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Fujishiro M, Iguchi M, Ono S, Funasaka K, Sakata Y, Mikami T, Kataoka M, Shimaoka S, Michida T, Igarashi Y, Tanaka S. Guidelines for endoscopic management of nonvariceal upper gastrointestinal bleeding (second edition). Dig Endosc 2025; 37:447-469. [PMID: 40114631 DOI: 10.1111/den.15019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2024] [Accepted: 02/19/2025] [Indexed: 03/22/2025]
Abstract
The Japan Gastroenterological Endoscopy Society has prepared Guidelines for Endoscopic Practice in Nonvariceal Upper Gastrointestinal Bleeding as part of the initiative to develop evidence-based endoscopic practice guidelines. Hemorrhagic gastroduodenal (peptic) ulcers are the primary cause of nonvariceal upper gastrointestinal bleeding. With the advent of a super-aged society, the cases caused by Helicobacter pylori are on the decline, whereas those caused by drugs (e.g. aspirin) have been increasing. Endoscopic hemostasis is currently the first-line treatment for nonvariceal upper gastrointestinal bleeding, and various methods have been devised for this purpose. It is recommended to stabilize the vital signs of the patient before and after endoscopic hemostasis with appropriate management based on an assessment of the severity of illness, in addition to the administration of acid secretion inhibitors. These guidelines describe the evaluation and initial treatment of nonvariceal upper gastrointestinal bleeding, as well as the selection of endoscopic hemostasis for nonvariceal upper gastrointestinal bleeding and its management after endoscopic hemostasis. This is achieved by classifying nonvariceal upper gastrointestinal bleeding into two main categories, namely, peptic ulcer and other types of gastrointestinal bleeding. We prepared statements for any available literature with supporting evidence, including the levels of evidence and recommendations. New evidence has been pooled since the publication of the first edition in this area; however, the levels of evidence and recommendations mostly remain low.
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Affiliation(s)
| | | | - Satoshi Ono
- Japan Gastroenterological Endoscopy Society, Tokyo, Japan
| | - Kohei Funasaka
- Japan Gastroenterological Endoscopy Society, Tokyo, Japan
| | | | - Tatsuya Mikami
- Japan Gastroenterological Endoscopy Society, Tokyo, Japan
| | | | | | - Tomoki Michida
- Japan Gastroenterological Endoscopy Society, Tokyo, Japan
| | | | - Shinji Tanaka
- Japan Gastroenterological Endoscopy Society, Tokyo, Japan
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Arıkoğlu S, Tezel O, Büyükturan G, Başgöz BB. The efficacy and comparison of upper gastrointestinal bleeding risk scoring systems on predicting clinical outcomes among emergency unit patients. BMC Gastroenterol 2025; 25:93. [PMID: 39972434 PMCID: PMC11840997 DOI: 10.1186/s12876-025-03684-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2024] [Accepted: 02/12/2025] [Indexed: 02/21/2025] Open
Abstract
BACKGROUND Gastrointestinal bleeding is a significant cause of morbidity and mortality among emergency unit patients. Several scoring systems are verified for predicting hospitalization and mortality such as Glasgow Blatchford Bleeding Score (GBS), AIMS65 score, Rockall score (RS), and International Bleeding Risk Score (INBS; ABC score). The aim of this study is to evaluate the efficacy and predictive value of these scoring systems. METHODS Adult emergency unit patients with gastrointestinal bleeding were retrospectively enrolled. The age, gender, complaints at admission, vitals and examination results, laboratory findings, outcomes, blood transfusion status, and endoscopic interventions were all reported, and GBS, AIMS65, RS, and INBS (ABC) scores were calculated individually for all enrollies. RESULTS A total of 311 patients were included. The median age of participants was 70 years (IQR (25-75%): 59-81), and 202 (65%) of them were male. The efficacy of all four scoring systems (GBS, AIMS65, RS, and INBS (ABC)) in predicting hospitalization, need of blood transfusion, determination of high- and low-risk patients, and mortality was found to be statistically significant (p < 0.05 for all). ROC-AUC analysis was revealed that while GBS is the most beneficial in predicting hospitalization, INBS (ABC) has the best predictive value on mortality. Besides, the only scoring model with predictive value in determining the need for endoscopic intervention was RS (p < 0.05). CONCLUSION The present study showed that, among adult emergency unit patients with gastrointestinal bleeding, GBS, AIMS65, RS, and INBS (ABC) scores could successfully predict hospitalization, need of blood transfusion, determination of high- and low-risk patients, and mortality. However, the only scoring system that could be used to determine the need of endoscopic intervention is RS. Finally, we believe further studies with prospective enrollment would be beneficial for more accurate conclusions.
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Affiliation(s)
- Sezer Arıkoğlu
- Gülhane School of Medicine, Department of Emergency Medicine, University of Health Sciences, Emrah/Etlik, Ankara, 06018, Turkey
| | - Onur Tezel
- Gülhane School of Medicine, Department of Emergency Medicine, University of Health Sciences, Emrah/Etlik, Ankara, 06018, Turkey.
| | - Galip Büyükturan
- Gülhane School of Medicine, Department of Gastroenterology, University of Health Sciences, Ankara, Turkey
| | - Bilgin Bahadır Başgöz
- Gülhane School of Medicine, Department of Internal Medicine, University of Health Sciences, Ankara, Turkey
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Kozai L, Tan A, Nebrejas K, Nishimura Y. Comparative diagnostic utility of Rockall and Glasgow-Blatchford scores in non-variceal upper gastrointestinal bleeding: a systematic review and meta-analysis. Eur J Gastroenterol Hepatol 2025; 37:161-166. [PMID: 39400553 DOI: 10.1097/meg.0000000000002867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/15/2024]
Abstract
INTRODUCTION The Rockall score and Glasgow-Blatchford score (GBS) are two scoring systems validated in the evaluation of upper gastrointestinal bleeding (UGIB). However, no meta-analysis exists to summarize the current data and clarify the use of Rockall score and GBS focusing on non-variceal UGIB. We aimed to evaluate and compare the utility of the Rockall score and GBS in predicting clinical outcomes in non-variceal UGIB. METHODS We conducted a systematic review and meta-analysis, searching the MEDLINE and EMBASE databases for all peer-reviewed articles using the terms including 'Glasgow-Blatchford', 'Rockall', and 'gastrointestinal bleed' from their inception to 22 March 2023. Outcomes included mortality, rebleeding, need for blood transfusion, and need for surgical intervention. RESULTS Seven studies with 755 participants with non-variceal bleeding were included in the analysis. Pooled analysis demonstrated no difference in the area under the receiver operating characteristic (AUROC) between GBS and Rockall score to predict mortality [weighted mean difference (WMD) = 0.01, 95% CI: -0.06 to 0.08] or rebleeding (WMD = 0.04, 95% CI: -0.03 to 0.11). GBS had a higher AUROC to predict the outcomes compared to Rockall score for the needs for transfusion (WMD = 0.09, 95% CI: 0.01-0.16) and surgical intervention (WMD = 0.21, 95% CI: 0.14-0.29). CONCLUSION The GBS could be superior to the Rockall score in predicting the needs for transfusion and surgical intervention in non-variceal UGIB. However, both scores demonstrate low performance for predicting mortality or rebleeding.
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Affiliation(s)
- Landon Kozai
- Department of Medicine, John A. Burns School of Medicine, University of Hawai'i, Honolulu, Hawai'i
| | - Arvin Tan
- Department of Medicine, John A. Burns School of Medicine, University of Hawai'i, Honolulu, Hawai'i
| | - Kevin Nebrejas
- Department of Medicine, John A. Burns School of Medicine, University of Hawai'i, Honolulu, Hawai'i
| | - Yoshito Nishimura
- Department of Hematology & Oncology, Mayo Clinic, Rochester, Minnesota, USA
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Alali AA, Boustany A, Martel M, Barkun AN. Strengths and limitations of risk stratification tools for patients with upper gastrointestinal bleeding: a narrative review. Expert Rev Gastroenterol Hepatol 2023; 17:795-803. [PMID: 37496492 DOI: 10.1080/17474124.2023.2242252] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 06/09/2023] [Accepted: 07/25/2023] [Indexed: 07/28/2023]
Abstract
INTRODUCTION Despite advances in the management of patients with upper gastrointestinal bleeding (UGIB), associated morbidity and mortality remain significant. Most patients, however, will experience favorable outcomes without a need for hospital-based interventions. Risk assessment scores may assist in such early risk-stratification. These scales may optimize identification of low-risk patients, resulting in better resource utilization, including a reduced need for early endoscopy and fewer hospital admissions. The aim of this article is to provide an updated detailed review of risk assessment scores in UGIB. AREA COVERED A literature review identified past and currently available pre-endoscopic risk assessment scores for UGIB, with a focus on low-risk prediction. Strengths and weaknesses of the different scales are discussed as well as their impact on clinical decision-making. EXPERT OPINION The current evidence supports using the Glasgow Blatchford Score as it is the most accurate tool available when attempting to identify low-risk patients who can be safely managed on an outpatient basis. Currently, no risk assessment tool appears accurate enough in confidently classifying patients as high risk. Future research should utilize more standardized methodologies, while favoring interventional trial designs to better characterize the clinical impact attributable to the use of such risk stratification schemes.
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Affiliation(s)
- Ali A Alali
- Department of Medicine, Faculty of Medicine, Kuwait University, Jabriyah, Kuwait
| | - Antoine Boustany
- Department of Medicine, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Myriam Martel
- Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | - Alan N Barkun
- Division of Gastroenterology, McGill University Health Center, McGill University, Montreal, Canada
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Aydin H, Berikol GB, Erdogan MO, Gemici E, Doğan H. CHAMPS score in predicting mortality of patients with acute nonvariceal upper gastrointestinal bleeding. REVISTA DA ASSOCIACAO MEDICA BRASILEIRA (1992) 2023; 69:e20221052. [PMID: 37075441 PMCID: PMC10176634 DOI: 10.1590/1806-9282.20221052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 01/10/2023] [Indexed: 04/21/2023]
Abstract
OBJECTIVE The aim of this study was to evaluate the performance of the Charlson Comorbidity Index ≥2, in-hospital onset, albumin <2.5 g/dL, altered mental status, Eastern Cooperative Oncology Group performance status ≥2, steroid use score in predicting mortality in patients with nonvariceal upper gastrointestinal bleeding and compare it with the Glasgow-Blatchford score; the albumin, international normalized ratio; alteration in mental status, systolic blood pressure, and age 65 score; the age, blood tests, and comorbidities score; and Complete Rockall score. METHODS The data of patients with acute upper gastrointestinal bleeding who visited the emergency department during the study period were obtained from the hospital automation system by using the classification of disease codes and analyzed in this retrospective study. Adult patients with endoscopically confirmed nonvariceal upper gastrointestinal bleeding were included in the study. Patients with bleeding from the tumor, bleeding after endoscopic resection, or missing data were excluded. The prediction accuracy of the Charlson Comorbidity Index ≥ 2, in-hospital onset, albumin < 2.5 g/dL, altered mental status, Eastern Cooperative Oncology Group performance status ≥ 2, steroid use score was calculated using the area under the receiver operating characteristic curve and compared with that of Glasgow-Blatchford score, the albumin, international normalized ratio; alteration in mental status, systolic blood pressure, and age 65 score, the age, blood tests, and comorbidities score, and Complete Rockall score. RESULTS A total of 805 patients were included in the study, and the in-hospital mortality rate was 6.6%. The performance of the Charlson Comorbidity Index ≥ 2, in-hospital onset, albumin < 2.5 g/dL, altered mental status, Eastern Cooperative Oncology Group performance status ≥ 2, steroid use score (area under the receiver operating characteristic curve 0.812, 95%CI 0.783-0.839) was better than Glasgow-Blatchford score (area under the receiver operating characteristic curve 0.683, 95%CI 0.650-0.713, p=0.008), and similar to the the age, blood tests, and comorbidities score (area under the receiver operating characteristic curve 0.829, 95%CI 0.801-0.854, p=0.563), the albumin, international normalized ratio; alteration in mental status, systolic blood pressure, and age 65 score (area under the receiver operating characteristic curve 0.794, 95%CI 0.764-0.821, p=0.672), and Complete Rockall score (area under the receiver operating characteristic curve 0.761, 95%CI 0.730-0.790, p=0.106). CONCLUSION The performance of the Charlson Comorbidity Index ≥ 2, in-hospital onset, albumin < 2.5 g/dL, altered mental status, Eastern Cooperative Oncology Group performance status ≥ 2, steroid use score in predicting in-hospital mortality for our study population is better than Glasgow-Blatchford score and similar to the the age, blood tests, and comorbidities score, the albumin, international normalized ratio; alteration in mental status, systolic blood pressure, and age 65 score, and Complete Rockall score.
