Which scoring system should be used for non-variceal upper gastrointestinal bleeding? Old or new?

Background and Aim Several scoring systems for predicting outcomes in patients with non-variceal upper gastrointestinal bleeding (NVUGIB) have recently been devised, but not sufficiently validated. We compared the predictive accuracy of several scoring systems and assessed the usefulness of new scoring systems. Methods The medical records of 1048 patients with NVUGIB were reviewed to collect demographic, clinical, laboratory, and endoscopic data. The areas under the receiver operating characteristic curve (AUROCs) were calculated for the ABC, new Japanese scoring system, Progetto Nazionale Emorrhagia Digestiva (PNED), and other scores to compare their predictive accuracy for 30-day mortality, therapeutic intervention, rebleeding, and prolonged hospital stay (>= 10 days). Outcome predictors were identified by multivariate analysis. Results The ABC, new Japanese scoring system, and PNED scores best predicted 30-day mortality (AUROC 0.907), need for therapeutic intervention (AUROC 0.707), and rebleeding (AUROC 0.874), respectively (all P < 0.001). The ABC and PNED scores were similarly better at predicting prolonged hospital stay (ABC AUROC: 0.765; PNED AUROC: 0.790; both P < 0.001). Thirty-day mortality was related to sex, systolic blood pressure (SBP), syncope, estimated glomerular filtration rate (eGFR), albumin, heart failure, disseminated malignancy, chronic obstructive pulmonary disease (COPD), and liver cirrhosis. Sex, age, SBP, hematemesis, blood urea nitrogen, and eGFR independently predicted the need for therapeutic intervention. Sex, SBP, pulse, albumin level, heart failure, disseminated malignancy, and COPD predicted rebleeding. Conclusion The outcomes of patients with NVUGIB were better predicted by newly developed than by old scoring systems.

Automated summary

The study compared the predictive accuracy of several scoring systems for non-variceal upper gastrointestinal bleeding (NVUGIB) patients and found that the new Japanese scoring system, ABC score, and PNED score performed better in predicting 30-day mortality, need for therapeutic intervention, and rebleeding. Factors such as sex, systolic blood pressure, and heart failure were related to outcomes in NVUGIB patients.