predicting outcomes (rebleeding, surgery and mortality) in elderly patients with acute upper gastrointestinal bleeding (AUGIB).

METHODS: A retrospective analysis was undertaken in 341 patients admitted to the emergency room and Intensive Care Unit of Xuanwu Hospital of Capital Medical University with non-variceal upper gastrointestinal bleeding. The Rockall scores were calculated, and the association between clinical Rockall scores and patient outcomes (rebleeding, surgery and mortality) was assessed. Based on the Rockall scores, patients were divided into three risk categories: low risk ≤ 3, moderate risk 3-4, high risk ≥ 4, and the percentages of rebleeding/death/surgery in each risk category were compared. The area under the receiver operating characteristic (ROC) curve was calculated to assess the validity of the Rockall system in predicting rebleeding, surgery and mortality of patients with AUGIB.

RESULTS: A positive linear correlation between clinical Rockall scores and patient outcomes in terms of rebleeding, surgery and mortality was observed (r = 0.962, 0.955 and 0.946, respectively, P = 0.001). High clinical Rockall scores > 3 were associated with adverse outcomes (rebleeding, surgery and death). There was a significant correlation between high Rockall scores and the occurrence of rebleeding, surgery and mortality in the entire patient population (χ2 = 49.29, 23.10 and 27.64, respectively, P = 0.001). For rebleeding, the area under the ROC curve was 0.788 (95%CI: 0.726-0.849, P = 0.001); For surgery, the area under the ROC curve was 0.752 (95%CI: 0.679-0.825, P = 0.001) and for mortality, the area under the ROC curve was 0.787 (95%CI: 0.716-0.859, P = 0.001).

CONCLUSION: The Rockall score is clinically useful, rapid and accurate in predicting rebleeding, surgery and mortality outcomes in elderly patients with AUGIB.

Keywords: Rockall score, Acute upper gastrointestinal bleeding, Prognosis, Elderly patients

Core tip: This study verified the advantages of the Rockall score in predicting the outcomes of the elderly patients with non-variceal upper gastrointestinal bleeding (UGIB) and assessed its clinical usefulness and prognostic value in rebleeding, surgery and mortality. The results suggest that the Rockall scoring system had satisfactory validity for the prediction of rebleeding, surgery and mortality in patients with acute non-variceal UGIB, and there was a positive linear correlation between the clinical Rockall scores and patient outcomes in terms of rebleeding, surgery and mortality.