Evaluation of the shock index and different scores in predicting the mortality in upper gastrointestinal bleeding

Feyza Alimoğlu 1, Abuzer Özkan 1 * , Mustafa Çalık 2
More Detail
1 Department of Emergency Medicine, University of Health Sciences, Umraniye Training and Research Hospital, Istanbul, Turkey
2 Department of Emergency Medicine, University of Health Sciences, Gaziosmanpasa Training and Research Hospital, Istanbul, Turkey
* Corresponding Author
J CLIN MED KAZ, Volume 20, Issue 3, pp. 32-37. https://doi.org/10.23950/jcmk/13316
OPEN ACCESS 712 Views 708 Downloads
Download Full Text (PDF)

ABSTRACT

The upper gastrointestinal bleeding (UGIB) is one of the most common causes of the adult emergency admissions. In the UGIB, scoring systems are used to predict the need for clinical intervention or provide insight into prognosis. In this study, we investigated the potential of the shock index to predict 30 day-mortality in comparison with GBS, Rockall Score and AIMS65 score.
Material and methods: This is a retrospective and single-center study conducted in the emergency department. The study included the patients, who admitted to the emergency service due to GIS bleeding complaints, with confirmed diagnosis of upper bleeding, who had endoscopy. The data of the admissions between 01.01.2016 and 01.01.2020 have been used.
Results: There were a total of 141 patients with upper gastrointestinal bleeding. The number of women was 34 (24.1%) and man was 107 (75.9%). The median value of the shock index was 1.6 (1.5 to 1.8). Glasgow Blatchford score median value was 8.0 (6.0 to 11.0). Rockall score median value was 4.0 (2.0 to 5.0). The area under the curve of the receiver operating characteristic curve (AUC ROC) values of Glasgow Blatchford and Rockall score were 0.63, 0.79 (respectively) for short-term mortality.
Conclusion: We have found that the shock index failed to predict short-term mortality in patients with UGIB. Until more powerful new scoring systems are developed, the Glagow Blatchford and Rockall scoring systems are effective for UGIB patients.
Keywords: Glasgow Blatchford bleeding score, Rockall score, AIMS65 score, shock index

CITATION

Alimoğlu F, Özkan A, Çalık M. Evaluation of the shock index and different scores in predicting the mortality in upper gastrointestinal bleeding. J CLIN MED KAZ. 2023;20(3):32-7. https://doi.org/10.23950/jcmk/13316