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Affiliation(s)
- Hakan Aydin
- University of Health Sciences, Bakırköy Dr. Sadi Konuk Training and Research Hospital, Department of Emergency Medicine - Istanbul, Turkey
| | - Göksu Bozdereli Berikol
- University of Health Sciences, Bakırköy Dr. Sadi Konuk Training and Research Hospital, Department of Emergency Medicine - Istanbul, Turkey
| | - Mehmet Ozgur Erdogan
- University of Health Sciences, Bakırköy Dr. Sadi Konuk Training and Research Hospital, Department of Emergency Medicine - Istanbul, Turkey
| | - Eyüp Gemici
- University of Health Sciences, Bakırköy Dr. Sadi Konuk Training and Research Hospital, Department of General Surgery - Istanbul, Turkey
| | - Halil Doğan
- University of Health Sciences, Bakırköy Dr. Sadi Konuk Training and Research Hospital, Department of Emergency Medicine - Istanbul, Turkey
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Renukaprasad AK, Narayanaswamy S, R V. A Comparative Analysis of Risk Scoring Systems in Predicting Clinical Outcomes in Upper Gastrointestinal Bleed. Cureus 2022; 14:e26669. [PMID: 35949732 PMCID: PMC9357970 DOI: 10.7759/cureus.26669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 07/07/2022] [Indexed: 11/08/2022] Open
Abstract
Background Upper gastrointestinal bleed (UGIB) is a life-threatening condition that presents as hematemesis (fresh blood), coffee-ground vomiting, or melena. Multiple scoring systems are developed to predict different clinical outcomes, which are important to managing UGIB and are essential to determining low and high-risk patients. The study aimed to compare the sensitivity and specificity of risk scoring systems and their optimum cut-off values in the assessment of UGIB. Methods The prospective cross-sectional study included patients (N = 81) with acute UGIB. Four different proposed scores [Glasgow-Blatchford score (GBS), AIMS65, pre-endoscopic Rockall, and full Rockall scoring system] were used for evaluating patients with UGIB. The optimum cut-off values of these risk scores were used to predict the clinical outcomes. Results The AIMS65 score [Area Under the Receiver Operating Characteristic curve (AUROC): 0.91, cut-off: >1, sensitivity: 100%, specificity: 76.62%] and pre-Rockall were similar (AUROC: 0.91, cut-off: >0, sensitivity: 100%, specificity: 93.51%) at predicting mortality. The GBS (cut-off: >9, AUROC: 0.79, sensitivity: 69.23, specificity: 87.50) and AIMS65 scores (cut-off: >0, AUROC: 0.67, sensitivity: 72.31, specificity: 62.5) were good predictors of need for ICU care. Conclusion GBS was superior in predicting categorization into high risk and low risk, and endoscopic intervention, blood transfusion, and intensive care unit (ICU) care in UGIB patients. Pre-Rockall score and AIMS65 score were similar in predicting the mortality rate in UGIB.
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Maghrebi H, Beji H, Haddad A, Sebai A, Safraoui S, Hafi M, Laabidi A, Jouini M, Kacem MJ. Risk stratifying patients with non-varicosic upper gastrointestinal hemorrhage using the Glasgow-Blatchford score: A case series of 91 patients. Ann Med Surg (Lond) 2022; 78:103778. [PMID: 35600194 PMCID: PMC9119816 DOI: 10.1016/j.amsu.2022.103778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 05/08/2022] [Accepted: 05/08/2022] [Indexed: 12/05/2022] Open
Abstract
Introduction Non-variceal upper gastrointestinal hemorrhage (NVUGIH) often leads to systematic hospitalization and emergency endoscopy. However, in most cases, it does not constitute an immediate life threat. This study aimed to evaluate the Glasgow-Blatchford Score (GBS) in predicting the need for transfusions, and/or endoscopic or surgical treatments. Materials and methods We conducted a retrospective monocentric study including 91 patients admitted in the general surgery department of the Hospital La Rabta Tunis for a NVUGIH. Univariate analysis was performed with the Student t-test for continuous variables and with the Chi-square test for categorical variables. For a cut-off point of 9, we calculated the sensibility and the sensitivity of the GBS to predict the need for transfusions and/or hemostatic procedure. Results During the study period, 91 patients were admitted for NVUGIH. Sixty-one patients (67%) were transfused. Seven patients (7.7%) underwent emergency surgery and two patients had endoscopic hemostasis. The predictive factors for the use of transfusion and/or hemostasic treatments were: Age >50 years, ASA score, HR ≥ 90 bpm, pallor, Hb ≤ 9,5 g/dl, Urea ≥9,7 mmol/L. For a cut-off of 9 points of the GBS, sensitivity was 85.71% and specificity 92.86%. The positive predictive value was 96%. The negative predictive value was 74%. Conclusion The main interest of the GBS lies in dispatching the patients between intensive care units for therapeutic intervention (if GBS> = 9) and ordinary hospitalization for surveillance (if GBS <9). It then makes it possible to rationalize the management of patients with digestive hemorrhage to identify those requiring hospital treatments (transfusion, endoscopic treatment, or surgery).
Non variceal upper gastrointestinal bleeding often leads to systematic emergency endoscopy. In most cases, bleeding does not constitute an immediate life threat. The Glasgow-Blatschford score can be reliable to predict the need for therapeutic intervention. For a score inferior to nine, patients can be admitted into an ordinary unit.
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Benedeto-Stojanov D, Bjelaković M, Stojanov D, Aleksovski B. Prediction of in-hospital mortality after acute upper gastrointestinal bleeding: cross-validation of several risk scoring systems. J Int Med Res 2022; 50:3000605221086442. [PMID: 35301889 PMCID: PMC8943321 DOI: 10.1177/03000605221086442] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE We aimed to identify the clinical, biochemical, and endoscopic features associated with in-hospital mortality after acute upper gastrointestinal bleeding (AUGIB), focusing on cross-validation of the Glasgow-Blatchford score (GBS), full Rockall score (RS), and Cedars-Sinai Medical Center Predictive Index (CSMCPI) scoring systems. METHODS Our prospective cross-sectional study included 156 patients with AUGIB. Several statistical approaches were used to assess the predictive accuracy of the scoring systems. RESULTS All three scoring systems were able to accurately predict in-hospital mortality (area under the receiver operating characteristic curve [AUC] > 0.9); however, the multiple logistic model separated the presence of hemodynamic instability (state of shock) and the CSMCPI as the only significant predictive risk factors. In compliance with the overall results, the CSMCPI was consistently found to be superior to the other two systems (highest AUC, highest sensitivity and specificity, highest positive and negative predictive values, highest positive likelihood ratio, lowest negative likelihood ratio, and 1-unit increase in CSMCPI associated with 6.3 times higher odds of mortality), outperforming the GBS and full RS. CONCLUSIONS We suggest consideration of the CSMCPI as a readily available and reliable tool for accurately predicting in-hospital mortality after AUGIB, thus providing an essential backbone in clinical decision-making.
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Affiliation(s)
| | - Milica Bjelaković
- Clinic of Gastroenterology and Hepatology, Clinical Center Niš, 18000 Niš, Serbia
| | | | - Boris Aleksovski
- Ss. Cyril and Methodius University in Skopje, Faculty of Natural Sciences and Mathematics-Skopje, Institute of Biology, Arhimedova 3, PO Box 162, 1000 Skopje, North Macedonia
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Ito N, Funasaka K, Furukawa K, Kakushima N, Hirose T, Muroi K, Suzuki T, Suzuki T, Hida E, Ishikawa T, Yamamura T, Ohno E, Nakamura M, Kawashima H, Miyahara R, Fujishiro M. A novel scoring system to predict therapeutic intervention for non-variceal upper gastrointestinal bleeding. Intern Emerg Med 2022; 17:423-430. [PMID: 34363550 DOI: 10.1007/s11739-021-02822-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Accepted: 07/29/2021] [Indexed: 11/26/2022]
Abstract
Various scoring systems have been developed to predict the need for endoscopic treatment in patients with non-variceal upper gastrointestinal bleeding (NVUGIB). However, they have rarely been applied in clinical practice because the processes are complicated. The aim of this study was to establish a simple scoring system that predicts the need for endoscopic intervention in patients with NVUGIB. We retrospectively enrolled 509 consecutive patients with suspected NVUGIB who underwent emergency endoscopy. In the development cohort (from January 2016 to December 2018), risk factors that predict the need for endoscopic intervention were determined from 349 patients' data by multivariate logistic regression analysis. This led to the development of a novel scoring system named the Nagoya University score (N score). In the validation cohort (from January 2019 to September 2020), we evaluated the diagnostic value of the N score, the Hirosaki score, and the Glasgow-Blatchford scores (GBS) by receiver operating characteristic (ROC) curves using another 160 patients' data. Multivariate logistic regression analysis revealed syncope, hematemesis, blood urea nitrogen (BUN), and BUN/Cr as significant predictive factors for endoscopic intervention. In the validation study, the N score was superior to the GBS and equal to the Hirosaki score in predicting the endoscopic intervention (AUC, N score 0.776 [95% CI 0.702-0.851] vs. GBS 0.615 [0.523-0.708], Hirosaki 0.719 [0.636-0.803]). The N score revealed a sensitivity of 84.5% and a specificity of 61.8%. Our N score, which is consisted of only four factors, would select patients who require endoscopic intervention with high probability.
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Affiliation(s)
- Nobuhito Ito
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kohei Funasaka
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan.
- Department of Gastroenterology and Hepatology, Fujita Health University School of Medicine, 1-98 Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan.
| | - Kazuhiro Furukawa
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Naomi Kakushima
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Takashi Hirose
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Koichi Muroi
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Tomohiko Suzuki
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Takahiro Suzuki
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Emiko Hida
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Takuya Ishikawa
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Takeshi Yamamura
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Eizaburo Ohno
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Masanao Nakamura
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hiroki Kawashima
- Department of Endoscopy, Nagoya University Hospital, Nagoya, Japan
| | - Ryoji Miyahara
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Mitsuhiro Fujishiro
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
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FRÍAS-ORDOÑEZ JS, ARJONA-GRANADOS DA, URREGO-DÍAZ JA, BRICEÑO-TORRES M, MARTÍNEZ-MARÍN JD. VALIDATION OF THE ROCKALL SCORE IN UPPER GASTROINTESTINAL TRACT BLEEDING IN A COLOMBIAN TERTIARY HOSPITAL. ARQUIVOS DE GASTROENTEROLOGIA 2022; 59:80-88. [DOI: 10.1590/s0004-2803.202200001-15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 10/20/2021] [Indexed: 11/21/2022]
Abstract
ABSTRACT Background Rockall score is the most widely used prognostic scale for assessing risk of complications from non-varicose upper gastrointestinal bleeding (UGIB). Several studies have been conducted in adult populations with non-varicose UGIB in different parts of the world, with conflicting findings regarding the extent of association between the score and some morbidity and mortality outcomes. Also, there is controversy regarding the best cut-off point for the score. Moreover, no studies validating this score in Colombia have been carried out. Objective To assess the diagnostic performance of the Rockall score in predicting rebleeding and mortality in patients with non-varicose UGIB. Methods A prospective cohort study was conducted in patients requiring upper gastrointestinal endoscopy (UGIE) for non-varicose bleeding. The pre-and post-endoscopy Rockall scores were calculated and outcomes, including mortality, UGIB-associated mortality and in hospital rebleeding were determined at the 1 and 3-month time points. The association between the scores and these outcomes was assessed using the chi2 or the Fisher test, whereas the discrimination ability of the score was determined using the areas under the ROC curve (AUC). High discrimination ability was considered to exist in cases in which an AUC ≤0.7 with α=0.05 could be rejected. Results Overall, 177 patients were analyzed. In-hospital outcomes at 1 and 3 months were 12%, 17% and 23% for general mortality, 6%, 12% and 15% for UGIB mortality, and 19%, 30% and 37% for rebleeding. The post-endoscopy Rockall score was associated with the three outcomes at the three time points assessed, while the pre-endoscopy score was only associated with general mortality at the three time points, and rebleeding at 1 and 3 months. Regarding discrimination ability, although the AUC was greater than expected by randomness (0.5) in all cases, only one AUC ≤0.7 was rejected in the post-endoscopy score for in-hospital UGIB mortality (AUC=0.901; 95%CI: 0.845—0.958), at 1 month (AUC=0.836; 95%CI: 0.717—0.954) and at 3 months (AUC=0.869; 95%CI: 0.771—0.967), and for rebleeding at 1 month (AUC=0.793; 95%CI: 0.725—0.861) and at 3 months (AUC=0.806; 95%CI: 0.741—0.871). Conclusion An association was found between the Rockall score and rebleeding and mortality in patients with non-varicose UGIB. Only the post-endoscopy score had a high predictive ability for rebleeding and UGIB mortality.
