A scoring system to aid in the simple triage of patients with upper gastrointestinal bleeding (UGIB) outperformed existing clinical scoring systems, according to results of a study published in Gastrointestinal Endoscopy.
Emergency endoscopies were performed in 1486 patients (mean age 69.3 ± 15.2 years) at 3 Japanese hospitals between 2012 and 2015. The patients were assessed for high-risk endoscopic stigmata risk by the 8 variable Glasgow Blatchford Score (GBS), 5 variable AIMS65, and newly developed Horibe Gastroinestinal Bleeding Prediction score (HARBINGER). The HARBINGER is a 3 variable score that adds 1 point for: no daily proton pump inhibitors for at least 1 week, shock index (heart rate/systolic blood pressure ≥1), and blood urea nitrogen/creatinine ≥30.
In total, 637 (43%) patients had high-risk endoscopic stigmata. The area under the receiver-operating characteristic curve (AUC) was significantly higher (P <.001) for the HARBINGER (AUC, 0.76; 95% CI, 0.72-0.79) then either the GBS (AUC, 0.68; 95% CI, 0.64-0.71) or the AIMS65 (AUC, 0.54; 95% CI, 0.50-0.58).
When the investigators applied a cut-off value of 1 to exclude patients who did not require emergency endoscopies, they measured sensitivity of the HARBINGER to be 98.8% (95% CI, 97.9%-99.6%) with a specificity of 15.5% (95% CI, 13.1%-18.0%). This reported sensitivity was higher than the other 2 scoring systems. The sensitivity and specificity of the GBS, which had a cut-off value of 12, were 50.1% and 71.7% respectively. The sensitivity and specificity of the AIM65, which had a cut-off value of 2, were 54.1% and 55.2%
A limitation of this study is that the investigators were unable to compare HARBINGER to the newly developed quick Sequential Organ Failure Assessment (qSOFA), MAP (ASH) score or The Manchester Triage System (MTS). Further studies are needed for comparisons between HARBINGER and these other newly developed scoring systems.
The study authors concluded that their simple 3-variable scoring system more accurately predicted UGIB in patients than either GBS or AIMS65. Furthermore, they content that its simple calculation positions HARBINGER as an ideal option in emergency clinical settings.
Horibe M, Iwasaki E, Bazerbaci F, et al. The Horibe GI bleeding prediction score: a simple score for triage decision-making in patients with suspected upper GI bleeding. [available online March 30, 2020] Gastrointest Endosc doi:10.1016/j.gie.2020.03.3846.