Copyright
©The Author(s) 2023.
World J Clin Cases. Jul 6, 2023; 11(19): 4513-4530
Published online Jul 6, 2023. doi: 10.12998/wjcc.v11.i19.4513
Published online Jul 6, 2023. doi: 10.12998/wjcc.v11.i19.4513
Table 1 Descriptive analysis of demographical data, clinical findings, type of intervention and outcome by type of bleeding, n (%)
Parameters | All cases, n = 363 (%) | Variceal bleeding, n = 127 (34%) | Non-variceal bleeding, n = 236 (65%) | P value |
Demographical data | ||||
Age, yr; median/interval | 60.90; 61/19-93 | 57.24; 57.50/19-88 | 62.87; 63/21-93 | 0.001 |
> 60 yr | 201 (55.4) | 56 (44.1) | 145 (61.4) | 0.002 |
Male | 240 (66.1) | 85 (66.9) | 155 (65.7) | 0.810 |
Comorbidities | ||||
Heart failure | 75 (20.7) | 9 (7.1) | 66 (28.0) | 0.001 |
Atrial fibrillation | 52 (14.3) | 8 (6.3) | 44 (18.6) | 0.001 |
Arterial hypertension | 119 (32.8) | 22 (17.3) | 97 (41.1) | 0.001 |
Coronary artery disease | 61 (16.8) | 4 (3.1) | 57 (24.2) | 0.001 |
Diabetes mellitus | 49 (13.5) | 18 (14.2) | 31 (13.1) | 0.783 |
COPD | 9 (2.5) | 1 (0.8) | 8 (3.4) | 0.096 |
Asthma | 3 (0.8) | 0 (0.0) | 3 (1.3) | 0.107 |
Kidney disease | 30 (8.3) | 2 (1.6) | 28 (11.9) | 0.001 |
Liver cirrhosis | 139 (38.3) | 99 (78.0) | 40 (16.9) | 0.001 |
Active malignancy | 25 (6.9) | 12 (9.4) | 13 (5.5) | 0.166 |
Hepatocarcinoma | 9 (2.5) | 8 (6.2) | 1 (0.5) | |
Cerebral vascular disease | 24 (6.6) | 2 (1.6) | 22 (9.3) | 0.002 |
Symptoms | ||||
Haematemesis | 279 (76.9) | 115 (90.6) | 164 (69.5) | 0.001 |
Melena | 267 (73.6) | 89 (70.1) | 178 (75.4) | 0.274 |
Abdominal pain | 60 (16.5) | 19 (15.0) | 41 (17.4) | 0.553 |
Syncope | 12 (3.3) | 2 (1.6) | 10 (4.2) | 0.151 |
Presyncope | 8 (2.2) | 2 (1.6) | 6 (2.5) | 0.539 |
Other symptoms | 36 (9.9) | 12 (9.4) | 24 (10.2) | 0.826 |
Chronic treatment | ||||
Antiplatelets | 36 (9.9) | 0.002 | ||
Aspirin | 22 (6.1) | 1 (0.8) | 21 (8.9) | |
Clopidogrel | 7 (1.9) | 0 (0) | 7 (3.0) | |
DAPT (aspirin clopidogrel or aspirin ticagrelor) | 6 (1.7) | 1 (0.8) | 5 (2.1) | |
Ticagrelor | 1 (0.3) | 0 (0) | 1 (0.4) | |
No treatment | 327 (90.1) | 125 (98.4) | 202 (85.6) | |
Anticoagulation | 32 (8.9) | 0.003 | ||
DOAC | 22 (6.1) | 0 (0) | 22 (9.3) | |
VKA | 10 (2.8) | 3 (2.4) | 7 (3.0) | |
No treatment | 331 (91.2) | 124 (97.6) | 207 (87.7) | |
Source of GI bleeding | ||||
Ulcerative and erosive lesions | 25 (6.9) | 0 (0) | 25 (10.6) | 0.001 |
Severe/erosive esophagitis | 27 (7.4) | 0 (0) | 27 (11.4) | |
Severe/erosive gastritis/duodenitis | 151 (41.6) | 0 (0) | 151 (64) | |
Vascular lesions (angiodysplasia) | 6 (1.7) | 0 (0) | 6 (2.5) | |
Mass lesions | 12 (3.3) | 0 (0) | 12 (5) | |
Traumatic lesions (Mallory Weiss tear) | 9 (2.4) | 0 (0) | 9 (3.8) | |
Lesion unidentified/Dieulafoy | 6 (1.6) | 0 (0) | 6 (2.7) | |
Oesophageal varices | 115 (31.7) | 115 (90.5) | 0 (0) | 0.003 |