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Mureşan EM, Golea A, Bolboacă SD, Perju-Dumbravă L. Feasibility of a pilot study on point-of-care biomarkers in spontaneous intracerebral hemorrhage in an emergency setting. Med Pharm Rep 2021; 94:307-317. [PMID: 34430852 DOI: 10.15386/mpr-1783] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 02/08/2021] [Accepted: 04/01/2021] [Indexed: 01/17/2023] Open
Abstract
Background and aims Stroke is a worldwide leading cause of death and disability and spontaneous intracerebral hemorrhage (sICH) has significant economic and social impact, regardless of recent efforts towards outcome-bettering acute interventions. The aim of the study was to assess the feasibility of a prospective observational research regarding point-of-care (POC) biomarkers in sICH, conducted in a level one emergency department (ED). Methods Patients with acute (<8 hours) sICH were enrolled in this study. Patients presenting a Glasgow Coma Scale score <8, secondary causes of intracerebral hemorrhage, seizures, recent ischemic events, known thromboembolic disease, anticoagulant treatment, severe pre-stroke disability, terminal disease, scheduled neurosurgery/hemostatic treatment were excluded. Feasibility was defined as ED inclusion and follow-up rates, time-to-inclusion, and frequency of missing data. Baseline demographic, imaging and POC biochemical status of the study group were documented, including inflammatory (complete blood count, C-reactive protein), metabolic (glucose, hepatic, and renal function) and cardiovascular markers (cardiac troponin I, D-dimer). Results The inclusion rate was 2.16 patients/month with a final sample of 35 patients out of 239 potentially eligible patients. The median time from symptom onset to ED presentation was 128 minutes (IQR 96-239), with 21/35 patients having presented within the first 3 hours from ictus. Median times between symptoms' onset to Computer Tomography (CT) scan and ED presentation to CT scan were 170 minutes (IQR 126-317) and 25 minutes (IQR 17-62), respectively. The median time from patient's presentation to CBC result was 12 minutes (IQR 6.5-20), with 21/35 study participants having the results available within 15 minutes from ED arrival. The median cohort age was 72-years, with a 19/16 male/female ratio. Hypertension was the most frequent risk factor (77%), along with ischemic heart disease (31%) and diabetes (29%). One-third of the hypertensive patients did not undergo blood pressure lowering treatment. Median values of POC biomarkers on ED admission were within normal range. Conclusions It was feasible to determine point-of-care biomarkers in spontaneous intracerebral hemorrhage on admission in ED, despite the urgency of the medical condition.
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Affiliation(s)
- Eugenia-Maria Mureşan
- Department of Neurosciences, Iuliu Hatieganu Univesrity of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Adela Golea
- Department of Surgery, Emergency Medicine Division, Iuliu Hatieganu Univesrity of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Sorana D Bolboacă
- Department of Medical Education, Medical Informatics and Biostatistics, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
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Taslidere B, Sonmez E, Özcan AB, Mehmetaj L, Keskin EB, Gulen B. Comparison of the quick SOFA score with Glasgow-Blatchford and Rockall scores in predicting severity in patients with upper gastrointestinal bleeding. Am J Emerg Med 2021; 45:29-36. [PMID: 33647759 DOI: 10.1016/j.ajem.2021.02.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Revised: 02/06/2021] [Accepted: 02/08/2021] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Upper gastrointestinal bleeding is one of the common causes of mortality and morbidity. The Rockall score (RS) and Glasgow-Blatchford score (GBS) are frequently used in determining the prognosis and predicting in-hospital adverse events, such as mortality, re-bleeding, hospital stay, and blood transfusion requirements. The quick Sepsis Related Organ Failure Assessment (qSOFA) score is easy and swift to calculate. The commonly used scores and the qSOFA score were compared and why and when these scores are most useful was investigated. METHOD 133 patients admitted to the emergency department with upper gastrointestinal bleeding over the period of a year, were evaluated in this retrospective study. The RS, GBS and qSOFA score were calculated for each patient, and their relationship with in-hospital adverse events, such as length of hospitalization, rebleeding, endoscopic treatment, blood transfusion requirements, and mortality, was investigated. RESULTS The mean overall GBS was 9.72 ± 3.72 (0-19), while that of patients who did not survive was 14.0 ± 1.1 (13-16), with an area under the curve (AUC) of 0.901, a cutoff value of 12.5, and specificity (Spe) and sensitivity (Sen) of 1 and 0.82, respectively. The median value of the GBS, in terms of transfusion need, was 7.12 ± 4.01 (0-15). (AUC = 0.752, cut-off = 9.5, Spe = 0.79, Sen = 0.69). The median value of the qSOFA score, in terms of intensive care need, was 1.73 ± 0.7 (0-3) (AUC = 0.921, cut-off = 0.5, Spe = 0.93, Sen = 0.79). The RS median, in terms of re-bleeding, was 8.22 ± 0.97 (6-9). CONCLUSION Early use of risk stratification scores in upper gastrointestinal bleeding is important due to the high risk of morbidity and mortality. All scoring systems were effective in predicting mortality, the need for intensive care, and re-bleeding. The GBS had a greater predictive power in terms of mortality and transfusion need, the qSOFA score for intensive care need, and the RS for re-bleeding. The simpler, more efficient, and more easily calculated qSOFA score can be used to estimate the severity of patients with upper gastrointestinal bleeding.
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Affiliation(s)
- Bahadır Taslidere
- Department of Emergency Medicine, Bezmialem Vakıf University, Faculty of Medicine, Istanbul, Turkey..
| | - Ertan Sonmez
- Department of Emergency Medicine, Bezmialem Vakıf University, Faculty of Medicine, Istanbul, Turkey
| | - Ayşe Büşra Özcan
- Department of Emergency Medicine, Bezmialem Vakıf University, Faculty of Medicine, Istanbul, Turkey
| | - Liljana Mehmetaj
- Department of Emergency Medicine, Bezmialem Vakıf University, Faculty of Medicine, Istanbul, Turkey
| | - Elmas Biberci Keskin
- Department of Gastroenterology, Bezmialem Vakıf University, Faculty of Medicine, Istanbul, Turkey
| | - Bedia Gulen
- Department of Emergency Medicine, Medipol Univercity, Istanbul, Turkey
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Khoury T, Darawsheh F, Daher S, Yaari S, Katz L, Mahamid M, Kadah A, Mari A, Sbeit W. Predictors of endoscopic intervention in upper gastrointestinal bleeding patients hospitalized for another illness: a multi-center retrospective study. Panminerva Med 2020; 62:244-251. [PMID: 32432444 DOI: 10.23736/s0031-0808.20.03960-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND To characterize variables that may predict the need for endoscopic intervention in inpatients admitted for several causes who during the hospitalization developed acute non-variceal upper gastrointestinal bleeding (NVUGIB). METHODS A retrospective analysis of inpatients who underwent upper gastro-intestinal endoscopy for acute NVUGIB while hospitalized for other causes from 1 January 2016 to 1 December 2017, was performed. In the primary outcome analysis, patients (N.=14) who underwent endoscopic intervention (group A) were compared to those (N.=87) who did not need for endoscopic intervention (group B). Secondary outcome analysis included patients who had significant endoscopic findings compared to those who did not have them. RESULTS Multivariate regression analysis showed that in the primary outcome analysis, two parameters were significant: the number of packed red blood cells (PRBC) units transfused (odds ratio [OR]: 1.5, P=0.01) and Rockall Score (RS) (OR: 1.4, P=0.06) with receiver operator characteristic (ROC) curve of 0.7844. In the secondary outcome analysis, only the use of proton pump inhibitor drugs at admission was associated with protective effect for the development of significant endoscopic findings (odds ratio [OR]: 0.42, P=0.05) with ROC curve of 0.7342. CONCLUSIONS In hospitalized patients, in case of de novo NVUGIB, the number of PRBC units transfused and RS are predictive of significant endoscopic findings.
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Affiliation(s)
- Tawfik Khoury
- Department of Gastroenterology, Galilee Medical Center, Nahariya, Israel
- Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Fares Darawsheh
- Department of Internal Medicine, Hadassah Medical Center, Jerusalem, Israel
| | - Saleh Daher
- Department of Gastroenterology, Hadassah Medical Center, Jerusalem, Israel
| | - Shaul Yaari
- Department of Gastroenterology, Hadassah Medical Center, Jerusalem, Israel
| | - Lior Katz
- Department of Gastroenterology, Hadassah Medical Center, Jerusalem, Israel
| | - Mahmud Mahamid
- Department of Gastroenterology, Sharee Zedek Medical Center, Jerusalem, Israel
| | - Anas Kadah
- Department of Gastroenterology, Galilee Medical Center, Nahariya, Israel
- Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Amir Mari
- Unit of Gastroenterology and Endoscopy, EMMS Nazareth Hospital, Nazareth, Israel -
- Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Wisam Sbeit
- Department of Gastroenterology, Galilee Medical Center, Nahariya, Israel
- Faculty of Medicine, Bar-Ilan University, Safed, Israel
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Schembre DB, Ely RE, Connolly JM, Padhya KT, Sharda R, Brandabur JJ. Semiautomated Glasgow-Blatchford Bleeding Score helps direct bed placement for patients with upper gastrointestinal bleeding. BMJ Open Gastroenterol 2020; 7:bmjgast-2020-000479. [PMID: 33214231 PMCID: PMC7681917 DOI: 10.1136/bmjgast-2020-000479] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Revised: 10/13/2020] [Accepted: 10/23/2020] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE The Glasgow-Blatchford Bleeding Score (GBS) was designed to identify patients with upper gastrointestinal bleeding (UGIB) who do not require hospitalisation. It may also help stratify patients unlikely to benefit from intensive care. DESIGN We reviewed patients assigned a GBS in the emergency room (ER) via a semiautomated calculator. Patients with a score ≤7 (low risk) were directed to an unmonitored bed (UMB), while those with a score of ≥8 (high risk) were considered for MB placement. Conformity with guidelines and subsequent transfers to MB were reviewed, along with transfusion requirement, rebleeding, length of stay, need for intervention and death. RESULTS Over 34 months, 1037 patients received a GBS in the ER. 745 had an UGIB. 235 (32%) of these patients had a GBS ≤7. 29 (12%) low-risk patients were admitted to MBs. Four low-risk patients admitted to UMB required transfer to MB within the first 48 hours. Low-risk patients admitted to UMBs were no more likely to die, rebleed, need transfusion or require more endoscopic, radiographic or surgical procedures than those admitted to MBs. No low-risk patient died from GIB. Patients with GBS ≥8 were more likely to rebleed, require transfusion and interventions to control bleeding but not to die. CONCLUSION A semiautomated GBS calculator can be incorporated into an ER workflow. Patients with a GBS ≤7 are unlikely to need MB care for UGIB. Further studies are warranted to determine an ideal scoring system for MB admission.
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Affiliation(s)
- Drew B Schembre
- Digestive Health, John Muir Health, Walnut Creek, California, USA
| | - Robson E Ely
- Clinical Transformation, Swedish Medical Center, Seattle, Washington, USA
| | | | - Kunjali T Padhya
- Gastroenterology, Swedish Medical Center, Seattle, Washington, USA
| | - Rohit Sharda
- Gastroenterology, Swedish Medical Center, Seattle, Washington, USA
| | - John J Brandabur
- Gastroenterology, Swedish Medical Center, Seattle, Washington, USA
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Mujtaba S, Chawla S, Massaad JF. Diagnosis and Management of Non-Variceal Gastrointestinal Hemorrhage: A Review of Current Guidelines and Future Perspectives. J Clin Med 2020; 9:402. [PMID: 32024301 PMCID: PMC7074258 DOI: 10.3390/jcm9020402] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 01/21/2020] [Accepted: 01/24/2020] [Indexed: 01/30/2023] Open
Abstract
Non-variceal gastrointestinal bleeding (GIB) is a significant cause of mortality and morbidity worldwide which is encountered in the ambulatory and hospital settings. Hemorrhage form the gastrointestinal (GI) tract is categorized as upper GIB, small bowel bleeding (also formerly referred to as obscure GIB) or lower GIB. Although the etiologies of GIB are variable, a strong, consistent risk factor is use of non-steroidal anti-inflammatory drugs. Advances in the endoscopic diagnosis and treatment of GIB have led to improved outcomes. We present an updated review of the current practices regarding the diagnosis and management of non-variceal GIB, and possible future directions.
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Affiliation(s)
| | | | - Julia Fayez Massaad
- Division of Digestive Diseases, Emory University, 1365 Clifton Road, Northeast, Building B, Suite 1200, Atlanta, GA 30322, USA; (S.M.); (S.C.)
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Tham J, Stanley A. Clinical utility of pre-endoscopy risk scores in upper gastrointestinal bleeding. Expert Rev Gastroenterol Hepatol 2019; 13:1161-1167. [PMID: 31791160 DOI: 10.1080/17474124.2019.1698292] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Accepted: 11/25/2019] [Indexed: 12/13/2022]
Abstract
Introduction: Acute upper-gastrointestinal bleeding (AUGIB) is a common medical emergency, with an incidence of 103-172 per 100,000 in the United Kingdom (UK) and mortality of 2% to 10%. Early and accurate prediction of the severity of an AUGIB episode may help guide management, including in or outpatient management, level of care required, and timing of endoscopy. This article aims to address the clinical utility of the various pre-endoscopic risk assessment tools used in AUGIB.Areas covered: The authors undertook a literature review of the current evidence on the pre-endoscopic risk assessment scores. Additional the authors discuss the recently published novel risk assessment scores.Expert opinion: The evidence shows that GBS is the most clinically useful risk assessment score in correctly identifying very low-risk patients suitable for outpatient management. At present, research is ongoing to assess machine learning in the assessment of patients presenting with AUGIB. More research is needed but it shows promise for the future.
