Comparison of assessment tools in acute upper gastrointestinal bleeding: Which one at which time point?
Death risk
Decisional cut-off
Scores
Upper gastrontestinal bleeding
Journal
Digestive and liver disease : official journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver
ISSN: 1878-3562
Titre abrégé: Dig Liver Dis
Pays: Netherlands
ID NLM: 100958385
Informations de publication
Date de publication:
02 2023
02 2023
Historique:
received:
22
07
2022
revised:
30
10
2022
accepted:
02
11
2022
pubmed:
10
12
2022
medline:
1
2
2023
entrez:
9
12
2022
Statut:
ppublish
Résumé
Decisions on managing bleeders remain a critical issue due to the high death risk. The Glasgow-Blatchford score (GBS) correctly identifies low-risk patients but none of the existing scores precisely assess the high risk patients. To evaluate bleeding scores' prognostic performances in predicting mortality risk. To compare the scores in low and high-risk patients and identify the "best performing cut-off" (if different from the standard one) in discriminating survivors from deceased. prospective multicenter cohort study including consecutive UGIB patients admitted to 50 Italian hospitals. We collected information to calculate Rockall, PNED, AIMS65, GB, and ABC scores, together with demographic and clinical data, and outcomes. for low-risk patients, the GB and the ABC are the best performing scores; for high-risk patients, all scores showed weak results, with the PNED score having the higher PPV. Searching for the "best performing cut-off", we found different points that determined a relevant numerical gain in terms of patients correctly assessed. we suggest using the GBS and the ABC score at admission, while the PNED appears to be more useful for high-risk. We also suggest using a new decisional cut-offs that, if validated, may increase the accuracy of current scores.
Sections du résumé
BACKGROUND
Decisions on managing bleeders remain a critical issue due to the high death risk. The Glasgow-Blatchford score (GBS) correctly identifies low-risk patients but none of the existing scores precisely assess the high risk patients.
AIMS
To evaluate bleeding scores' prognostic performances in predicting mortality risk.
SECONDARY OUTCOMES
To compare the scores in low and high-risk patients and identify the "best performing cut-off" (if different from the standard one) in discriminating survivors from deceased.
METHODS
prospective multicenter cohort study including consecutive UGIB patients admitted to 50 Italian hospitals. We collected information to calculate Rockall, PNED, AIMS65, GB, and ABC scores, together with demographic and clinical data, and outcomes.
RESULTS
for low-risk patients, the GB and the ABC are the best performing scores; for high-risk patients, all scores showed weak results, with the PNED score having the higher PPV. Searching for the "best performing cut-off", we found different points that determined a relevant numerical gain in terms of patients correctly assessed.
CONCLUSIONS
we suggest using the GBS and the ABC score at admission, while the PNED appears to be more useful for high-risk. We also suggest using a new decisional cut-offs that, if validated, may increase the accuracy of current scores.
Identifiants
pubmed: 36494298
pii: S1590-8658(22)00785-X
doi: 10.1016/j.dld.2022.11.008
pii:
doi:
Types de publication
Comparative Study
Journal Article
Multicenter Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
262-267Informations de copyright
Copyright © 2022. Published by Elsevier Ltd.
Déclaration de conflit d'intérêts
Declaration of Competing Interest None declared.