Scoring systems for peptic ulcer bleeding: Which one to use?

Table 1 Glasgow-Blatchford score

		Assigned score
Blood urea, mmol/L	6.5 -7.9	2
	8.0-9.9	3
	10.0-24.9	4
	≥ 25	6
Hemoglobin for men, g/dL	12 -12.9	1
	10-11.9	3
	< 10	6
Hemoglobin for women, g/dL	10-11.9	1
	< 10	6
Systolic blood pressure, mmHg	100-109	1
	90-99	2
	< 90	3
Other markers	Pulse ≥ 100	1
	Melena	1
	Syncope	2
	Hepatic disease	2
	Cardiac failure	2

Table 2 Rockall score

		Points
	Variable	0	1	2	3
Pre-endoscopic score	Age, yr	< 60	60-79	≥ 80
	Shock	Systolic blood pressure ≥ 100	Systolic blood pressure ≥ 100 mmHg	Systolic blood pressure < 100
			Pulse ≥ 100/min
		Pulse < 100/min
	Comorbidity	No major comorbidity		Cardiac failure, ischemic heart disease, any major comorbidity	Renal failure, liver failure, disseminated malignancy
Post-endoscopic score	Diagnosis	Mallory-Weiss tear, no lesion identified and no signs of recent hemorrhage	All other diagnosis	Malignancy of upper gastrointestinal tract
	Major signs of recent hemorrhage	None or dark spot only		Blood in upper gastrointestinal tract, adherent clot, visible or spurting vessel

Table 3 Baylor bleeding score

Assigned score	Age, yr	No. of parallel illnesses	Severity of illnesses	Site of bleeding	Stigmata of bleeding
0	< 30	0
1	30-49	1 or 2			Clot
2	50-59
3	60-69				Visible vessel
4		3 or 4	Chronic	Posterior wall bulb
5	≥ 70	≥ 5	Acute		Active bleeding
Score	Pre-endoscopic			Post-endoscopic

Table 4 Patient characteristics and clinical outcomes

Age
Median, yr	65.3 (20-100)
Sex
Male/Female	638 (63)/374 (37)
Findings at endoscopy
Gastric ulcers	496 (49)
Duodenal ulcers	476 (47)
Gastric and duodenal ulcers	24 (2.4)
Ulcer on gastro-enteric anastomosis	16 (1.6)
High-risk ulcers (Forrest Ia-IIb)	526 (52)
Forrest Ia	61 (6)
Forrest Ib	111 (11)
Forrest IIa	212 (21)
Forrest IIb	142 (14)
Low- risk ulcers (Forrest IIc-III)	486 (48)
Forrest IIc	172 (17)
Forrest III	314 (31)
Hemodynamic shock	111 (11)
Comorbidity
Ischemic and valvular heart disease	213 (21.5)
Liver disease	172 (17)
Renal failure	111 (11)
Any malignancy	131 (12.9)
Comorbidity (ASA class)
ASA I	142 (14)
ASA II	283 (28)
ASA III-IV	587 (58)
H. pylori
Tested	760 (75.1)
H. pylori-positive	324 (42.6)
Drugs
Without previous therapy	433 (42.8)
NSAIDs	284 (28.1)
Acetylsalicylic acid	203 (20)
Antiplatelet therapy	31 (3.1)
Anticoagulant therapy	41 (4)
NOAC	20 (2)
Treatment
Endoscopic therapy	587 (58)
Epinephrine	213 (36.3)
Hemoclips	156 (26.6)
Hemoclips + epinephrine	180 (30.7)
Thermocoagulation	26 (4.4)
Thermocoagulation + epinephrine	12 (2)
Repeated endoscopic therapy	71 (7)
Blood transfusion required	496 (49)
Red blood cell	406 (40.1)
Median (range), unit	2.5 (1-16)
Fresh frozen plasma	81 (8)
Median (range), unit	2 (1-6)
Platelet	9 (0.9)
Median (range), unit	6 (4-8)
Whole blood	0 (0)
Surgery	55 (5.4)
Outcome
Rebleeding	95 (9.4)
Rebleeding (anticoag. and NOAC)	9 (14.8)
30-d mortality	53 (5.2)
Median hospital stay, d	6 (0-45)

Data are presented as n (%) or mean (range). ASA: American society of anesthesiology; NOAC: New(er) oral anticoagulant; NSAIDs: Non-steroidal anti-inflammatory drugs.