Gastric varices | 12 (3.3) | 12 (9.5) | 0 (0) | |
Intervention | ||||
Injection therapy (dilute epinephrine) with thermal coagulation | 29 (8.0) | 0 (0.0) | 28 (11.9) | 0.001 |
Mechanical endoscopic therapy | 59 (16.3) | 50 (39.4) | 9 (3.8) | 0.001 |
Haemostatic clip | 9 (2.5) | 0 (0) | 9 (3.8) | |
Variceal ligation | 48 (13.2) | 48 (37.7) | 0 (0) | |
Variceal sclerotherapy | 2 (0.6) | 2 (1.6) | 0 (0) | |
Failed endoscopic therapy | 17 (4.7) | 9 (7) | 8 (3.4) | 0.001 |
Surgical interventions | 9 (2.5) | 0 (0) | 9 (3.8) | 0.026 |
Transfusion | ||||
Transfusions | 112 (30.9) | 38 (29.9) | 74 (31.5) | 0.758 |
In-hospital mortality | ||||
Death | 34 (9.4) | 16 (12.6) | 18 (7.7) | 0.131 |
Table 2 Mean values of scores in variceal and non-variceal bleed
Scores | All cases, n = 363, mean | Variceal bleeding, n = 127, mean (SD) | Non-variceal bleeding, n = 236, mean (SD) | P value |
AIMS-65 | 1.52 | 1.74 (0.95) | 1.40 (1.05) | 0.003 |
PERS | 3.30 | 3.76 (1.35) | 3.06 (1.70) | 0.001 |
ABC | 5.02 | 5.83 (2.42) | 4.59 (2.51) | 0.001 |
GBS | 12.32 | 12.98 (2.90) | 11.97 (3.74) | 0.008 |
Table 3 Linear regression analysis of age older than 65 score against each determined outcome
Model | R | R square | Adjusted R square | Std. error of the estimate | Change statistics | ||||
R square change | F change | df1 | df2 | Sig. F change | |||||
1 | 0.261 (a) | 0.068 | 0.065 | 0.994 | 0.068 | 260.305 | 1 | 361 | 0.000 |
2 | 0.281 (b) | 0.079 | 0.074 | 0.989 | 0.011 | 40.320 | 1 | 360 | 0.038 |
3 | 0.286 (c) | 0.082 | 0.074 | 0.989 | 0.003 | 10.010 | 1 | 359 | 0.316 |
4 | 0.316 (d) | 0.100 | 0.090 | 0.981 | 0.018 | 70.290 | 1 | 358 | 0.007 |
Table 4 Linear regression analysis of pre-endoscopic Rockall score against each determined outcome
Model | R | R square | Adjusted R square | Std. error of the estimate | Change statistics | ||||
R square change | F change | df1 | df2 | Sig. F change | |||||
1 | 0.202 (a) | 0.041 | 0.038 | 10.588 | 0.041 | 150.411 | 1 | 361 | 0.000 |
2 | 0.243 (b) | 0.059 | 0.054 | 10.575 | 0.018 | 60.987 | 1 | 360 | 0.009 |
3 | 0.248 (c) | 0.062 | 0.054 | 10.575 | 0.002 | 0.941 | 1 | 359 | 0.333 |
4 | 0.260 (d) | 0.068 | 0.057 | 10.572 | 0.006 | 20.359 | 1 | 358 | 0.125 |
Table 5 Linear regression analysis of age, blood tests and comorbidities score against each determined outcome
Model | R | R square | Adjusted R square | Std. error of the estimate | Change statistics | ||||
R square change | F change | df1 | df2 | Sig. F change | |||||
1 | 0.294 (a) | 0.087 | 0.084 | 20.435 | 0.087 | 340.206 | 1 | 361 | 0.000 |
2 | 0.324 (b) | 0.105 | 0.100 | 20.413 | 0.019 | 70.543 | 1 | 360 | 0.006 |
3 | 0.329 (c) | 0.108 | 0.101 | 20.413 | 0.003 | 10.241 | 1 | 359 | 0.266 |
4 | 0.334 (d) | 0.111 | 0.101 | 20.412 | 0.003 | 10.183 | 1 | 358 | 0.277 |
