The AIMS65 score compared with the Glasgow-Blatchford score in predicting outcomes in upper GI bleeding

摘要

Introduction: We previously derived and validated the AIMS65 score, a mortality prognostic scale for upper GI bleeding (UGIB). Objective: To validate the AIMS65 score in a different patient population and compare it with the Glasgow-Blatchford risk score (GBRS). Design: Retrospective cohort study. Patients: Adults with a primary diagnosis of UGIB. Main Outcome Measurements: Primary outcome: inpatient mortality. Secondary outcomes: composite clinical endpoint of inpatient mortality, rebleeding, and endoscopic, radiologic or surgical intervention; blood transfusion; intensive care unit admission; rebleeding; length of stay; timing of endoscopy. The area under the receiver-operating characteristic curve (AUROC) was calculated for each score. Results: Of the 278 study patients, 6.5% died and 35% experienced the composite clinical endpoint. The AIMS65 score was superior in predicting inpatient mortality (AUROC, 0.93 vs 0.68; P <.001), whereas the GBRS was superior in predicting blood transfusions (AUROC, 0.85 vs 0.65; P <.01) The 2 scores were similar in predicting the composite clinical endpoint (AUROC, 0.62 vs 0.68; P =.13) as well as the secondary outcomes. A GBRS of 10 and 12 or more maximized the sum of the sensitivity and specificity for inpatient mortality and rebleeding, respectively. The cutoff was 2 or more for the AIMS65 score for both outcomes. Limitations: Retrospective, single-center study. Conclusion: The AIMS65 score is superior to the GBRS in predicting inpatient mortality from UGIB, whereas the GBRS is superior for predicting blood transfusion. Both scores are similar in predicting the composite clinical endpoint and other outcomes in clinical care and resource use.