REFERENCES

  • Lanas A, Dumonceau J-M, Hunt RH, Fujishiro M, Scheiman JM, Gralnek IM, et al. Non-variceal upper gastrointestinal bleeding. Nat Rev Dis Primers. 2018;4:18020. https://doi.org/10.1038/nrdp.2018.20
  • Lee EW, Laberge JM. Differential Diagnosis of Gastrointestinal Bleeding. Techniques in Vascular and Interventional Radiology 2004;7:112–22. https://doi.org/10.1053/j.tvir.2004.12.001
  • Hajiagha Mohammadi AA, Reza Azizi M. Prognostic factors in patients with active non-variceal upper gastrointestinal bleeding. Arab Journal of Gastroenterology. 2019;20:23–7. https://doi.org/10.1016/j.ajg.2019.01.001
  • Stolow E, Moreau C, Sayana H, Patel S. Management of Non-Variceal Upper GI Bleeding in the Geriatric Population: An Update. Curr Gastroenterol Rep. 2021;23:5. https://doi.org/10.1007/s11894-021-00805-6
  • Kim JS, Kim B-W, Kim DH, Park CH, Lee H, Joo MK, et al. Guidelines for Non-variceal Upper Gastrointestinal Bleeding.. Korean J Gastroenterol. 2020;75:322–32. https://doi.org/10.4166/kjg.2020.75.6.322
  • Erten M, Sevi̇mli̇ H, Algin A, Özdemi̇r S, Eroğlu SE, Akça HŞ. A Rare Cause of Gastrointestinal Hemorrhage: Secondary Aortoenteric Fistula. Abantmedj. 2020;9:65–8. https://doi.org/10.47493/abantmedj.2020.12
  • Lakatos L, Gonczi L, Lontai L, Izbeki F, Patai A, Racz I, et al. Incidence, Predictive Factors, Clinical Characteristics and Outcome of Non-variceal Upper Gastrointestinal Bleeding - A Prospective Population-based Study from Hungary. J Gastrointestin Liver Dis. 2021;30:327–33. https://doi.org/10.15403/jgld-3495
  • Wilkins T, Wheeler B, Carpenter M. Upper Gastrointestinal Bleeding in Adults: Evaluation and Management. Afp. 2020;101:294–300.
  • Custovic N, Husic-Selimovic A, Srsen N, Prohic D. Comparison of Glasgow-Blatchford Score and Rockall Score in Patients with Upper Gastrointestinal Bleeding. Med Arch. 2020;74:270–4. https://doi.org/10.5455/medarh.2020.74.270-274
  • Ak R, Hökenek NM. Comparison of AIMS65 and Glasgow Blatchford scores in predicting mortality in patients with upper gastrointestinal bleeding. Rev Assoc Med Bras. 2021;67:766–70. https://doi.org/10.1590/1806-9282.20210580
  • Yönak H, Özdemi̇r S, Kokulu K, Akça Hş, Islam Mm, Algin A, et al. Are AIMS65 and glasgow-blatchford scores useful in predicting health costs in patients admitted to emergency department with acute upper gastrointestinal bleeding: a prospective and observational study. JECM. 2021;38:326–30. https://doi.org/10.52142/omujecm.38.3.23
  • Horibe M, Kaneko T, Yokogawa N, Yokota T, Okawa O, Nakatani Y, et al. A simple scoring system to assess the need for an endoscopic intervention in suspected upper gastrointestinal bleeding: A prospective cohort study. Dig Liver Dis. 2016;48:1180–6. https://doi.org/10.1016/j.dld.2016.07.009
  • Saffouri E, Blackwell C, Laursen SB, Laine L, Dalton HR, Ngu J, et al. The Shock Index is not accurate at predicting outcomes in patients with upper gastrointestinal bleeding. Aliment Pharmacol Ther. 2020;51:253–60. https://doi.org/10.1111/apt.15541
  • Chiu PWY. Second look endoscopy in acute non-variceal upper gastrointestinal bleeding. Best Pract Res Clin Gastroenterol. 2013;27:905–11. https://doi.org/10.1016/j.bpg.2013.09.009
  • Bein T, Taeger K. Score systems in emergency medicine. Anasthesiol Intensivmed Notfallmed Schmerzther. 1993;28:222–7. https://doi.org/10.1055/s-2007-998911
  • Barkun AN, Almadi M, Kuipers EJ, Laine L, Sung J, Tse F, et al. Management of Nonvariceal Upper Gastrointestinal Bleeding: Guideline Recommendations From the International Consensus Group. Ann Intern Med. 2019;171:805–22. https://doi.org/10.7326/M19-1795
  • Stanley AJ, Laine L, Dalton HR, Ngu JH, Schultz M, Abazi R, et al. Comparison of risk scoring systems for patients presenting with upper gastrointestinal bleeding: international multicentre prospective study. BMJ. 2017;356:i6432. https://doi.org/10.1136/bmj.i6432
  • Eming SA, Hammerschmidt M, Krieg T, Roers A. Interrelation of immunity and tissue repair or regeneration. Semin Cell Dev Biol. 2009;20:517–27. https://doi.org/10.1016/j.semcdb.2009.04.009
  • Shrestha UK, Sapkota S. Etiology and Adverse Outcome Predictors of Upper Gastrointestinal Bleeding in 589 Patients in Nepal. Dig Dis Sci. 2014;59:814–22. https://doi.org/10.1007/s10620-013-2946-9
  • Marmo R, Soncini M, de Franchis R, GISED – Gruppo Italiano per lo Studio dell’Emorragia Digestiva. Patient’s performance status should dictate transfusion strategy in nonvariceal acute upper gastrointestinal bleeding NV-AUGIB.: A prospective multicenter cohort study: Transfusion strategy in NV-AUGIB. Dig Liver Dis. 2020;52:1156–63. https://doi.org/10.1016/j.dld.2020.07.018
  • Wang C-Y, Qin J, Wang J, Sun C-Y, Cao T, Zhu D-D. Rockall score in predicting outcomes of elderly patients with acute upper gastrointestinal bleeding. World J Gastroenterol. 2013;19:3466–72. https://doi.org/10.3748/wjg.v19.i22.3466
  • 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. https://doi.org/10.1016/j.ajem.2021.02.016
  • Ushida T, Kotani T, Imai K, Nakano-Kobayashi T, Nakamura N, Moriyama Y, et al. Shock Index and Postpartum Hemorrhage in Vaginal Deliveries: A Multicenter Retrospective Study. Shock. 2021;55:332–7. https://doi.org/10.1097/SHK.0000000000001634
  • Oakland K. Risk stratification in upper and upper and lower GI bleeding: Which scores should we use? Best Pract Res Clin Gastroenterol. 2019;42–43:101613. https://doi.org/10.1016/j.bpg.2019.04.006
  • Dicu D, Pop F, Ionescu D, Dicu T. Comparison of risk scoring systems in predicting clinical outcome at upper gastrointestinal bleeding patients in an emergency unit. Am J Emerg Med. 2013;31:94–9. https://doi.org/10.1016/j.ajem.2012.06.009
  • Stanley AJ, Dalton HR, Blatchford O, Ashley D, Mowat C, Cahill A, et al. Multicentre comparison of the Glasgow Blatchford and Rockall Scores in the prediction of clinical end-points after upper gastrointestinal haemorrhage. Aliment Pharmacol Ther. 2011;34:470–5. https://doi.org/10.1111/j.1365-2036.2011.04747.x
  • Bryant RV, Kuo P, Williamson K, Yam C, Schoeman MN, Holloway RH, et al. Performance of the Glasgow-Blatchford score in predicting clinical outcomes and intervention in hospitalized patients with upper GI bleeding. Gastrointest Endosc. 2013;78:576–83. https://doi.org/10.1016/j.gie.2013.05.003
  • Sasaki Y, Abe T, Kawamura N, Keitoku T, Shibata I, Ohno S, et al. Prediction of the need for emergency endoscopic treatment for upper gastrointestinal bleeding and new score model: a retrospective study. BMC Gastroenterol. 2022;22:337. https://doi.org/10.1186/s12876-022-02413-8