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Affiliation(s)
- Jennifer Tham
- Department of Gastroenterology, Glasgow Royal Infirmary, Glasgow, UK
| | - Adrian Stanley
- Department of Gastroenterology, Glasgow Royal Infirmary, Glasgow, UK
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Lazăr DC, Ursoniu S, Goldiş A. Predictors of rebleeding and in-hospital mortality in patients with nonvariceal upper digestive bleeding. World J Clin Cases 2019; 7:2687-2703. [PMID: 31616685 PMCID: PMC6789381 DOI: 10.12998/wjcc.v7.i18.2687] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 08/16/2019] [Accepted: 08/27/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Nonvariceal upper digestive bleeding (NVUDB) represents a severe emergency condition and is associated with significant morbidity and mortality. Despite a decrease in the incidence due to the widespread use of potent therapy with proton pump inhibitors as well as the implementation of modern endoscopic techniques, the mortality rate associated with NVUDB is still high. AIM To identify the clinical, biological, and endoscopic parameters associated with a poor outcome in patients with NVUDB to allow the stratification of risk, which will lead to the implementation of the most accurate management. METHODS We performed a retrospective study including patients who were admitted to the Gastroenterology Department of Clinical Emergency County Hospital Timisoara, Romania, with a diagnosis of NVUDB between 1 January 2008 and 31 December 2016. All the data were collected from the patient's records, including demographic data, medication history, hemodynamic status, paraclinical tests, and endoscopic features as well as the methods of hemostasis, rate of rebleeding, need for surgery and death; we also assessed the Rockall score of the patients, length of hospitalization and associated comorbidities. All these parameters were evaluated as potential risk factors associated with rebleeding and death in patients with NVUDB. RESULTS We included a batch of 1581 patients with NVUDB, including 523 (33%) females and 1058 (67%) males with a median age of 66 years. The main cause of NVUDB was peptic ulcer (73% of patients). More than one-third of the patients needed endoscopic treatment. Rebleeding rate was 7.72%; surgery due to failure of endoscopic hemostasis was needed in 3.22% of cases; the in-hospital mortality rate was 8.09%, and the bleeding-episode-related mortality rate was 2.97%. Although our predictive models for rebleeding and death had a low sensitivity, the specificity was very high, suggesting a better discriminative capacity for identifying patients with better outcomes. Our results showed that the Rockall score was associated with both rebleeding and death; comorbidities such as respiratory conditions, liver cirrhosis and sepsis increased significantly the risk of in-hospital mortality (OR of 3.29, 2.91 and 8.03). CONCLUSION Our study revealed that the Rockall score, need for endoscopic therapy, necessity of transfusion and sepsis were risk factors for rebleeding. Moreover, an increased Rockall score and the presence of comorbidities were predictive factors for in-hospital mortality.
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Affiliation(s)
- Daniela Cornelia Lazăr
- Department of Internal Medicine I, University Medical Clinic, University of Medicine and Pharmacy “Victor Babeş”, Timişoara 300041, Timiş County, Romania
| | - Sorin Ursoniu
- Department of Public Health and Health Management, University of Medicine and Pharmacy “Victor Babeş”, Timişoara 300041, Timiş County, Romania
| | - Adrian Goldiş
- Department of Gastroenterology and Hepatology, University of Medicine and Pharmacy “Victor Babeş”, Timişoara 300041, Timiş County, Romania
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Jono F, Iida H, Fujita K, Kaai M, Kanoshima K, Ohkuma K, Nonaka T, Ida T, Kusakabe A, Nakamura A, Koyama S, Nakajima A, Inamori M. Comparison of computed tomography findings with clinical risks factors for endoscopic therapy in upper gastrointestinal bleeding cases. J Clin Biochem Nutr 2019; 65:138-145. [PMID: 31592208 DOI: 10.3164/jcbn.18-115] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Accepted: 02/16/2019] [Indexed: 12/14/2022] Open
Abstract
Several risk scoring systems exist for acute upper gastrointestinal bleeding (UGIB). The clinical Rockall score (clinical RS) and the Glasgow-Blatchford score (GBS) are major risk scores that consider only clinical data. Computed tomography (CT) findings are equivocal in non-variceal UGIB. We compared CT findings with clinical data to predict mortality, rebleeding and need for endoscopic therapy in non-variceal UGIB patients. This retrospective, single-center study included 386 patients admitted to our emergency department with diagnosis of non-variceal UGIB by urgent endoscopy between January 2009 and March 2015. Multivariable logistic regression analysis was used to investigate CT findings and risk factors derived from clinical data. CT findings could not significantly predict mortality and rebleeding in non-variceal UGIB patients. However, upper gastrointestinal hemorrhage in CT findings better predicted the need for endoscopic therapy than clinical data. The adjusted odds ratios were 10.10 (95% CI 5.01-20.40) for clinical RS and 10.70 (95% CI 5.08-22.70) for the GBS. UGI hemorrhage in CT findings could predict the need for endoscopic therapy in non-variceal UGIB patients in our emergency department. CT findings as well as risk score systems may be useful for predicting the need for endoscopic therapy.
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Affiliation(s)
- Fumitake Jono
- Department of Medical Education, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama 236-0004, Japan
| | - Hiroshi Iida
- Department of Hepatology and Gastroenterology, Yokohama City University Hospital, 3-9 Fukuura, Kanazawa-ku, Yokohama 236-0004, Japan
| | - Koji Fujita
- Office of Postgraduate Medical Education, Yokohama City University Hospital, 3-9 Fukuura, Kanazawa-ku, Yokohama 236-0004, Japan
| | - Megumi Kaai
- Yokohama Hodogaya Central Hospital, 43-1, Kamadai-cho, Hodogaya-ku, Yokohama 240-8585, Japan
| | - Kenji Kanoshima
- Department of Hepatology and Gastroenterology, Yokohama City University Hospital, 3-9 Fukuura, Kanazawa-ku, Yokohama 236-0004, Japan
| | - Kanji Ohkuma
- Department of Hepatology and Gastroenterology, Yokohama City University Hospital, 3-9 Fukuura, Kanazawa-ku, Yokohama 236-0004, Japan
| | - Takashi Nonaka
- Department of Hepatology and Gastroenterology, Yokohama City University Hospital, 3-9 Fukuura, Kanazawa-ku, Yokohama 236-0004, Japan
| | - Tomonori Ida
- Department of Medical Education, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama 236-0004, Japan
| | - Akihiko Kusakabe
- Office of Postgraduate Medical Education, Yokohama City University Hospital, 3-9 Fukuura, Kanazawa-ku, Yokohama 236-0004, Japan
| | - Atsushi Nakamura
- Department of Endoscopy and Gastroenterology, Tokyo Metropolitan Hiroo Hospital, 2-34-10 Ebisu, Shibuya-ku, Tokyo 150-0013, Japan
| | - Shigeru Koyama
- Department of Endoscopy and Gastroenterology, Tokyo Metropolitan Hiroo Hospital, 2-34-10 Ebisu, Shibuya-ku, Tokyo 150-0013, Japan
| | - Atsushi Nakajima
- Department of Hepatology and Gastroenterology, Yokohama City University Hospital, 3-9 Fukuura, Kanazawa-ku, Yokohama 236-0004, Japan
| | - Masahiko Inamori
- Department of Medical Education, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama 236-0004, Japan
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Lu M, Sun G, Huang H, Zhang X, Xu Y, Chen S, Song Y, Li X, Lv B, Ren J, Chen X, Zhang H, Mo C, Wang Y, Yang Y. Comparison of the Glasgow-Blatchford and Rockall Scores for prediction of nonvariceal upper gastrointestinal bleeding outcomes in Chinese patients. Medicine (Baltimore) 2019; 98:e15716. [PMID: 31124950 PMCID: PMC6571241 DOI: 10.1097/md.0000000000015716] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
The Glasgow-Blatchford scores (GBS) and Rockall scores (RS) are commonly used for stratifying patients with nonvariceal upper gastrointestinal hemorrhage (NVUGIH). Although predictive value of these scoring methods has been extensively validated, their clinical effectiveness remains unclear. The following study evaluated the GBS and RS scoring system with reference to bleeding, needs for further surgery, endoscopic intervention and death, in order to verify their effectiveness and accuracy in clinical application.Patients who presented with NVUGIH, or who were consequently diagnosed with the disease (by endoscopy examination) between January 1, 2008, and December 31, 2012 were enrolled in the study. GBS and RS scores were compared to predict bleeding, the needs for further surgery, endoscopic intervention, death by ROC curves and AUC value.Among 2977 patients, the pre-endoscopic RS and complete RS score (CRS) were superior to the GBS score (AUC: 0.842 vs 0.804 vs 0.622, respectively) for predicting the mortality risk in patients. The pre-endoscopic RS score predicting re-bleeding was significantly higher than the CRS and the GBS score (AUC: 0.658 vs 0.548 vs 0.528, respectively). In addition, the 3 scoring systems revealed to be poor predictors of surgical operation effectiveness (AUC: 0.589 vs 0.547 vs 0.504, respectively).Our data demonstrated that the GBS and RS scoring systems could be used to predict outcomes in patients with nonvariceal upper gastrointestinal bleeding.
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Affiliation(s)
- Mingliang Lu
- Department of Gastroenterology, The Second Affiliated Hospital, Kunming Medical University, Kunming
| | - Gang Sun
- Institute of Digestive Diseases, Chinese PLA General Hospital
| | - Hua Huang
- Department of Gastroenterology, The Second Affiliated Hospital, Kunming Medical University, Kunming
| | - Xiaomei Zhang
- Institute of Digestive Diseases, Chinese PLA General Hospital
| | - Youqing Xu
- Department of Gastroenterology, Beijing Tian Tan Hospital, Beijing
| | - Shiyao Chen
- Department of Gastroenterology, Zhongshan Hospital, Fudan University, Shanghai
| | - Ying Song
- Department of Gastroenterology, Xi’an Central Hospital, Xi’an
| | - Xueliang Li
- Department of Gastroenterology, First Affiliated Hospital, Nanjing Medical University, Nanjing
| | - Bin Lv
- Department of Gastroenterology, First Affiliated Hospital, Zhejiang Chinese Medical University, Hangzhou
| | - Jianlin Ren
- Department of Gastroenterology, Zhongshan Hospital, Xiamen University, Xiamen
| | - Xueqing Chen
- Department of Gastroenterology, First People's Hospital of Foshan, Foshan, China
| | - Hui Zhang
- Department of Gastroenterology, Beijing Tian Tan Hospital, Beijing
| | - Chen Mo
- Institute of Digestive Diseases, Chinese PLA General Hospital
| | - Yanzhi Wang
- Institute of Digestive Diseases, Chinese PLA General Hospital
| | - Yunsheng Yang
- Institute of Digestive Diseases, Chinese PLA General Hospital
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Clinical Outcomes of Patients with Non-ulcer and Non-variceal Upper Gastrointestinal Bleeding: A Prospective Multicenter Study of Risk Prediction Using a Scoring System. Dig Dis Sci 2018; 63:3253-3261. [PMID: 30132232 DOI: 10.1007/s10620-018-5255-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Accepted: 08/16/2018] [Indexed: 01/19/2023]
Abstract
BACKGROUND AND AIMS Compared with ulcer bleeding (UB) in non-variceal upper gastrointestinal bleeding (NVUGIB), non-ulcer bleeding (NUB) is often considered to have a low risk of poor outcomes and is treated less intensively without any risk stratification. We conducted this study to assess the predictability of scoring systems for NUB and compare the outcomes of NUB and UB. METHODS A total of 1831 UGIB patients were registered in the database during the period from February 2011 to December 2013. Among them, 1424 patients with NVUGIB were divided into two groups: Group UB (1101 patients with peptic ulcer bleeding) and Group NUB (323 patients with non-peptic ulcer-related bleeding). RESULTS The most common cause of bleeding in Group NUB was Mallory-Weiss tears (51.1%), followed by Dieulafoy lesions (18.9%). A receiver operating characteristic (ROC) analysis revealed that the pre-Rockall score [area under the ROC (AUROC) = 0.798; 95% CI 0.707-0.890] and full Rockall score (AUROC = 0.794; 95% CI 0.693-0.895) were relatively good at predicting overall mortality in NUB. Glasgow-Blatchford score (AUROC = 0.783; 95% CI 0.730-0.836) was the most closely correlated with the need for clinical intervention in NUB. Those who had Glasgow-Blatchford score of 0 did not require any interventions, including blood transfusions. There were no statistical differences in overall mortality (p = 0.387), bleeding-related mortality (p = 0.447), or the incidence of re-bleeding (p = 0.117) between the two groups. CONCLUSIONS Scoring systems are useful to predict mortality and the need for clinical intervention in patients with NUB.
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Cúrdia Gonçalves T, Barbosa M, Xavier S, Boal Carvalho P, Firmino Machado J, Magalhães J, Marinho C, Cotter J. Optimizing the Risk Assessment in Upper Gastrointestinal Bleeding: Comparison of 5 Scores Predicting 7 Outcomes. GE PORTUGUESE JOURNAL OF GASTROENTEROLOGY 2018; 25:299-307. [PMID: 30480047 PMCID: PMC6243953 DOI: 10.1159/000486802] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Accepted: 01/07/2018] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Although different scores have been suggested to predict outcomes in the setting of upper gastrointestinal bleeding (UGIB), few comparative studies between simplified versions of older scores and recent scores have been published. We aimed to evaluate the accuracy of pre- (PreRS) and postendoscopic Rockall scores (PostRS), the Glasgow-Blatchford score (GBS) and its simplified version (sGBS), as well as the AIMS65 score in predicting different clinical outcomes. METHODS In this retrospective study, PreRS, PostRS, GBS, sGBS, and AIMS65 score were calculated, and then, areas under the receiver operating characteristic curve were used to evaluate the performance of each score to predict blood transfusion, endoscopic therapy, surgery, admission to intensive/intermediate care unit, length of hospital stay, as well as 30-day rebleeding or mortality. RESULTS PreRS, PostRS, GBS, and sGBS were calculated for all the 433 included patients, but AIMS65 calculation was only possible for 315 patients. Only the PreRS and PostRS were able to fairly predict 30-day mortality. The GBS and sGBS were good in predicting blood transfusion and reasonable in predicting surgery. None of the studied scores were good in predicting the need for endoscopic therapy, admission to intensive/intermediate care unit, length of hospital stay, and 30-day rebleeding. CONCLUSIONS Owing to the identified limitations, none of the 5 studied scores could be singly used to predict all the clinically relevant outcomes in the setting of UGIB. The sGBS was as precise as the GBS in predicting blood transfusion and surgery. The PreRS and PostRS were the only scores that could predict 30-day mortality. An algorithm using the PreRS and the sGBS as an initial approach to patients with UGIB is presented and suggested.
