Scoring systems for peptic ulcer bleeding: which one to use?

• Published in: World journal of gastroenterology : WJG 2017-11, Vol.23 (41), p.7450-7458
• Main Authors: Budimir, Ivan, Stojsavljević, Sanja, Baršić, Neven, Bišćanin, Alen, Mirošević, Gorana, Bohnec, Sven, Kirigin, Lora Stanka, Pavić, Tajana, Ljubičić, Neven
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Blood Transfusion - statistics & numerical data; Croatia - epidemiology; Endoscopy, Gastrointestinal; Female; Hospitalization - statistics & numerical data; Humans; Male; Middle Aged; Peptic Ulcer - complications; Peptic Ulcer - diagnosis; Peptic Ulcer Hemorrhage - diagnosis; Peptic Ulcer Hemorrhage - mortality; Peptic Ulcer Hemorrhage - therapy; Prognosis; Prospective Studies; Prospective Study; Risk Assessment - methods; ROC Curve; Severity of Illness Index; Young Adult
• ISSN: 1007-9327; 2219-2840
• DOI: 10.3748/wjg.v23.i41.7450

AIM To compare the Glasgow-Blatchford score(GBS), Rockall score(RS) and Baylor bleeding score(BBS) in predicting clinical outcomes and need for interventions in patients with bleeding peptic ulcers. METHODS Between January 2008 and December 2013, 1012consecutive patients admitted with peptic ulcer bleeding(PUB) were prospectively followed. The pre-endoscopic RS, BBS and GBS, as well as the post-endoscopic diagnostic scores(RS and BBS) were calculated for all patients according to their urgent upper endoscopy findings. Area under the receiver-operating characteristics(AUROC) curves were calculated for the prediction of lethal outcome, rebleeding, needs for blood transfusion and/or surgical intervention, and the optimal cutoff values were evaluated.RESULTS PUB accounted for 41.9% of all upper gastrointestinal tract bleeding, 5.2% patients died and 5.4% patients underwent surgery. By comparing the AUROC curves of the aforementioned pre-endoscopic scores, the RS best predicted lethal outcome(AUROC 0.82 vs 0.67 vs0.63, respectively), but the GBS best predicted need for hospital-based intervention or 30-d mortality(AUROC0.84 vs 0.57 vs 0.64), rebleeding(AUROC 0.75 vs 0.61 vs 0.53), need for blood transfusion(AUROC 0.83 vs0.63 vs 0.58) and surgical intervention(0.82 vs 0.63 vs 0.52) The post-endoscopic RS was also better than the post-endoscopic BBS in predicting lethal outcome(AUROC 0.82 vs 0.69, respectively).CONCLUSION The RS is the best predictor of mortality and the GBS is the best predictor of rebleeding, need for blood transfusion and/or surgical intervention in patients with PUB. There is no one ’perfect score’ and we suggest that these two tests be used concomitantly.