Introduction
Upper gastrointestinal bleeding is one of the common medical emergencies which is associated with significant morbidity, mortality, and resource utilization.(1) This burden is compounded in resource-poor settings, where patients often pay out-of-pocket for care, thereby hampering appropriate early diagnosis to determine the location and severity of bleeding.(2) Effective management requires risk stratification of patients into low or high-risk groups to guide subsequent treatment and follow-up.(3)
The Rockall Score, Glasgow Blatchford Score and recently, the AIMS65 score are widely used and have been validated to predict outcomes in several studies. (4)
Aims & Methods
We aim to compare the performance of the Rockall score, Glasgow Blatchford Score and AIMS65 score in predicting outcomes among patients with upper gastrointestinal bleeding. This was a single-centre prospective study among 195 patients who presented with symptoms of UGIB at the Emergency department of a tertiary hospital in Ghana from May 2022 to April 2023. The relevant baseline clinical characteristics, Glasgow Blatchford and AIMS65 scores were obtained. The Rockall score and the cause of UGIB was determined as per findings at upper gastrointestinal endoscopy. Patients were followed up for 6 weeks from admission looking out for primary outcomes of need for transfusion, rebleeding and mortality. Receiver operating characteristic curve analysis was performed to assess the ability of each risk score to predict primary outcomes.
Results
There were 195 patients in this study, 145 (74.4%) were males, the mean age (SD) was 51.4 (17.4) years and 68 (34.9%) had variceal bleeding. The 6-week mortality was 34 (17.4%), rebleeding occurred in 14 (7.2%) and 138 (70.8%) received blood transfusion.
Rockall score (area under the curve (AUC) 0.83, 95% confidence interval (CI), 0.76-0.88, p<0.001) was superior in predicting 6-week mortality compared to AIMS65 score (AUC 0.72, 95% CI, 0.63-0.81, p<0.001) and Glasgow Blatchford score (AUC 0.71, 95% CI, 0.61-0.82, p<0.001). The need for transfusion was best predicted by the Glasgow Blatchford score (AUC 0.77, 95% CI 0.70-0.85, p<0.001) compared to the AIMS65 score (AUC 0.66, 95% CI, 0.57-0.74, p<0.001) and Rockall score (AUC 0.77, 95% CI 0.57-0.75, p <0.001). Only Rockall score (AUC 0.71, 95% CI, 0.60-0.83, p<0.001) showed significance in predicting rebleeding.
| Outcome | Risk score | AUC | p-value | 95% CI |
| 6-week Mortality | Rockall | 0.83 | <0.001 | 0.77-0.88 |
| Glasgow Blatchford | 0.71 | <0.001 | 0.61-0.82 |
| AIMS65 | 0.72 | <0.001 | 0.63-0.81 |
| Need for transfusion | Rockall | 0.66 | <0.001 | 0.57-0.75 |
| Glasgow Blatchford | 0.77 | <0.001 | 0.70-0.85 |
| AIMS65 | 0.66 | <0.001 | 0.57-0.75 |
| 6- week Rebleeding | Rockall | 0.71 | <0.001 | 0.60-0.83 |
| Glasgow Blatchford | 0.53 | 0.659 | 0.39-0.68 |
| AIMS65 | 0.56 | 0.455 | 0.40-0.72 |
Conclusion
Although the endoscopy dependent Rockall score has the highest accuracy in predicting mortality, non-endoscopy dependent Glasgow Blatchford and AIMS65 scores, which are derived from readily available clinical and laboratory parameters, were found to be significant in predicting mortality and will be useful in a low resource setting. Glasgow Blatchford score has the best accuracy for predicting the need for transfusion compared to Rockall and AIMS65 scores. Only Rockall score was useful in predicting 6-week rebleeding among all the three risk scoring systems.
References
1. Esrailian E, Gralnek IM. Nonvariceal upper gastrointestinal bleeding: Epidemiology and diagnosis. Vol. 34, Gastroenterology Clinics of North America. 2005.
2. Rukewe A., Otegbayo J.A., Fatiregun A. Clinical characeristics and outcome of patients with upper gastrointestinal bleeding at the emergency department of a tertiary hospital in Nigeria. Ann Ib Postgrad Med. 2015 Dec;13(2):89–93.
3. Balaban D.V., Strambu V, Florea B.G., Cazan A.R., Bratucu M. Predictors for In-hospital mortality and need for clinical intervention in upper GI Bleeding: A 5-year observational study. Chirugua. 2014 Jan;109(1):48–54.
4. Chang A, Ouejiaraphant C, Akarapatima K, Rattanasupa A, Prachayakul V. Prospective Comparison of the AIMS65 Score, Glasgow-Blatchford Score, and Rockall Score for Predicting Clinical Outcomes in Patients with Variceal and Nonvariceal Upper Gastrointestinal Bleeding. Clin Endosc. 2021 Mar 30;54(2):211–21.