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Affiliation(s)
- Tiago Cúrdia Gonçalves
- Gastroenterology Department, Hospital da Senhora da Oliveira, Guimarães, Portugal
- Life and Health Sciences Research Institute, School of Medicine, University of Minho, Braga, Portugal
- ICVS/3B's, PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Mara Barbosa
- Gastroenterology Department, Hospital da Senhora da Oliveira, Guimarães, Portugal
- Life and Health Sciences Research Institute, School of Medicine, University of Minho, Braga, Portugal
- ICVS/3B's, PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Sofia Xavier
- Gastroenterology Department, Hospital da Senhora da Oliveira, Guimarães, Portugal
- Life and Health Sciences Research Institute, School of Medicine, University of Minho, Braga, Portugal
- ICVS/3B's, PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Pedro Boal Carvalho
- Gastroenterology Department, Hospital da Senhora da Oliveira, Guimarães, Portugal
- Life and Health Sciences Research Institute, School of Medicine, University of Minho, Braga, Portugal
- ICVS/3B's, PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | | | - Joana Magalhães
- Gastroenterology Department, Hospital da Senhora da Oliveira, Guimarães, Portugal
- Life and Health Sciences Research Institute, School of Medicine, University of Minho, Braga, Portugal
- ICVS/3B's, PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Carla Marinho
- Gastroenterology Department, Hospital da Senhora da Oliveira, Guimarães, Portugal
- Life and Health Sciences Research Institute, School of Medicine, University of Minho, Braga, Portugal
- ICVS/3B's, PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - José Cotter
- Gastroenterology Department, Hospital da Senhora da Oliveira, Guimarães, Portugal
- Life and Health Sciences Research Institute, School of Medicine, University of Minho, Braga, Portugal
- ICVS/3B's, PT Government Associate Laboratory, Braga/Guimarães, Portugal
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Saeidseyedian S, Shayesteh AA, Beyranvandi F. Dataset for evaluation of threescoring systems for forecasting the clinical outcomes of patients with upper gastrointestinal bleeding (UGIB) - Ahvaz, Iran. Data Brief 2018; 21:2526-2530. [PMID: 30761334 PMCID: PMC6288395 DOI: 10.1016/j.dib.2018.10.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Revised: 10/07/2018] [Accepted: 10/08/2018] [Indexed: 11/28/2022] Open
Abstract
Upper gastrointestinal bleeding (UGIB) which occurs proximal to the Treitz ligament is one of the most common cases is emergency medical conditions. The aim of this data article is to evaluation of Rockall and Blatchford scoring systems for predicting the clinical outcomes of patients with upper gastrointestinal bleeding in Imam-Khomeini Hospital, Ahvaz, Iran. This dataset was collected by retrospective descriptive epidemiologic survey which 350 non-cirrhotic patients with UGIB who referred to Ahwaz Imam-Khomeini Hospital for six months. According to the obtained data, in both clinical Rockall and complete Rockall systems, the need for re-endoscopy and the risk of re-bleeding in patients with high scores was more compared to patients with low scores. While, the obtained data about Blatchford score for re-endoscopy and re-bleeding risk was showed which no significant difference. Based on to present dataset, the Rockall systems was superior to Blatchford systems in predicting the re-bleeding as well as the need for re-endoscopy while, none of the systems were efficient in terms of predicting the need for urgent endoscopy and surgery.
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Affiliation(s)
- Seyed Saeidseyedian
- Alimentary Tract Research Center, Jundishapur University of Medical Science, Ahvaz, Iran
| | - Ali Akbar Shayesteh
- Department of Gastroenterology, Research Center for Infectious Diseases of Digestive System, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Fereshteh Beyranvandi
- Department of Gastroenterology, Research Center for Infectious Diseases of Digestive System, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
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Lee CH, Yoon H, Choi YJ, Jang ES, Kim J, Shin CM, Park YS, Hwang JH, Kim JW, Jeong SH, Kim N, Lee DH, Kim JS. Predictive factors of therapeutic intervention in on-call endoscopy for suspected gastrointestinal bleeding. Scand J Gastroenterol 2018; 53:958-963. [PMID: 30134741 DOI: 10.1080/00365521.2018.1493533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND AIMS Performing an endoscopy out of hours confer significant burdens on limited health-care resources. However, not all on-call endoscopies lead to therapeutic interventions. The purpose of the present study was to analyze predictive factors for performing therapeutic intervention in patients with suspected gastrointestinal bleeding. METHODS We reviewed and analyzed electronic medical records regarding on-call endoscopy that were prospectively collected for quality control. The subjects were patients with suspected gastrointestinal bleeding who underwent on-call endoscopies at night, on weekends and on holidays between April 2013 and January 2017 in Seoul National University Bundang Hospital. To determine predictive factors for performing therapeutic intervention, the following variables were analyzed: symptoms, patient status, coexisting disease, laboratory findings and medications. To clarify the association between the likelihood of therapeutic intervention in on-call endoscopy and AIMS65 score, the included variables were divided by cutoffs. RESULTS A total of 270 patients (male: 72.6%, mean age: 62.6 years) with suspected gastrointestinal bleeding had on-call endoscopies and 153 (56.7%) patients had therapeutic intervention. Gastroscopy, colonoscopy and both endoscopic techniques were performed in 215, 42 and 13 patients, respectively. In the multivariate analysis, hematemesis (p < .001, odds ratio [OR], 2.484) and prolonged prothrombin time-international normalized ratio (PT-INR) (p = .033; OR, 1.958) were correlated with performing therapeutic intervention in on-call endoscopy. AIMS65 score with a cutoff of 2 was associated with the likelihood of intervention (p = .043). CONCLUSIONS Hematemesis and prolonged PT-INR were predictive factors of therapeutic intervention when on-call endoscopy was performed in patients with suspected gastrointestinal bleeding.
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Affiliation(s)
- Chan Hyung Lee
- a Department of Internal Medicine and Liver Research Institute , Seoul National University College of Medicine , Seoul , South Korea.,b Department of Internal Medicine , Seoul National University Bundang Hospital , Seongnam , Gyeonggi-do , South Korea
| | - Hyuk Yoon
- b Department of Internal Medicine , Seoul National University Bundang Hospital , Seongnam , Gyeonggi-do , South Korea
| | - Yoon Jin Choi
- b Department of Internal Medicine , Seoul National University Bundang Hospital , Seongnam , Gyeonggi-do , South Korea
| | - Eun Sun Jang
- b Department of Internal Medicine , Seoul National University Bundang Hospital , Seongnam , Gyeonggi-do , South Korea
| | - Jaihwan Kim
- b Department of Internal Medicine , Seoul National University Bundang Hospital , Seongnam , Gyeonggi-do , South Korea
| | - Cheol Min Shin
- b Department of Internal Medicine , Seoul National University Bundang Hospital , Seongnam , Gyeonggi-do , South Korea
| | - Young Soo Park
- b Department of Internal Medicine , Seoul National University Bundang Hospital , Seongnam , Gyeonggi-do , South Korea
| | - Jin-Hyeok Hwang
- b Department of Internal Medicine , Seoul National University Bundang Hospital , Seongnam , Gyeonggi-do , South Korea
| | - Jin-Wook Kim
- b Department of Internal Medicine , Seoul National University Bundang Hospital , Seongnam , Gyeonggi-do , South Korea
| | - Sook-Hayng Jeong
- b Department of Internal Medicine , Seoul National University Bundang Hospital , Seongnam , Gyeonggi-do , South Korea
| | - Nayoung Kim
- b Department of Internal Medicine , Seoul National University Bundang Hospital , Seongnam , Gyeonggi-do , South Korea
| | - Dong Ho Lee
- b Department of Internal Medicine , Seoul National University Bundang Hospital , Seongnam , Gyeonggi-do , South Korea
| | - Joo Sung Kim
- a Department of Internal Medicine and Liver Research Institute , Seoul National University College of Medicine , Seoul , South Korea
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Tsui ATS, Chau CW, Leung JKS. Validation of a Modified Glasgow-Blatchford Score for Risk Stratification of Patients with Suspected Upper Gastrointestinal Bleeding in an Accident and Emergency Department in Hong Kong. HONG KONG J EMERG ME 2017. [DOI: 10.1177/102490791602300201] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Objectives To validate the use of a modified Glasgow-Blatchford Score (mGBS) for risk stratification of patients with suspected upper gastrointestinal bleeding (UGIB) in an accident and emergency department in Hong Kong. Methods This was a retrospective cohort study of patients who attended the emergency department of the study centre from January 2014 to June 2014 who were subsequently admitted to surgical wards with suspected UGIB. High risk patients were considered to be those who required in-patient clinical interventions (blood transfusion, therapeutic endoscopy, angiographic embolisation, or surgery). The mGBS was calculated for each patient. The sensitivity, specificity, and area under the receiver-operating characteristic curve (AUC) of the score were calculated. Results A total of 372 patients were included in the study. With an mGBS of 0 (low risk) for detecting the primary outcome, the sensitivity was 99.2% (95% CI, 95.6100%), and the specificity was 25.91 (95% CI 20.6-31.8%). The negative likelihood ratio was 0.031 (95% CI 0.004-0.2). The AUC was 0.90 (95% CI 0.87 to 0.93). Conclusion The modified Glasgow-Blatchford Score is a clinically useful tool for emergency physician to identify UGIB patients at low-risk of requiring in-hospital clinical interventions. (Hong Kong j.emerg.med. 2016;23:3-11)
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Zamparini E, Ahmed P, Belhassan M, Horaist C, Bouguerba A, Ayed S, Barchasz J, Boukari M, Goldgran-Toledano D, Yaacoubi S, Bornstain C, Nahon S, Vincent F. Orientation des patients adultes consultant aux urgences pour hémorragie digestive (hors hypertension portale prouvée ou présumée) : intérêt des scores pronostiques. MEDECINE INTENSIVE REANIMATION 2017. [DOI: 10.1007/s13546-017-1288-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Attard TM, Miller M, Pant C, Thomson M. Readmission after Gastrointestinal Bleeding in Children: A Retrospective Cohort Study. J Pediatr 2017; 184:106-113.e4. [PMID: 28237379 DOI: 10.1016/j.jpeds.2017.01.044] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Revised: 12/30/2016] [Accepted: 01/18/2017] [Indexed: 12/20/2022]
Abstract
INTRODUCTION To compare the demographic, clinical, and therapeutic characteristics in a cohort of patients discharged following acute gastrointestinal bleeding, representing to the emergency department (ED) and readmitted within 30 days of discharge with the characteristics of non-readmitted patients. STUDY DESIGN Hospitalization data was obtained from the Pediatric Hospital Information System including 49 tertiary children's hospitals in the US. Children 1-21 years of age diagnosed with acute gastrointestinal bleeding, admitted between January 2007 and September 2015 were included. The primary outcomes in this study were 30-day inpatient readmission through the ED and 30-day return to the ED only. Unadjusted, univariate followed by multivariable analysis of the associations between patient characteristics and treatment course at the index encounter using the R statistical package, v. 3.2.3. RESULTS During the study period, 9902 patients were admitted with acute gastrointestinal bleeding; in the following month, 1460 (16.1%) represented to the ED and 932 (9%) were readmitted; 68.7% within 14 days from discharge. Readmission was most frequently associated with portal hypertension or esophageal variceal hemorrhage. There was a decreased likelihood of readmission with endoscopy (OR 0.77, 95% CI, 0.661, 0.906) and with Meckel scan (OR 0.513, 95% CI 0.362, 0.727) during the initial admission. Multiple comorbidities, longer initial stay and the early proton pump inhibitor therapy were associated with higher likelihood of readmission. DISCUSSION Readmission following acute gastrointestinal bleeding is common and is more likely following variceal hemorrhage, long initial admission, and chronic comorbidities.
