The following article is a part of conference coverage from the Digestive Disease Week 2021 Annual Meeting , held virtually from May 21 to 23, 2021. The team at Gastroenterology Advisor will be reporting on the latest news and research conducted by leading experts in gastroenterology. Check back for more from DDW 2021.
Among 3 pre-endoscopic risk stratification scores assessed, AIMS65 was the best for predicting patient outcomes with upper gastrointestinal (GI) bleeding, according to study results presented at Digestive Disease Week 2021.
There is conflicting evidence regarding the utility of pre-endoscopic risk stratification scores such as the Glassgow-Blatchforford bleeding score (GBS), AIMS65, or Rockall pre-endoscopy score to decide the timing of endoscopy. Despite the uncertainty, these scores may have the potential to provide valuable data to dictate the urgency or need for intervention. Hence, a group of researchers aimed to compare the performance of these scores directly with patient outcomes.
In this single center retrospective study, a total of 718 consecutive patient admissions for upper GI bleeds receiving upper endoscopy were reviewed. Based on the available variables, the following pre-endoscopic risk stratification scores were calculated: GBS (n=627), AIMS65 (n=576), and Rockall pre-endoscopy score (n=639).
The pre-procedural scores were compared with several outcomes which included: all-cause mortality, GI bleed related mortality, length of stay, and number of packed red blood cell (pRBC) transfusions. The researchers utilized the area under the curve (AUC) to assess binary outcomes such as mortality and interventional radiology (IR) referral. They used the Pearson correlation coefficient to analyze continuous outcomes such as length of stay or number of transfusion.
According to the researchers, the AIMS65 had the best overall performance in predicting all-cause mortality (AUC, 0.77; 95% CI, 0.70-0.84) and IR referral (AUC, 0.673; 95% CI, 0.55-0.79). AIMS65 had the strongest association with intensive care unit (ICU) length of stay (Pearson coefficient, 0.31; P <.01) and number of pRBC transfusions (Pearson coefficient, 0.28; P <.01).
GBS score was determined to be the strongest predictor of death due to GI bleed (AUC, 0.73; 95% CI, 0.57-0.88). Compared with the AIMS65 and Rockall, GBS scores performed best for predicting the need for any intervention, clips, and thermal therapy. However, none of these scores performed efficiently with regard to these outcomes overall.
The study authors concluded that AIMS65 performed the best for predicting patient outcomes with upper GI bleeding. However, none of the 3 pre-endoscopic risk stratification scores performed adequately. While these tools are valuable, their performance is not efficient enough to guide management.
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Fazel Y, Cheung R, Tahir M, et al. AIMS65 best predictor of outcomes for patients with upper GI bleeding. Poster presented at: Digestive Disease Week Annual Meeting; May 21-23, 2021. Abstract Sa106.