Introduction
Upper gastrointestinal bleeding (UGIB) is one of the main potentially life-threatening emergencies encountered in gastroenterology that requires prompt management. For this reason, numerous prognostic scores have been developed to predict the level of risk in patients. However, there are few studies in the literature comparing these scores.
Aims & Methods
The main objective of this study was to compare the performance of the pre-endoscopic scores Glasgow-Blatchford Score (GBS), Rockall Score (pRS), and quick Sequential Organ Failure Assessment (qSOFA) in predicting the severity of UGIB according to predefined criteria.
Methods: This is a retrospective descriptive and analytical study of 102 patients who presented with upper gastrointestinal bleeding at the International University Hospital Cheikh Khalifa over a period of 1 year between October 2021 and October 2022. Scores were calculated for each patient with complete medical records. The data was analyzed using the Jamovi 2.2.5 software. The accuracy of each risk score in predicting clinical criteria was evaluated by the area under the receiver operating characteristic curve (AUROC). A p-value less than 0.05 was considered statistically significant.
Results
The included patients had a mean age of 57.1 years with a slight female predominance (53.9%). GBS was found to be more predictive of the risk of admission to the Intensive care Unit (ICU) and the need for blood transfusion than pRS and qSOFA with an AUROC of 0.914 for these two criteria. GBS was also more predictive of the risk of therapeutic intervention (AUROC 0.882) compared to pRS (AUROC 0.788) and qSOFA (AUROC 0.676). Regarding endoscopic intervention, pRS and GBS were equally able to predict this criterion with moderate power (AUROC pRS 0.721) (AUROC GBS 0.747). qSOFA showed no significant performance, especially in its preferred domain of admission to the ICU (AUROC 0.735) (Table). None of the 3 scores was able to predict the need for surgical intervention.
Table: Comparison of AUC, sensitivity, specificity, PPV and NPV along with cut-off value of Glasgow-Blatchford Score, pre-Rockall, and Quick-Sofa scores to predict the clinical outcomes
| Variable | AUC (95% CI) | Cut-off value | Specificity | Sensitivity | PPV | NPV |
Need for Intensive Care Unit | GBS | 0,914 | >10 | 81,82% | 88,89% | 72,73% | 93,1% |
pRS | 0,843 | > 3 | 71,21% | 86,11% | 62% | 90,38% |
qSOFA | 0,735 | > 1 | 80,3% | 66,67% | 64,86% | 81,54% |
Need for blood transfusion
|
GBS |
0,914 |
> 10 |
85,25% |
85,37% |
79,55% |
89,66% |
pRS | 0,769 | > 3 | 67,21% | 67,21% | 60% | 78,85% |
qSOFA | 0,687 | > 1 | 78,69% | 78,69% | 64,86% | 73,85% |
Endoscopic intervention
| GBS | 0.747 | > 8 | 60,00% | 81,08% | 53,57% | 84,78% |
pRS | 0.721 | > 2 | 56,92% | 86,49% | 53,33% | 88,1%
|
qSOFA | 0.615 | > 1 | 72,31% | 51,35% | 51,35% | 72,31% |
Conclusion
At the end of this study, the use of GBS and pRS in daily clinical practice in emergency departments is strongly recommended to predict the need for therapeutic intervention, hospitalization, or re-bleeding episodes. However, it would be interesting to study the usefulness of these prognostic scores, especially qSOFA, through larger prospective studies.
References
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Disclosure
All co-authors have seen and agree with the contents of the manuscript and there is no conflict of interest.