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Affiliation(s)
- Thomas M Attard
- Department of Gastroenterology, Children's Mercy Hospital, Kansas City, MO.
| | - Mikaela Miller
- Health Information Management, Children's Mercy Hospital, Kansas City, MO
| | - Chaitanya Pant
- Department of Gastroenterology, University of Kansas, Kansas City, KS
| | - Mike Thomson
- Sheffield Children's Hospital, Sheffield, United Kingdom
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Anchu AC, Mohsina S, Sureshkumar S, Mahalakshmy T, Kate V. External validation of scoring systems in risk stratification of upper gastrointestinal bleeding. Indian J Gastroenterol 2017; 36:105-112. [PMID: 28393330 DOI: 10.1007/s12664-017-0740-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Accepted: 03/09/2017] [Indexed: 02/04/2023]
Abstract
AIM The aim of this study was to externally validate the four commonly used scoring systems in the risk stratification of patients with upper gastrointestinal bleed (UGIB). METHODS Patients of UGIB who underwent endoscopy within 24 h of presentation were stratified prospectively using the pre-endoscopy Rockall score (PRS) >0, complete Rockall score (CRS) >2, Glasgow Blatchford bleeding scores (GBS) >3, and modified GBS (m-GBS) >3 scores. Patients were followed up to 30 days. Prognostic accuracy of the scores was done by comparing areas under curve (AUC) in terms of overall risk stratification, re-bleeding, mortality, need for intervention, and length of hospitalization. RESULTS One hundred and seventy-five patients were studied. All four scores performed better in the overall risk stratification on AUC [PRS = 0.566 (CI: 0.481-0.651; p-0.043)/CRS = 0.712 (CI: 0.634-0.790); p<0.001)/GBS = 0.810 (CI: 0.744-0.877; p->0.001); m-GBS = 0.802 (CI: 0.734-0.871; p<0.001)], whereas only CRS achieved significance in identifying re-bleed [AUC-0.679 (CI: 0.579-0.780; p = 0.003)]. All the scoring systems except PRS were found to be significantly better in detecting 30-day mortality with a high AUC (CRS = 0.798; p-0.042)/GBS = 0.833; p-0.023); m-GBS = 0.816; p-0.031). All four scores demonstrated significant accuracy in the risk stratification of non-variceal patients; however, only GBS and m-GBS were significant in variceal etiology. Higher cutoff scores achieved better sensitivity/specificity [RS > 0 (50/60.8), CRS > 1 (87.5/50.6), GBS > 7 (88.5/63.3), m-GBS > 7(82.3/72.6)] in the risk stratification. CONCLUSION GBS and m-GBS appear to be more valid in risk stratification of UGIB patients in this region. Higher cutoff values achieved better predictive accuracy.
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Affiliation(s)
- Anna Cherian Anchu
- Department of Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Dhanvantri Nagar, Gorimedu, Puducherry, 605 006, India
| | - Subair Mohsina
- Department of Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Dhanvantri Nagar, Gorimedu, Puducherry, 605 006, India
| | - Sathasivam Sureshkumar
- Department of Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Dhanvantri Nagar, Gorimedu, Puducherry, 605 006, India
| | - T Mahalakshmy
- Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Dhanvantri Nagar, Gorimedu, Puducherry, 605 006, India
| | - Vikram Kate
- Department of Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Dhanvantri Nagar, Gorimedu, Puducherry, 605 006, India.
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Zhong M, Chen WJ, Lu XY, Qian J, Zhu CQ. Comparison of three scoring systems in predicting clinical outcomes in patients with acute upper gastrointestinal bleeding: a prospective observational study. J Dig Dis 2016; 17:820-828. [PMID: 27930875 DOI: 10.1111/1751-2980.12433] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Revised: 11/23/2016] [Accepted: 12/05/2016] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To compare the performances of the Glasgow-Blatchford score (GBS), modified GBS (mGBS) and AIMS65 in predicting clinical outcomes in patients with acute upper gastrointestinal bleeding (AUGIB). METHODS This study enrolled 320 consecutive patients with AUGIB. Patients at high and low risks of developing adverse clinical outcomes (rebleeding, the need of clinical intervention and death) were categorized according to the GBS, mGBS and AIMS65 scoring systems. The outcome of the patients were the occurrences of adverse clinical outcomes. The areas under the receiver operating characteristics curve (AUROC) of three scoring systems were compared. RESULTS Irrespective of the systems used, the high-risk groups showed higher rates of rebleeding, intervention and death compared with the low-risk groups (P < 0.05). For the prediction of rebleeding, AIMS65 (AUROC 0.735, 95% CI 0.667-0.802) performed significantly better than GBS (AUROC 0.672, 95% CI 0.597-0.747; P < 0.01) and mGBS (AUROC 0.677, 95% CI 0.602-0.753; P < 0.01). For the prediction of interventions, there was no significant difference among the three systems (GBS: AUROC 0.769, 95% CI 0.668-0.870; mGBS: AUROC 0.745, 95% CI 0.643-0.847; AIMS65: AUROC 0.746, 95% CI 0.640-0.851). For the prediction of in-hospital mortality, there was no significant difference among the three systems (GBS: AUROC 0.796, 95% CI 0.694-0.898; mGBS: AUROC 0.803, 95% CI 0.703-0.904; AIMS65: AUROC 0.786, 95% CI 0.670-0.903). CONCLUSIONS The three scoring systems are reliable and accurate in predicting the rates of rebleeding, surgery and mortality in AUGIB. However, AIMS65 outperforms GBS and mGBS in predicting rebleeding.
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Affiliation(s)
- Min Zhong
- Department of Emergency Medicine, Renjii Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Wan Jun Chen
- Department of Emergency Medicine, Renjii Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Xiao Ye Lu
- Department of Emergency Medicine, Renjii Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Jie Qian
- Department of Emergency Medicine, Renjii Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Chang Qing Zhu
- Department of Emergency Medicine, Renjii Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
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Iino C, Mikami T, Igarashi T, Aihara T, Ishii K, Sakamoto J, Tono H, Fukuda S. Evaluation of scoring models for identifying the need for therapeutic intervention of upper gastrointestinal bleeding: A new prediction score model for Japanese patients. Dig Endosc 2016; 28:714-721. [PMID: 27061908 DOI: 10.1111/den.12666] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Revised: 04/02/2016] [Accepted: 04/06/2016] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIM Multiple scoring systems have been developed to predict outcomes in patients with upper gastrointestinal bleeding. We determined how well these and a newly established scoring model predict the need for therapeutic intervention, excluding transfusion, in Japanese patients with upper gastrointestinal bleeding. METHODS We reviewed data from 212 consecutive patients with upper gastrointestinal bleeding. Patients requiring endoscopic intervention, operation, or interventional radiology were allocated to the therapeutic intervention group. Firstly, we compared areas under the curve for the Glasgow-Blatchford, Clinical Rockall, and AIMS65 scores. Secondly, the scores and factors likely associated with upper gastrointestinal bleeding were analyzed with a logistic regression analysis to form a new scoring model. Thirdly, the new model and the existing model were investigated to evaluate their usefulness. RESULTS Therapeutic intervention was required in 109 patients (51.4%). The Glasgow-Blatchford score was superior to both the Clinical Rockall and AIMS65 scores for predicting therapeutic intervention need (area under the curve, 0.75 [95% confidence interval, 0.69-0.81] vs 0.53 [0.46-0.61] and 0.52 [0.44-0.60], respectively). Multivariate logistic regression analysis retained seven significant predictors in the model: systolic blood pressure <100 mmHg, syncope, hematemesis, hemoglobin <10 g/dL, blood urea nitrogen ≥22.4 mg/dL, estimated glomerular filtration rate ≤ 60 mL/min per 1.73 m2 , and antiplatelet medication. Based on these variables, we established a new scoring model with superior discrimination to those of existing scoring systems (area under the curve, 0.85 [0.80-0.90]). CONCLUSION We developed a superior scoring model for identifying therapeutic intervention need in Japanese patients with upper gastrointestinal bleeding.
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Affiliation(s)
- Chikara Iino
- Department of Internal Medicine, Hirosaki Municipal Hospital, Hirosaki, Japan. .,Department of Gastroenterology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan.
| | - Tatsuya Mikami
- Department of Internal Medicine, Hirosaki Municipal Hospital, Hirosaki, Japan.,Division of Endoscopy, Hirosaki University Hospital, Hirosaki, Japan
| | - Takasato Igarashi
- Department of Internal Medicine, Hirosaki Municipal Hospital, Hirosaki, Japan.,Department of Gastroenterology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Tomoyuki Aihara
- Department of Internal Medicine, Hirosaki Municipal Hospital, Hirosaki, Japan
| | - Kentaro Ishii
- Department of Internal Medicine, Hirosaki Municipal Hospital, Hirosaki, Japan
| | - Jyuichi Sakamoto
- Department of Internal Medicine, Hirosaki Municipal Hospital, Hirosaki, Japan
| | - Hiroshi Tono
- Department of Internal Medicine, Hirosaki Municipal Hospital, Hirosaki, Japan
| | - Shinsaku Fukuda
- Department of Gastroenterology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
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Mokhtare M, Bozorgi V, Agah S, Nikkhah M, Faghihi A, Boghratian A, Shalbaf N, Khanlari A, Seifmanesh H. Comparison of Glasgow-Blatchford score and full Rockall score systems to predict clinical outcomes in patients with upper gastrointestinal bleeding. Clin Exp Gastroenterol 2016; 9:337-343. [PMID: 27826205 PMCID: PMC5096755 DOI: 10.2147/ceg.s114860] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Background Various risk scoring systems have been recently developed to predict clinical outcomes in patients with upper gastrointestinal bleeding (UGIB). The two commonly used scoring systems include full Rockall score (RS) and the Glasgow-Blatchford score (GBS). Bleeding scores were assessed in terms of prediction of clinical outcomes in patients with UGIB. Patients and methods Two hundred patients (age >18 years) with obvious symptoms of UGIB in the emergency department of Rasoul Akram Hospital were enrolled. Full RS and GBS were calculated. We followed the patients for records of rebleeding and 1-month mortality. A receiver operating characteristic curve by using areas under the curve (AUCs) was used to statistically identify the best cutoff point. Results Eighteen patients were excluded from the study due to failure to follow-up. Rebleeding and mortality rate were 9.34% (n=17) and 11.53% (n=21), respectively. Regarding 1-month mortality, full RS was better than GBS (AUC, 0.648 versus 0.582; P=0.021). GBS was more accurate in terms of detecting transfusion need (AUC, 0.757 versus 0.528; P=0.001), rebleeding rate (AUC, 0.722 versus 0.520; P=0.002), intensive care unit admission rate (AUC, 0.648 versus 0.582; P=0.021), and endoscopic intervention rate (AUC, 0.771 versus 0.650; P<0.001). Conclusion We found the full RS system is better for 1-month mortality prediction while GBS system is better for prediction of other outcomes.
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Affiliation(s)
- Marjan Mokhtare
- Colorectal Research Center, Rasoul Akram Hospital, Tehran, Iran
| | - Vida Bozorgi
- Colorectal Research Center, Rasoul Akram Hospital, Tehran, Iran
| | - Shahram Agah
- Colorectal Research Center, Rasoul Akram Hospital, Tehran, Iran
| | - Mehdi Nikkhah
- Colorectal Research Center, Rasoul Akram Hospital, Tehran, Iran
| | | | | | - Neda Shalbaf
- Colorectal Research Center, Rasoul Akram Hospital, Tehran, Iran
| | - Abbas Khanlari
- Colorectal Research Center, Rasoul Akram Hospital, Tehran, Iran
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Robertson M, Majumdar A, Boyapati R, Chung W, Worland T, Terbah R, Wei J, Lontos S, Angus P, Vaughan R. Risk stratification in acute upper GI bleeding: comparison of the AIMS65 score with the Glasgow-Blatchford and Rockall scoring systems. Gastrointest Endosc 2016; 83:1151-60. [PMID: 26515955 DOI: 10.1016/j.gie.2015.10.021] [Citation(s) in RCA: 87] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Accepted: 10/11/2015] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS The American College of Gastroenterology recommends early risk stratification in patients presenting with upper GI bleeding (UGIB). The AIMS65 score is a risk stratification score previously validated to predict inpatient mortality. The aim of this study was to validate the AIMS65 score as a predictor of inpatient mortality in patients with acute UGIB and to compare it with established pre- and postendoscopy risk scores. METHODS ICD-10 (International Classification of Diseases, Tenth Revision) codes identified patients presenting with UGIB requiring endoscopy. All patients were risk stratified by using the AIMS65, Glasgow-Blatchford score (GBS), pre-endoscopy Rockall, and full Rockall scores. The primary outcome was inpatient mortality. Secondary outcomes were a composite endpoint of inpatient mortality, rebleeding, and endoscopic, radiologic, or surgical intervention; blood transfusion requirement; intensive care unit (ICU) admission; rebleeding; and hospital length of stay. The area under the receiver-operating characteristic curve (AUROC) was calculated for each score. RESULTS Of the 424 study patients, 18 (4.2%) died and 69 (16%) achieved the composite endpoint. The AIMS65 score was superior to both the GBS (AUROC, 0.80 vs 0.76, P < .027) and the pre-endoscopy Rockall score (0.74, P = .001) and equivalent to the full Rockall score (0.78, P = .18) in predicting inpatient mortality. The AIMS65 score was superior to all other scores in predicting the need for ICU admission and length of hospital stay. AIMS65, GBS, and full Rockall scores were equivalent (AUROCs, 0.63 vs 0.62 vs 0.63, respectively) and superior to pre-endoscopy Rockall (AUROC, 0.55) in predicting the composite endpoint. GBS was superior to all other scores for predicting blood transfusion. CONCLUSION The AIMS65 score is a simple risk stratification score for UGIB with accuracy superior to that of GBS and pre-endoscopy Rockall scores in predicting in-hospital mortality and the need for ICU admission.
