When comparing prognostic performance of lower gastrointestinal (GI) bleeding risk scores, researchers found the Oakland score most discriminative for predicting safe discharge, major bleeding, or need for transfusions, and the Strate score best for predicting need for hemostasis, according to study findings published in JAMA Network Open.

Researchers conducted a systematic review using data from Ovid MEDLINE, Embase, and Cochrane Central Register of Controlled Trials, from January 1, 1990, to August 31, 2021. Of 3268 records identified, 9 studies were included for a meta-analysis to determine the lower GI bleeding prognostic value of 4 risk scores:

  • Oakland
  • Strate
  • NOBLADS (nonsteroidal anti-inflammatory drug use, no diarrhea, no abdominal tenderness, blood pressure ≤100 mm Hg, antiplatelet drug use, albumin <3.0 g/dL, disease score ≥2 [Charlson Comorbidity Index], and syncope)
  • BLEED (ongoing bleeding, low systolic blood pressure, elevated prothrombin time, erratic mental status, and unstable comorbid disease)

The researchers calculated the area under the receiver operating characteristic curve (AUROC) to analyze the predictive value of the 4 risk scores for 5 outcomes of interest: the prediction of safe discharge; major bleeding; transfusion of at least 1 unit of red blood cells; need for hemostasis through endoscopic methods, radiologic embolization, or surgery; and mortality.

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The Oakland score was most discriminative for predicting safe discharge (AUROC, 0.86; 95% CI, 0.82-0.88), major bleeding (AUROC, 0.93; 95% CI, 0.90-0.95), and the need for transfusion (AUROC, 0.99; 95% CI, 0.98-1.00). In comparison, the AUROC for major bleeding was 0.73 (95% CI, 0.69-0.77) for the Strate score, 0.58 (95% CI, 0.53-0.62) for the NOBLADS score, and 0.65 (95% CI, 0.61-0.69) for the BLEED score.

The Strate score most accurately predicted patient need for hemostasis (AUROC, 0.82; 95% CI, 0.79-0.85) compared with the Oakland score (AUROC, 0.36; 95% CI, 0.32-0.40) and the NOBLADS (AUROC; 0.24; 95% CI, 0.20-0.28). An insufficient number of studies prevented the researchers from determining the predictive value of the 4 risk scores for mortality using meta-analysis.

“Of all the study outcomes examined, safe discharge is perhaps the most clinically meaningful because it can be used directly to guide patient care,” the study authors wrote. “This outcome is similar to the evolution of risk prognostication for upper gastrointestinal bleeding, for which risk scores originally developed to identify adverse outcomes are now used to aid discharge decision-making instead. The only risk score in the meta-analysis that predicts safe discharge was the Oakland score, which was specifically modeled to predict this outcome.”

Study limitations included lack of generalizability of the meta-analysis to populations outside of Europe and North America and an inability to analyze death as an outcome or certain lower GI bleeding risk scores due to insufficient number of available studies required for the meta-analysis. Additionally, lower GI bleeding risk scores correlated only with short-term outcomes and were not predictive of long-term outcomes.

Disclosures: One study author declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.


Almaghrabi M, Gandhi M, Guizzetti L, et al. Comparison of risk scores for lower gastrointestinal bleeding: A systematic review and meta-analysis. JAMA Netw Open. 2022;5(5):e2214253. doi:10.1001/jamanetworkopen.2022.14253