Predictive Utility of Pre- and Post-Endoscopic Risk Scores and Hemodynamic Indexes in Acute Upper Gastrointestinal Bleeding in the Emergency Department.

Abstract

Purpose: There is a controversy about risk scores for risk stratification of acute upper gastrointestinal bleeding (AUGIB) in the emergency department (ED). This study aimed to compare the prognostic utility of UGIB scores with perfusion index (PI) and shock index (SI) in these patient groups in the ED.

Patients and methods: A prospective cross-sectional study was conducted on a convenience sample of patients with AUGIB who were admitted to the ED of a tertiary care hospital. Areas under the receiver operating characteristic curve (AUROC) were used to evaluate the predictive performance of pre- and post-endoscopic risk scores, as well as hemodynamic indexes (PI and SI), in terms of composite endpoints.

Results: Rockall Score (RS), Cedars Sinai Medical Centre Predictive Index (CSMCPI), Progetto nazionale emorragia digestiva score (PNED), Glasgow Blatchford Score (GBS), and albumin, international normalized ratio, mental status, systolic blood pressure, age ≥65 years score (AIMS65) were significantly higher for endoscopic intervention (p=0.002, p<0.001, p=0.001, p=0.002, p=0.004, respectively). RS, Cedarsiani, PNED, and GBS were significantly higher in hospitalized patients (p = 0.001, p < 0.001, p = 0.021, p = 0.002, respectively). RS, PNED, and AIMS65 scores were significantly higher for recurrent hemorrhage (p = 0.019, p = 0.005, p = 0.008, respectively). RS, Baylor Bleeding Score (BBS), Cedarsinai, PNED, and AIMS65 were significantly higher for mortality (p = 0.01, p = 0.013, p = 0.026, p = 0.005, p = 0.003, respectively). SI was statistically significant only for the transfusion need of patients (p = 0.019).

Conclusion: AIMS-65 seems to be more valuable and feasible than the others in the ED. Hemodynamic indexes should be used in conjunction with risk scores.