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Comparison of Scoring Systems for the Prediction of Outcomes in Patients with Nonvariceal Upper Gastrointestinal Bleeding: A Prospective Study

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Abstract

The authors aimed to compare the clinical utility of five scoring systems for the prediction of rebleeding and death in patients with nonvariceal upper gastrointestinal bleeding (UGIB). A total of 239 consecutive patients who had undergone endoscopy due to nonvariceal UGIB were prospectively investigated on the basis of five scoring systems (Forrest classification, Rockall scoring system, Cedars-Sinai Medical Centre Predict Index, Blatchford scoring system, and Baylor college scoring system). Thirty-five patients (14.6%) experienced rebleeding and 20 patients (8.4%) died. Comparison of the high-risk categories of the four predictive systems showed that the Forrest classification was superior to the others in predicting rebleeding and death. The Cedars-Sinai Medical Centre Predict Index and the Rockall scoring system showed high positive predictive values for predicting rebleeding and death, respectively. We concluded that the Forrest classification was the most useful scoring system for the prediction of rebleeding and death in patients with nonvariceal UGIB.

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References

  1. Das A, Wong RC. Prediction of outcome of acute GI hemorrhage: a review of risk scores and predictive models. Gastrointest Endosc. 2004;60:85–93. doi:10.1016/S0016-5107(04)01291-X.

    Article  PubMed  Google Scholar 

  2. Hay JA, Lyubashevsky E, Elashoff J, Maldonado L, Weingarten SR, Ellrodt AG. Upper gastrointestinal hemorrhage clinical–guideline determining the optimal hospital length of stay. Am J Med. 1996;100:313–322. doi:10.1016/S0002-9343(97)89490-9.

    Article  PubMed  CAS  Google Scholar 

  3. Camellini L, Merighi A, Pagnini C, et al. Comparison of three different risk scoring systems in non-variceal upper gastrointestinal bleeding. Dig Liver Dis. 2004;36:271–277. doi:10.1016/j.dld.2003.10.017.

    Article  PubMed  CAS  Google Scholar 

  4. Chen IC, Hung MS, Chiu TF, Chen JC, Hsiao CT. Risk scoring systems to predict need for clinical intervention for patients with nonvariceal upper gastrointestinal tract bleeding. Am J Emerg Med. 2007;25:774–779. doi:10.1016/j.ajem.2006.12.024.

    Article  PubMed  Google Scholar 

  5. Ch’ng CL, Kingham JG. Scoring systems and risk assessment for upper gastrointestinal bleeding. Eur J Gastroenterol Hepatol. 2001;13:1137–1139. doi:10.1097/00042737-200110000-00002.

    Article  PubMed  Google Scholar 

  6. Masaoka T, Suzuki H, Hori S, Aikawa N, Hibi T. Blatchford scoring system is a useful scoring system for detecting patients with upper gastrointestinal bleeding who do not need endoscopic intervention. J Gastroenterol Hepatol. 2007;22:1404–1408. doi:10.1111/j.1440-1746.2006.04762.x.

    Article  PubMed  Google Scholar 

  7. Sanders DS, Carter MJ, Goodchap RJ, Cross SS, Gleeson DC, Lobo AJ. Prospective validation of the Rockall risk scoring system for upper GI hemorrhage in subgroups of patients with varices and peptic ulcers. Am J Gastroenterol. 2002;97:630–635. doi:10.1111/j.1572-0241.2002.05541.x.

    Article  PubMed  CAS  Google Scholar 

  8. Imperiale TF, Dominitz JA, Provenzale DT, et al. Predicting poor outcome from acute upper gastrointestinal hemorrhage. Arch Intern Med. 2007;167:1291–1296. doi:10.1001/archinte.167.12.1291.

    Article  PubMed  Google Scholar 

  9. Guglielmi A, Ruzzenente A, Sandri M, et al. Risk assessment and prediction of rebleeding in bleeding gastroduodenal ulcer. Endoscopy. 2002;34:778–786. doi:10.1055/s-2002-34261.

    Article  PubMed  CAS  Google Scholar 

  10. Barkun A, Bardou M, Marshall JK. Consensus recommendations for managing patients with nonvariceal upper gastrointestinal bleeding. Ann Intern Med. 2003;139:843–857.

    PubMed  Google Scholar 

  11. Heldwein W, Schreiner J, Pedrazzoli J, Lehnert P. Is the Forrest classification a useful tool for planning endoscopic therapy of bleeding peptic ulcers? Endoscopy. 1989;21:258–262. doi:10.1055/s-2007-1010729.

    Article  PubMed  CAS  Google Scholar 

  12. Parente F, Anderloni A, Bargiggia S, et al. Outcome of non-variceal acute upper gastrointestinal bleeding in relation to the time of endoscopy and the experience of the endoscopist: a two-year survey. World J Gastroenterol. 2005;11:7122–7130.

    PubMed  Google Scholar 

  13. Zaragoza AM, Tenias JM, Llorente MJ, Alborch A. Prognostic factors in gastrointestinal bleeding due to peptic ulcer: construction of a predictive model. J Clin Gastroenterol. 2008;42:786–790.

    Article  PubMed  Google Scholar 

  14. Saeed ZA, Ramirez FC, Hepps KS, Cole RA, Graham DY. Prospective validation of the Baylor bleeding score for predicting the likelihood of rebleeding after endoscopic hemostasis of peptic ulcers. Gastrointest Endosc. 1995;41:561–565. doi:10.1016/S0016-5107(95)70191-5.

    Article  PubMed  CAS  Google Scholar 

  15. Romagnuolo J, Barkun AN, Enns R, Armstrong D, Gregor J. Simple clinical predictors may obviate urgent endoscopy in selected patients with nonvariceal upper gastrointestinal tract bleeding. Arch Intern Med. 2007;167:265–270. doi:10.1001/archinte.167.3.265.

    Article  PubMed  Google Scholar 

  16. Das A, Ben-Menachem T, Farooq FT, et al. Artificial neural network as a predictive instrument in patients with acute nonvariceal upper gastrointestinal hemorrhage. Gastroenterology. 2008;134:65–74. doi:10.1053/j.gastro.2007.10.037.

    Article  PubMed  Google Scholar 

  17. Gralnek IM, Dulai GS. Incremental value of upper endoscopy for triage of patients with acute non-variceal upper-GI hemorrhage. Gastrointest Endosc. 2004;60:9–14. doi:10.1016/S0016-5107(04)01524-X.

    Article  PubMed  Google Scholar 

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Correspondence to Jun Haeng Lee.

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Kim BJ and Park MK contributed equally to this work.

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Kim, B.J., Park, M.K., Kim, SJ. et al. Comparison of Scoring Systems for the Prediction of Outcomes in Patients with Nonvariceal Upper Gastrointestinal Bleeding: A Prospective Study. Dig Dis Sci 54, 2523–2529 (2009). https://doi.org/10.1007/s10620-008-0654-7

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  • DOI: https://doi.org/10.1007/s10620-008-0654-7

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