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Affiliation(s)
- Marcus Robertson
- Department of Gastroenterology and Liver Transplant Unit, Austin Hospital, Heidelberg, Victoria, Australia
| | - Avik Majumdar
- Department of Gastroenterology and Liver Transplant Unit, Austin Hospital, Heidelberg, Victoria, Australia
| | - Ray Boyapati
- Department of Gastroenterology and Liver Transplant Unit, Austin Hospital, Heidelberg, Victoria, Australia
| | - William Chung
- Department of Gastroenterology and Liver Transplant Unit, Austin Hospital, Heidelberg, Victoria, Australia
| | - Tom Worland
- Department of Gastroenterology and Liver Transplant Unit, Austin Hospital, Heidelberg, Victoria, Australia
| | - Ryma Terbah
- Department of Gastroenterology and Liver Transplant Unit, Austin Hospital, Heidelberg, Victoria, Australia
| | - James Wei
- Department of Gastroenterology and Liver Transplant Unit, Austin Hospital, Heidelberg, Victoria, Australia
| | - Steve Lontos
- Department of Gastroenterology and Liver Transplant Unit, Austin Hospital, Heidelberg, Victoria, Australia
| | - Peter Angus
- Department of Gastroenterology and Liver Transplant Unit, Austin Hospital, Heidelberg, Victoria, Australia; Department of Medicine, The University of Melbourne, Austin Health, Heidelberg, Victoria, Australia
| | - Rhys Vaughan
- Department of Gastroenterology and Liver Transplant Unit, Austin Hospital, Heidelberg, Victoria, Australia; Department of Medicine, The University of Melbourne, Austin Health, Heidelberg, Victoria, Australia
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Fujishiro M, Iguchi M, Kakushima N, Kato M, Sakata Y, Hoteya S, Kataoka M, Shimaoka S, Yahagi N, Fujimoto K. Guidelines for endoscopic management of non-variceal upper gastrointestinal bleeding. Dig Endosc 2016; 28:363-378. [PMID: 26900095 DOI: 10.1111/den.12639] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Revised: 02/16/2016] [Accepted: 02/17/2016] [Indexed: 01/10/2023]
Abstract
Japan Gastroenterological Endoscopy Society (JGES) has compiled a set of guidelines for endoscopic management of non-variceal upper gastrointestinal bleeding using evidence-based methods. The major cause of non-variceal upper gastrointestinal bleeding is peptic gastroduodenal ulcer bleeding. As a result, these guidelines mainly focus on peptic gastroduodenal ulcer bleeding, although bleeding from other causes is also overviewed. From the epidemiological aspect, in recent years in Japan, bleeding from drug-related ulcers has become predominant in comparison with bleeding from Helicobacter pylori (HP)-related ulcers, owing to an increase in the aging population and coverage of HP eradication therapy by national health insurance. As for treatment, endoscopic hemostasis, in which there are a variety of methods, is considered to be the first-line treatment for bleeding from almost all causes. It is very important to precisely evaluate the severity of the patient's condition and stabilize the patient's vital signs with intensive care for successful endoscopic hemostasis. Additionally, use of antisecretory agents is recommended to prevent rebleeding after endoscopic hemostasis, especially for gastroduodenal ulcer bleeding. Eighteen statements with evidence and recommendation levels have been made by the JGES committee of these guidelines according to evidence obtained from clinical research studies. However, some of the statements that are supported by a low level of evidence must be confirmed by further clinical research.
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Affiliation(s)
| | | | | | - Motohiko Kato
- Japan Gastroenterological Endoscopy Society, Tokyo, Japan
| | | | - Shu Hoteya
- Japan Gastroenterological Endoscopy Society, Tokyo, Japan
| | | | | | - Naohisa Yahagi
- Japan Gastroenterological Endoscopy Society, Tokyo, Japan
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Thanapirom K, Ridtitid W, Rerknimitr R, Thungsuk R, Noophun P, Wongjitrat C, Luangjaru S, Vedkijkul P, Lertkupinit C, Poonsab S, Ratanachu-ek T, Hansomburana P, Pornthisarn B, Thongbai T, Mahachai V, Treeprasertsuk S. Prospective comparison of three risk scoring systems in non-variceal and variceal upper gastrointestinal bleeding. J Gastroenterol Hepatol 2016; 31:761-767. [PMID: 26514879 DOI: 10.1111/jgh.13222] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Revised: 10/21/2015] [Accepted: 10/22/2015] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND AIM Data regarding the efficacy of the Glasgow Blatchford score (GBS), full Rockall score (FRS) and pre-endoscopic Rockall scores (PRS) in comparing non-variceal and variceal upper gastrointestinal bleeding (UGIB) are limited. Our aim was to determine the performance of these three risk scores in predicting the need for treatment, mortality, and re-bleeding among patients with non-variceal and variceal UGIB. METHODS During January, 2010 and September, 2011, patients with UGIB from 11 hospitals were prospectively enrolled. The GBS, FRS, and PRS were calculated. Discriminative ability for each score was assessed using the receiver operated characteristics curve (ROC) analysis. RESULTS A total of 981 patients presented with acute UGIB, 225 patients (22.9%) had variceal UGIB. The areas under the ROC (AUC) of the GBS, FRS, and PRS for predicting the need for treatment were 0.77, 0.69, and 0.61 in non-variceal versus 0.66, 0.66, and 0.59 in variceal UGIB. The AUC for predicting mortality and re-bleeding during admission were 0.66, 0.80, and 0.76 in non-variceal versus 0.63, 0.57, and 0.63 in variceal UGIB. AUC score was not statistically significant for predicting need for therapy and clinical outcome in variceal UGIB. The GBS ≤ 2 and FRS ≤ 1 identified low-risk non-variceal UGIB patients for death and re-bleeding during hospitalization. CONCLUSION In contrast to non-variceal UGIB, the GBS, FRS, and PRS were not precise scores for assessing the need for therapy, mortality, and re-bleeding during admission in variceal UGIB.
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Affiliation(s)
- Kessarin Thanapirom
- Division of Gastroenterology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | - Wiriyaporn Ridtitid
- Division of Gastroenterology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | - Rungsun Rerknimitr
- Division of Gastroenterology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | - Rattikorn Thungsuk
- Division of Gastroenterology, Sawanpracharak Hospital, Nakhon Sawan, Thailand
| | - Phadet Noophun
- Division of Gastroenterology, Surin Hospital, Surin, Thailand
| | - Chatchawan Wongjitrat
- Division of Gastroenterology, HRH Princess Maha Chakri Sirindhorn Medical Center-MSMC Hospital, Bangkok, Thailand
| | - Somchai Luangjaru
- Division of Gastroenterology, Maharat Nakhon Ratchasima Hospital, Nakhon Ratchasima, Thailand
| | - Padet Vedkijkul
- Division of Gastroenterology, Maharaj Nakhon Si Thammarat Hospital, Nakhon Si Thammarat, Thailand
| | | | | | | | | | - Bubpha Pornthisarn
- Division of Gastroenterology, Department of Medicine, Faculty of Medicine, Thammasat University Hospital, Pathum Thani, Thailand
| | - Thirada Thongbai
- Division of Gastroenterology, Bangkok Metropolitan Administration General Hospital, Bangkok, Thailand
| | - Varocha Mahachai
- Division of Gastroenterology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | - Sombat Treeprasertsuk
- Division of Gastroenterology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
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The Importance of Rockall Scoring System for Upper Gastrointestinal Bleeding in Long-Term Follow-Up. Indian J Surg 2016; 79:188-191. [PMID: 28659669 DOI: 10.1007/s12262-015-1434-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Accepted: 12/23/2015] [Indexed: 10/22/2022] Open
Abstract
The aim of the study is to examine the importance of Rockall scoring system in long-term setting to estimate re-bleeding and mortality rate due to upper gastrointestinal bleeding. A total of 321 patients who had been treated for upper gastrointestinal bleeding were recruited to the study. Patients' demographic and clinical data, the amount of blood transfusion, endoscopy results, and Rockall scores were retrieved from patients' charts. The re-bleeding, morbidity, and mortality rates were noted after 3 years of follow-up with telephone. Re-bleeding rate was statistically significantly higher in Rockall 4 group compared to Rockall 0 group. Mortality rate was also statistically significantly higher in Rockall 4 group. Rockall risk scoring system is a valuable tool to predict re-bleeding and mortality rates for patients with upper gastrointestinal bleeding in long-term setting.
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Bozkurt S, Köse A, Arslan ED, Erdoğan S, Üçbilek E, Çevik İ, Ayrık C, Sezgin O. Validity of modified early warning, Glasgow Blatchford, and pre-endoscopic Rockall scores in predicting prognosis of patients presenting to emergency department with upper gastrointestinal bleeding. Scand J Trauma Resusc Emerg Med 2015; 23:109. [PMID: 26714636 PMCID: PMC4696211 DOI: 10.1186/s13049-015-0194-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Accepted: 12/22/2015] [Indexed: 12/16/2022] Open
Abstract
Background GBS, MEWS, and PER scoring systems are not commonly used for patients presenting to emergency department with GIS bleeding. This study aimed to determine the value of MEWS, GBS, and PER scores in predicting bleeding at follow-up, endoscopic therapy and blood transfusion need, mortality, and rebleeding within a 1-month period. Methods A total of 202 consecutive patients with upper GIS bleeding between July 2013 and November 2014 were prospectively enrolled in the study. The relationship between MEWS, GBS, and PER scores and hospital outcome, bleeding at follow-up, endoscopic therapy, transfusion need, rebleeding, and death were examined. Results The study included a total of 202 subjects, with 84 (41.6 %) females and 118 (58.4 %) males. There was a significant correlation between GBS, MEWS, and PER scores and hospital outcomes (p <0.004, p <0.001, p <0.001, respectively). A GBS score greater than 11 succesfully predicted bleeding at follow-up (p = 0.0237). GBS score's sensitivity for predicting endoscopic therapy was greater than those of other scoring systems. The discriminatory power of each scoring system was significant for predicting transfusion (p <0.0001, p = 0.0470, and p = 0.0014, respectively). A GBS score greater than 13, a MEWS score greater than 2, and a PER score greater than 3 predicted death. A PER score greater than 3 predicted rebleeding (p <0.0001). Conclusion The scoring systems in question can be easily calculated in patients presenting to ED with upper GIS bleeding and may be beneficial for risk stratification, determination of transfusion need, prediction of rebleeding, and decisions of hospitalization or discharge.
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Affiliation(s)
- Seyran Bozkurt
- Emergency Medicine Department, Mersin University Medical Faculty, Mersin, Turkey.
| | - Ataman Köse
- Emergency Medicine Department, Mersin University Medical Faculty, Mersin, Turkey
| | - Engin Deniz Arslan
- Department of Emergency Medicine, Diskapı Yıldırım Beyazit Training and Research Hospital, Ankara, Turkey
| | - Semra Erdoğan
- Biostatistics and Medical Informatics Department, Mersin University Medical Faculty, Mersin, Turkey
| | - Enver Üçbilek
- Gastroenterology Department, Mersin University Medical Faculty, Mersin, Turkey
| | - İbrahim Çevik
- Emergency Medicine Department, Mersin University Medical Faculty, Mersin, Turkey
| | - Cüneyt Ayrık
- Emergency Medicine Department, Mersin University Medical Faculty, Mersin, Turkey
| | - Orhan Sezgin
- Gastroenterology Department, Mersin University Medical Faculty, Mersin, Turkey
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Thandassery RB, Sharma M, John AK, Al-Ejji KM, Wani H, Sultan K, Al-Mohannadi M, Yakoob R, Derbala M, Al-Dweik N, Butt MT, Al-Kaabi SR. Clinical Application of AIMS65 Scores to Predict Outcomes in Patients with Upper Gastrointestinal Hemorrhage. Clin Endosc 2015; 48:380-384. [PMID: 26473120 PMCID: PMC4604275 DOI: 10.5946/ce.2015.48.5.380] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2014] [Revised: 12/05/2014] [Accepted: 12/26/2014] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND/AIMS To evaluate the ability of the recently proposed albumin, international normalized ratio (INR), mental status, systolic blood pressure, age >65 years (AIMS65) score to predict mortality in patients with acute upper gastrointestinal bleeding (UGIB). METHODS AIMS65 scores were calculated in 251 consecutive patients presenting with acute UGIB by allotting 1 point each for albumin level <30 g/L, INR >1.5, alteration in mental status, systolic blood pressure ≤90 mm Hg, and age ≥65 years. Risk stratification was done during the initial 12 hours of hospital admission. RESULTS Intensive care unit (ICU) admission, endoscopic therapy, or surgery were required in 51 patients (20.3%), 64 (25.5%), and 12 (4.8%), respectively. The predictive accuracy of AIMS65 scores ≥2 was high for blood transfusion (area under the receiver operator characteristic curve [AUROC], 0.59), ICU admission (AUROC, 0.61), and mortality (AUROC, 0.74). The overall mortality was 10.3% (n=26), and was 3%, 7.8%, 20%, 36%, and 40% for AIMS65 scores of 0, 1, 2, 3, and 4, respectively; these values were significantly higher in those with scores ≥2 (30.9%) than in those with scores <2 (4.5%, p<0.001). CONCLUSIONS AIMS65 is a simple, accurate, non-endoscopic risk score that can be applied early (within 12 hours of hospital admission) in patients with acute UGIB. AIMS65 scores ≥2 predict high in-hospital mortality.