Table 6 Linear regression analysis of Glasgow-Blatchford score against each determined outcome
Model | R | R square | Adjusted R square | Std. error of the estimate | Change statistics | ||||
R square change | F change | df1 | df2 | Sig. F change | |||||
1 | 0.198 (a) | 0.039 | 0.036 | 30.434 | 0.039 | 140.659 | 1 | 361 | 0.000 |
2 | 0.241 (b) | 0.058 | 0.053 | 30.405 | 0.019 | 70.250 | 1 | 360 | 0.007 |
3 | 0.256 (c) | 0.065 | 0.058 | 30.396 | 0.007 | 20.873 | 1 | 359 | 0.091 |
4 | 0.273 (d) | 0.075 | 0.064 | 30.384 | 0.009 | 30.534 | 1 | 358 | 0.061 |
Table 7 Analysis of area under the receiver operating characteristics curve, cut-off value, 95% confidence interval for in-hospital mortality
Test result variable | Area | Cut off | Std. error(a) | Asymptotic Sig.(b) | Asymptotic 95% confidence interval |
Variceal bleed | |||||
AIMS-65 | 0.772 | 1.0 | 0.051 | 0.001 | 0.673-0.871 |
PERS | 0.705 | 3.5 | 0.067 | 0.008 | 0.573-0.837 |
ABC | 0.744 | 5.5 | 0.052 | 0.002 | 0.642-0.845 |
GBS | 0.752 | 10.5 | 0.067 | 0.001 | 0.621-0.883 |
Non-variceal bleed | |||||
AIMS-65 | 0.693 | 1.5 | 0.059 | 0.006 | 0.577-0.810 |
PERS | 0.680 | 3.5 | 0.053 | 0.011 | 0.576-0.785 |
ABC | 0.775 | 5.5 | 0.051 | 0.001 | 0.675-0.874 |
GBS | 0.657 | 12.5 | 0.077 | 0.027 | 0.505-0.808 |
Table 8 Analysis of area under the receiver operating characteristics curve, cut-off value, 95% confidence interval for in-patient mortality in mixed variceal and non-variceal bleeding population
Scores | Cut off | Sensitivity | Specificity | Area | Std. error | Asymptotic Sig. | Asymptotic 95% confidence interval |
AIMS-65 | 1.50 | 82.4 | 52.6 | 0.730 | 0.041 | 0.001 | 0.650-0.809 |
PERS | 3.50 | 82.4 | 49.2 | 0.696 | 0.042 | 0.001 | 0.615-0.778 |
ABC | 5.50 | 88.2 | 59.6 | 0.770 | 0.036 | 0.001 | 0.700-0.840 |
GBS | 12.50 | 76.5 | 47.7 | 0.704 | 0.052 | 0.001 | 0.602-0.805 |
Table 9 Analysis of area under the receiver operating characteristics curve, cut-off value, 95% confidence interval for intervention
Test result variable | Area | Cut off | Std. error(a) | Asymptotic Sig.(b) | Asymptotic 95% confidence interval |
Endoscopy-variceal bleed | |||||
AIMS-65 | 0.538 | 0.051 | 0.470 | 0.437-0.638 | |
PERS | 0.604 | 3.5 | 0.050 | 0.046 | 0.506-0.703 |
ABC | 0.553 | 0.052 | 0.313 | 0.452-0.654 | |
GBS | 0.538 | 0.052 | 0.468 | 0.437-0.639 | |
Surgical intervention-non-variceal bleed | |||||
AIMS-65 | 0.621 | 1.5 | 0.081 | 0.218 | 0.461-0.781 |
PERS | 0.624 | 3.5 | 0.088 | 0.208 | 0.451-0.796 |
ABC | 0.657 | 5.5 | 0.079 | 0.111 | 0.502-0.811 |
GBS | 0.722 | 12.5 | 0.092 | 0.024 | 0.541-0.903 |
Table 10 Analysis of area under the receiver operating characteristics curve, cut-off value, 95% confidence interval for length of admission (over 7 d)
Test result variable | Area | Std. error(a) | Asymptotic Sig.(b) | Asymptotic 95% confidence interval |
Variceal bleeding | ||||
