Prospective Study
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Nov 7, 2017; 23(41): 7450-7458
Published online Nov 7, 2017. doi: 10.3748/wjg.v23.i41.7450
Scoring systems for peptic ulcer bleeding: Which one to use?
Ivan Budimir, Sanja Stojsavljević, Neven Baršić, Alen Bišćanin, Gorana Mirošević, Sven Bohnec, Lora Stanka Kirigin, Tajana Pavić, Neven Ljubičić
Ivan Budimir, Sanja Stojsavljević, Neven Baršić, Alen Bišćanin, Tajana Pavić, Neven Ljubičić, Division of Gastroenterology, Department of Internal Medicine, “Sestre Milosrdnice” University Hospital Center, Zagreb 10000, Croatia
Gorana Mirošević, Lora Stanka Kirigin, Division of Endocrinology, Department of Internal Medicine, “Sestre Milosrdnice” University Hospital Center, Medical and Dental Faculty, University of Zagreb, Zagreb 10000, Croatia
Sven Bohnec, Gastronterologie, Allgemeine Innere Medizin und Geriatrie, Rems-Murr Klinik Winnenden, 71364 Winnenden, Germany
Author contributions: Budimir I, Stojsavljević S and Baršić N contributed equally to this work; Budimir I and Ljubičić N designed the research; Budimir I, Stojsavljević S, Baršić N Bišćanin A and Pavić T performed the research; Budimir I, Stojsavljević S, Baršić N, Mirošević G, Bohnec S, Kirigin LS and Pavić T analyzed the data; Budimir I, Stojsavljević S and Baršić N wrote the paper.
Institutional review board statement: The study was reviewed and approved by the Ethics Board of the Clinical Hospital Center ‘’Sestre Milosrdnice’’, Vinogradska cesta 29, Zagreb.
Clinical trial registration statement: The study was registered in the Clinical Hospital Center ‘’Sestre Milosrdnice’’ clinical trials register.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: None declared.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Sanja Stojsavljević, MD, Division of Gastroenterology, Department of Internal Medicine, “Sestre Milosrdnice” University Hospital Center, Vinogradska ul. 29, Zagreb 10000, Croatia. sanja.stojsavljevic@kbcsm.hr
Telephone: +385-1-3787178 Fax: +385-1-3787448
Received: July 26, 2017
Peer-review started: July 26, 2017
First decision: August 10, 2017
Revised: August 24, 2017
Accepted: September 13, 2017
Article in press: September 13, 2017
Published online: November 7, 2017
Processing time: 103 Days and 13.1 Hours
Abstract
AIM

To compare the Glasgow-Blatchford score (GBS), Rockall score (RS) and Baylor bleeding score (BBS) in predicting clinical outcomes and need for interventions in patients with bleeding peptic ulcers.

METHODS

Between January 2008 and December 2013, 1012 consecutive patients admitted with peptic ulcer bleeding (PUB) were prospectively followed. The pre-endoscopic RS, BBS and GBS, as well as the post-endoscopic diagnostic scores (RS and BBS) were calculated for all patients according to their urgent upper endoscopy findings. Area under the receiver-operating characteristics (AUROC) curves were calculated for the prediction of lethal outcome, rebleeding, needs for blood transfusion and/or surgical intervention, and the optimal cutoff values were evaluated.

RESULTS

PUB accounted for 41.9% of all upper gastrointestinal tract bleeding, 5.2% patients died and 5.4% patients underwent surgery. By comparing the AUROC curves of the aforementioned pre-endoscopic scores, the RS best predicted lethal outcome (AUROC 0.82 vs 0.67 vs 0.63, respectively), but the GBS best predicted need for hospital-based intervention or 30-d mortality (AUROC 0.84 vs 0.57 vs 0.64), rebleeding (AUROC 0.75 vs 0.61 vs 0.53), need for blood transfusion (AUROC 0.83 vs 0.63 vs 0.58) and surgical intervention (0.82 vs 0.63 vs 0.52) The post-endoscopic RS was also better than the post-endoscopic BBS in predicting lethal outcome (AUROC 0.82 vs 0.69, respectively).

CONCLUSION

The RS is the best predictor of mortality and the GBS is the best predictor of rebleeding, need for blood transfusion and/or surgical intervention in patients with PUB. There is no one 'perfect score' and we suggest that these two tests be used concomitantly.

Keywords: Upper gastrointestinal bleeding; Peptic ulcer bleeding; Glasgow-Blatchford score; Rockall score; Baylor bleeding score

Core tip: Endoscopic hemostasis represents the cornerstone of upper gastrointestinal bleeding treatment, and several scores have been developed for the prediction of rebleeding. This is a first study on Croatian patients to include over 1000 participants with peptic ulcer bleeding, and the aim was to compare three scores (Glasgow Blatchford score, Rockall score and Baylor bleeding score) in the prediction of peptic ulcer bleeding treatment outcome, including need for hospital-based intervention or 30-d mortality, 30-d rebleeding rate, 30-d mortality rate, and needs for surgical intervention and blood transfusion, and to find optimal cutoff values that indicate high-risk patients.