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Affiliation(s)
| | - Manik Sharma
- Division of Gastroenterology, Department of Medicine, Hamad General Hospital, Doha, Qatar
| | - Anil K John
- Division of Gastroenterology, Department of Medicine, Hamad General Hospital, Doha, Qatar
| | - Khalid Mohsin Al-Ejji
- Division of Gastroenterology, Department of Medicine, Hamad General Hospital, Doha, Qatar
| | - Hamidulla Wani
- Division of Gastroenterology, Department of Medicine, Hamad General Hospital, Doha, Qatar
| | - Khaleel Sultan
- Division of Gastroenterology, Department of Medicine, Hamad General Hospital, Doha, Qatar
| | - Muneera Al-Mohannadi
- Division of Gastroenterology, Department of Medicine, Hamad General Hospital, Doha, Qatar
| | - Rafie Yakoob
- Division of Gastroenterology, Department of Medicine, Hamad General Hospital, Doha, Qatar
| | - Moutaz Derbala
- Division of Gastroenterology, Department of Medicine, Hamad General Hospital, Doha, Qatar
| | - Nazeeh Al-Dweik
- Division of Gastroenterology, Department of Medicine, Hamad General Hospital, Doha, Qatar
| | - Muhammed Tariq Butt
- Division of Gastroenterology, Department of Medicine, Hamad General Hospital, Doha, Qatar
| | - Saad Rashid Al-Kaabi
- Division of Gastroenterology, Department of Medicine, Hamad General Hospital, Doha, Qatar
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Prospective multicenter validation of the Glasgow Blatchford bleeding score in the management of patients with upper gastrointestinal hemorrhage presenting at an emergency department. Eur J Gastroenterol Hepatol 2015; 27:1011-6. [PMID: 26049709 DOI: 10.1097/meg.0000000000000402] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND/AIMS The Glasgow Blatchford Bleeding Score (GBS) has been developed to assess the need for treatment in patients with acute upper gastrointestinal hemorrhage (UGIH) presenting at emergency departments (EDs). We aimed (a) to determine the validity of the GBS and Rockall scoring systems for prediction of need for treatment and (b) to identify the optimal cut-off value of the GBS. METHODS We carried out a population-based, prospective multicenter study of 520 consecutive patients presenting with acute UGIH at EDs of three hospitals. The accuracy of GBS and Rockall scores in predicting the need for treatment (i.e. endoscopic, surgical, or radiological intervention and blood transfusion) was analyzed using receiver operating characteristic curves. RESULTS Receiver operating characteristic curve analysis showed that the GBS had a good discriminative ability to determine the need for treatment in patients with acute UGIH (area under the curve: 0.88; 95% confidence interval: 0.85-0.91). The GBS was superior to both the clinical Rockall and the full Rockall score in predicting the need for treatment (area under the curve: 0.86 vs. 0.70 vs. 0.77). At a cut-off value of up to 2, the GBS had the optimal combination of sensitivity (99.4%) and specificity (42.4%). CONCLUSION The GBS is superior compared with both Rockall scores in predicting the need for treatment in patients with suspected acute UGIH presenting at EDs in the Netherlands. Patients with a GBS of 2 or less form a subgroup of low-risk patients. These low-risk patients are eligible for outpatient management, which might reduce hospital admissions and healthcare costs.
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Yaka E, Yılmaz S, Özgür Doğan N, Pekdemir M. Comparison of the Glasgow-Blatchford and AIMS65 scoring systems for risk stratification in upper gastrointestinal bleeding in the emergency department. Acad Emerg Med 2015; 22:22-30. [PMID: 25556538 DOI: 10.1111/acem.12554] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2014] [Revised: 08/07/2014] [Accepted: 08/19/2014] [Indexed: 02/06/2023]
Abstract
OBJECTIVES The aim of this study was to compare the performance of the Glasgow-Blatchford and the AIMS65 scoring systems as early risk assessment tools for accurately identifying patients with upper gastrointestinal (GI) bleeding who are at a low risk of requiring clinical interventions, including emergency endoscopy. The secondary objective was to compare their performance regarding relevant clinical outcomes. METHODS Data were collected prospectively over a 2-year period in the emergency department of a university hospital. Adult patients with upper GI bleeding from either variceal or nonvariceal sources were included. Composite clinical outcomes consisted of a need for surgical or endoscopic intervention, rebleeding, intensive care unit admission, or in-hospital mortality. Patients who required blood transfusions or suffered composite clinical outcomes were considered high-risk patients. Glasgow-Blatchford score (GBS) and AIMS65 score were calculated for each patient. The sensitivity and specificity of the scoring systems were calculated. The areas under the receiver-operating characteristic curve (AUC) of the scores were compared. RESULTS There were 254 patients in the study, of whom 163 (64.2%) were men. The median age was 61 years (interquartile range = 45 to 72 years). Among the patients, 211 (83.1%) underwent endoscopy, of whom 49 (19.3%) required endoscopic intervention to achieve hemostasis. Five (2%) patients required surgical intervention. Rebleeding was observed in 33 (13%) patients. A total of 143 (56.3%) patients received blood transfusions. A total of 152 (59.8%) were defined as high risk. Eighty-one (31.9%) experienced at least one component of the composite clinical outcomes, 18 (7.1%) of whom suffered in-hospital mortality. A GBS of 0 was observed in 16 patients (6.3%) in the study group. Two of these were high-risk patients. A total of 101 (39.8%) patients had AIMS65 scores of 0. Thirty-four of these were high-risk patients. A GBS of 0 had higher sensitivity than an AIMS65 score of 0 (98.68% vs. 77.6%). The negative predictive values of the GBS and AIMS65 of 0 were 87.5 and 66.3%, respectively. The GBS and AIMS65 were similar with regard to the composite outcome prediction, with AUCs of 0.795 (95% confidence interval [CI] = 0.74 to 0.843) and 0.746 (95% CI = 0.688 to 0.798), respectively (p = 0.137). The scores were also similar with respect to predicting in-hospital mortality (AUCs of 0.85 vs. 0.81; p = 0.342). The GBS was superior to the AIMS65 in identifying high-risk patients, with AUCs of 0.896 (95% CI = 0.85 to 0.93) and 0.771 (95% CI = 0.714 to 0.821; p < 0.001), respectively. The GBS was also more accurate than the AIM65 in predicting the need for blood transfusions (AUCs of 0.904 vs. 0.796; p < 0.001) and interventions (AUCs of 0.727 vs. 0.647; p = 0.05). CONCLUSIONS These results suggest that the GBS has superior sensitivity relative to the AIMS65 in identifying patients who were not likely to require interventions, including emergency endoscopy. Additional work to determine the use in real-time decision making may be warranted and helpful in providing guidance to clinicians.
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Affiliation(s)
- Elif Yaka
- The Department of Emergency Medicine; School of Medicine; Kocaeli University; Kocaeli Turkey
| | - Serkan Yılmaz
- The Department of Emergency Medicine; School of Medicine; Kocaeli University; Kocaeli Turkey
| | - Nurettin Özgür Doğan
- The Department of Emergency Medicine; School of Medicine; Kocaeli University; Kocaeli Turkey
| | - Murat Pekdemir
- The Department of Emergency Medicine; School of Medicine; Kocaeli University; Kocaeli Turkey
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Girardin M, Bertolini D, Ditisheim S, Frossard JL, Giostra E, Goossens N, Morard I, Nguyen-Tang T, Spahr L, Vonlaufen A, Hadengue A, Dumonceau JM. Use of glasgow-blatchford bleeding score reduces hospital stay duration and costs for patients with low-risk upper GI bleeding. Endosc Int Open 2014; 2:E74-9. [PMID: 26135264 PMCID: PMC4423275 DOI: 10.1055/s-0034-1365542] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2013] [Accepted: 01/23/2014] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND AND STUDY AIMS Upper gastrointestinal (UGI) bleeding is a frequent cause of hospitalization. Its severity may be assessed before endoscopy using the Glasgow-Blatchford Bleeding Score (GBS), a score validated to identify patients requiring clinical intervention. The aim of this study was to assess whether the GBS was effective for shortening hospital stay and reducing costs in patients with an UGI bleeding predicted at low risk of requiring clinical intervention. PATIENTS AND METHODS Consecutive outpatients presenting with UGI bleeding at our hospital were prospectively included. In the observational study phase, UGI endoscopy was performed in all patients according to routine clinical practice. In the interventional study phase, patients with a GBS of 0 were discharged with an appointment for an outpatient UGI endoscopy. All patients had follow-up at 7 and 30 days. Need for clinical intervention was defined as performance of endoscopic hemostasis, blood transfusion or surgery. Results Two-hundred and eight patients were included, 104 in each study phase; complete follow-up was obtained in 201 patients. GBS varied from 0 to 18, with 15 (14 %) and 11 (11 %) patients having a GBS of 0 in the observational and interventional study phase, respectively. For patients with a GBS of 0, hospital stay was shorter (6 versus 19 h, P < 0.01), and costs were lower (845 EUR versus 1272 EUR, P = 0.002) in the interventional versus the observational study phase. For patients with a GBS > 0, hospital stay duration did not significantly differ between study phases (189 versus 207 h, P = 0.726). No adverse event was observed in the patients sent home with a GBS of 0 during the interventional study phase. Conclusions Implementing the GBS as a tool for triage of hospital outpatients who present with UGI bleeding allowed us to identify those who could safely be discharged for ambulatory management. Implementing this change in the hospital strategy significantly shortened hospital stay and decreased management costs.
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Affiliation(s)
- Marc Girardin
- Division of Gastroenterology and Hepatology, Geneva University Hospital, Geneva, Switzerland,Corresponding author Marc Girardin, MD 4 Gabrielle-Perret Gentil Street1211 Geneva 14Switzerland
| | - David Bertolini
- Division of Gastroenterology and Hepatology, Geneva University Hospital, Geneva, Switzerland
| | - Saskia Ditisheim
- Division of Gastroenterology and Hepatology, Geneva University Hospital, Geneva, Switzerland
| | - Jean-Louis Frossard
- Division of Gastroenterology and Hepatology, Geneva University Hospital, Geneva, Switzerland
| | - Emiliano Giostra
- Division of Gastroenterology and Hepatology, Geneva University Hospital, Geneva, Switzerland
| | - Nicolas Goossens
- Division of Gastroenterology and Hepatology, Geneva University Hospital, Geneva, Switzerland
| | - Isabelle Morard
- Division of Gastroenterology and Hepatology, Geneva University Hospital, Geneva, Switzerland
| | - Thai Nguyen-Tang
- Division of Gastroenterology and Hepatology, Geneva University Hospital, Geneva, Switzerland
| | - Laurent Spahr
- Division of Gastroenterology and Hepatology, Geneva University Hospital, Geneva, Switzerland
| | - Alain Vonlaufen
- Division of Gastroenterology and Hepatology, Geneva University Hospital, Geneva, Switzerland
| | - Antoine Hadengue
- Division of Gastroenterology and Hepatology, Geneva University Hospital, Geneva, Switzerland
| | - Jean-Marc Dumonceau
- Division of Gastroenterology and Hepatology, Geneva University Hospital, Geneva, Switzerland
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Nakamura S, Matsumoto T, Sugimori H, Esaki M, Kitazono T, Hashizume M. Emergency endoscopy for acute gastrointestinal bleeding: prognostic value of endoscopic hemostasis and the AIMS65 score in Japanese patients. Dig Endosc 2014; 26:369-76. [PMID: 24168099 DOI: 10.1111/den.12187] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2013] [Accepted: 09/06/2013] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND AIM To evaluate the prognostic factors, including risk scores (Glasgow-Blatchford score and AIMS65) in patients with acute upper or lower gastrointestinal bleeding. METHODS The medical records of patients who had undergone emergency gastrointestinal endoscopy for suspected gastrointestinal bleeding during the past 5 years were retrospectively analyzed. RESULTS A total of 232 endoscopies (130 esophagogastroduodenoscopies, 102 colonoscopies) for 192 patients met the inclusion criteria. Median age was 66 years, and 64% of patients were males. Endoscopy identified causes for bleeding in 173 patients (post-endoscopic interventions for neoplastic lesions in 36 cases, colonic diverticula in 34, gastroduodenal ulcers in 29, gastric erosions in 15, vascular ectasia in 14, post-biopsy bleeding in 13, malignant tumors in 10, inflammatory conditions in nine, esophagogastric varices in five, Mallory-Weiss tears in four, nasalbleeding in three, and injury by swallowed blister pack in one), whereas the source of bleeding remained obscure in 19 patients. Blood transfusion was given in 97 patients (51%), and 97 (51%) underwent endoscopic hemostasis. During the follow-up period, 49 patients (26%) experienced rebleeding, seven of whom were treated by interventional radiology. Thirty-nine patients (20%) died as a result of various diseases. The probabilities of overall survival (OS) after 3 and 5 years were 71% and 67%, respectively. Cox multivariate analysis revealed blood transfusion, co-existing malignancy, absence of endoscopic hemostasis, and high AIMS65 score to be independent prognostic factors for poor OS. CONCLUSION The AIMS65 score is useful for predicting the prognosis of patients with acute gastrointestinal bleeding.
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Affiliation(s)
- Shotaro Nakamura
- Department of R/D for Surgical Support System, Center for Advanced Medical Innovation, Kyushu University, Fukuoka, Japan; Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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Reply to: Risk scoring systems for upper gastrointestinal bleeding. Am J Emerg Med 2013; 31:986. [DOI: 10.1016/j.ajem.2013.02.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2013] [Accepted: 02/12/2013] [Indexed: 11/21/2022] Open
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Appropriate outcome periods for assessing risk scoring systems for upper GI bleeding. Am J Emerg Med 2013; 31:985-6. [DOI: 10.1016/j.ajem.2013.02.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2013] [Accepted: 02/12/2013] [Indexed: 11/19/2022] Open
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