AIMS65 | 0.516 | 0.053 | 0.768 | 0.412-0.619 |
PERS | 0.497 | 0.054 | 0.960 | 0.391-0.604 |
ABC | 0.434 | 0.053 | 0.215 | 0.330-0.538 |
GBS | 0.496 | 0.053 | 0.946 | 0.393-0.600 |
Non-variceal bleeding | ||||
AIMS65 | 0.587 | 0.037 | 0.024 | 0.514-0.660 |
PERS | 0.557 | 0.038 | 0.139 | 0.482-0.631 |
ABC | 0.550 | 0.039 | 0.194 | 0.473-0.627 |
GBS | 0.566 | 0.038 | 0.084 | 0.491-0.641 |
Table 11 Analysis of area under the receiver operating characteristics curve, cut-off value, 95% confidence interval of venous lactate in variceal and non-variceal bleed
Venous lactate | Cut off | Area | Std. error | Asymptotic Sig. | Asymptotic 95% confidence interval |
Variceal bleed | 2.05 | 0.643 | 0.030 | 0.001 | 0.585-0.701 |
Non variceal bleed | 2.45 | 0.357 | 0.030 | 0.001 | 0.299-0.415 |
Table 12 Logistic regression model for age older than 65, pre-endoscopic Rockall score, age, blood tests and comorbidities, Glasgow-Blatchford score and lactate
Logistic regression models | Independent variable | Odds ratio (95% confidence interval) | P value |
In-hospital mortality (Yes/No) | |||
Adjusted model variceal bleed | AIMS-65 | 1.434 (1.202-1.930) | 0.032 |
PERS | 1.028 (0.591-1.789) | 0.922 | |
ABC | 0.799 (0.608-1.049) | 0.106 | |
GBS | 0.915 (0.740-1.132) | 0.415 | |
Venous lactate | 4.944 (2.207-11.008) | 0.001 | |
Adjusted model, non-variceal bleed | AIMS-65 | 0.716 (0.374-1.372) | 0.314 |
PERS | 0.965 (0.669-1.393) | 0.850 | |
ABC | 0.824 (0.627-1.084) | 0.167 | |
GBS | 1.159 (1.053-1.276) | 0.003 | |
Venous lactate | 11.720 (3.437-39.968) | 0.001 | |
Endoscopy (Yes/No) | |||
Adjusted model variceal bleed | AIMS-65 | 1.049 (0.688-1.599) | 0.823 |
PERS | 0.762 (0.544-1.067) | 0.113 | |
ABC | 1.025 (0.850-1.236) | 0.794 | |
GBS | 1.029 (0.905-1.171) | 0.659 | |
Venous lactate | 2.222 (0.531-9.305) | 0.274 | |
Adjusted model non variceal bleed | AIMS-65 | 0.860 (0.533-1.388) | 0.537 |
PERS | 1.205 (0.904-1.604) | 0.203 | |
ABC | 0.931 (0.743-1.166) | 0.533 | |
GBS | 0.982 (0.891-1.083) | 0.721 | |
Venous lactate | 5.550 (1.943-15.853) | 0.001 | |
Surgical intervention (Yes/No) | |||
Adjusted model non variceal bleed | AIMS-65 | 0.928 (0.533-1.388) | 0.870 |
PERS | 0.870 (0.904-1.604) | 0.663 | |
ABC | 1.255 (0.743-1.166) | 0.280 | |
GBS | 1.214 (0.891-1.083) | 0.130 | |
Venous lactate | 2.002 (1.002-2.047) | 0.001 |
- Citation: Morarasu BC, Sorodoc V, Haisan A, Morarasu S, Bologa C, Haliga RE, Lionte C, Marciuc EA, Elsiddig M, Cimpoesu D, Dimofte GM, Sorodoc L. Age, blood tests and comorbidities and AIMS65 risk scores outperform Glasgow-Blatchford and pre-endoscopic Rockall score in patients with upper gastrointestinal bleeding. World J Clin Cases 2023; 11(19): 4513-4530
- URL: https://www.wjgnet.com/2307-8960/full/v11/i19/4513.htm
- DOI: https://dx.doi.org/10.12998/wjcc.v11.i19.4513