Age, blood tests and comorbidities and AIMS65 risk scores outperform Glasgow-Blatchford and pre-endoscopic Rockall score in patients with upper gastrointestinal bleeding

doi:10.12998/wjcc.v11.i19.4513

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World Journal of Clinical Cases

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Retrospective Cohort Study

World J Clin Cases. Jul 6, 2023; 11(19): 4513-4530
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

COPD: Chronic obstructive pulmonary disease; DAPT: Dual antiplatelets treatment DOAC: Direct oral anticoagulation VKA: Vitamin K antagonist GI: Gastrointestinal.

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

AIMS65: Age older than 65; PERS: Pre-endoscopic Rockall score; ABC: Age, blood tests and comorbidities; GBS: Glasgow-Blatchford score.

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
Model	R	R square	Adjusted R square	Std. error of the estimate	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
Model	R	R square	Adjusted R square	Std. error of the estimate	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
Model	R	R square	Adjusted R square	Std. error of the estimate	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
Model	R	R square	Adjusted R square	Std. error of the estimate	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

AIMS65: Age older than 65; PERS: Pre-endoscopic Rockall score; ABC: Age, blood tests and comorbidities; GBS: Glasgow-Blatchford score.

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

AIMS65: Age older than 65; PERS: Pre-endoscopic Rockall score; ABC: Age, blood tests and comorbidities; GBS: Glasgow-Blatchford score.

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

AIMS65: Age older than 65; PERS: Pre-endoscopic Rockall score; ABC: Age, blood tests and comorbidities; GBS: Glasgow-Blatchford score.

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

AIMS65: Age older than 65; PERS: Pre-endoscopic Rockall score; ABC: Age, blood tests and comorbidities; GBS: Glasgow-Blatchford score.

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

AIMS65: Age older than 65; PERS: Pre-endoscopic Rockall score; ABC: Age, blood tests and comorbidities; GBS: Glasgow-Blatchford score.

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