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Abstract Background Upper gastrointestinal bleeding (UGIB) in older patients is associated with substantial in-hospital morbidity and mortality. This study aimed to develop and validate a simplified risk score for predicting 30-day in-hospital mortality in this population. Methods A retrospective analysis was conducted on data from 1899 UGIB patients aged ≥ 65 years admitted to a single medical center between January 2010 and December 2019. An additional cohort of 330 patients admitted from January 2020 to October 2021 was used for external validation. Variable selection was performed using five distinct methods, and models were generated using generalized linear models, random forest, support vector machine, and k-nearest neighbors approaches. The developed score, “ABCAP,” incorporated Albumin 7.5 mmol/L, Cancer presence, Altered mental status, and Pulse rate > 100/min, each assigned a score of 1. Internal and external validation procedures compared the ABCAP score with the AIMS65 score. Results In internal validation, the ABCAP score demonstrated robust predictive capability with an area under the curve (AUC) of 0.878 (95% CI: 0.824–0.932), which was significantly better than the AIMS65 score (AUC: 0.827, 95% CI: 0.751–0.904), as revealed by the DeLong test (p = 0.048). External validation of the ABCAP score resulted in an AUC of 0.799 (95% CI: 0.709–0.889), while the AIMS65 score yielded an AUC of 0.743 (95% CI: 0.647–0.838), with no significant difference between the two scores based on the DeLong test (p = 0.16). However, the ABCAP score at the 3–5 score level demonstrated superior performance in identifying high-risk patients compared to the AIMS65 score. This score exhibited consistent predictive accuracy across variceal and non-variceal UGIB subgroups. Conclusions The ABCAP score incorporates easily obtained clinical variables and demonstrates promising predictive ability for 30-day in-hospital mortality in older UGIB patients. It allows effective mortality risk stratification and showed slightly better performance than the AIMS65 score. Further cohort validation is required to confirm generalizability.

Background: Upper gastrointestinal bleeding (UGIB) in older patients is associated with substantial in-hospital morbidity and mortality. This study aimed to develop and validate a simplified risk score for predicting 30-day in-hospital mortality in this population. Methods: A retrospective analysis was conducted on data from 1899 UGIB patients aged ≥ 65 years admitted to a single medical center between January 2010 and December 2019. An additional cohort of 330 patients admitted from January 2020 to October 2021 was used for external validation. Variable selection was performed using five distinct methods, and models were generated using generalized linear models, random forest, support vector machine, and k-nearest neighbors approaches. The developed score, "ABCAP," incorporated Albumin < 30 g/L, Blood Urea Nitrogen (BUN) > 7.5 mmol/L, Cancer presence, Altered mental status, and Pulse rate > 100/min, each assigned a score of 1. Internal and external validation procedures compared the ABCAP score with the AIMS65 score. Results: In internal validation, the ABCAP score demonstrated robust predictive capability with an area under the curve (AUC) of 0.878 (95% CI: 0.824–0.932), which was significantly better than the AIMS65 score (AUC: 0.827, 95% CI: 0.751–0.904), as revealed by the DeLong test (p = 0.048). External validation of the ABCAP score resulted in an AUC of 0.799 (95% CI: 0.709–0.889), while the AIMS65 score yielded an AUC of 0.743 (95% CI: 0.647–0.838), with no significant difference between the two scores based on the DeLong test (p = 0.16). However, the ABCAP score at the 3–5 score level demonstrated superior performance in identifying high-risk patients compared to the AIMS65 score. This score exhibited consistent predictive accuracy across variceal and non-variceal UGIB subgroups. Conclusions: The ABCAP score incorporates easily obtained clinical variables and demonstrates promising predictive ability for 30-day in-hospital mortality in older UGIB patients. It allows effective mortality risk stratification and showed slightly better performance than the AIMS65 score. Further cohort validation is required to confirm generalizability. [ABSTRACT FROM AUTHOR]

Introduction: Several scoring systems were developed for early risk stratification in Upper Gastrointestinal Bleeding (UGIB) patients. AIMS65 score is a scoring system that only consists of five parameters, it might be used in daily clinical practice because of rapid and easy to calculate within 12 hours of admission. Objective: To evaluate the AIMS65 scoring system as a predictor of mortality, rebleeding events, need for endoscopic therapy, blood transfusion, and ICU admission for all causes of UGIB. Methods: We conducted a systematic review on PubMed, ScienceDirect, ProQuest, and Cochrane Library databases from the 2012 to 2022 publication period. We included either prospective or retrospective cohort studies that reported UGIB with all kinds of aetiologies who presented in the emergency department (ED), reported discriminative performance for each outcome, and reported the optimal cut-off of AIMS65. The primary measurement of discriminative performance for clinical outcomes includes mortality, rebleeding incidents, need for endoscopic therapy, blood transfusion, and ICU admission. Results: We identified 351 published studies, of which 20 were included in this study. Most of the studies reported discriminative performance for predicting mortality, which amounts to about 18 out of 20 studies. Rebleeding prediction was reported in 11 studies, need for endoscopic therapy in 5 studies, blood transfusion in 7 studies, and ICU admission in 2 studies. Most of the studies reported fair to excellent discriminative performance for predicting mortality, but in contrast for predicting rebleeding, the need for endoscopic therapy, blood transfusion, and ICU admission. Cut-off values≥ 2 are frequently reported to distinguish between high-risk and low-risk patients in mortality. Conclusion: AIMS65 can be applied to patients with UGIB in ED for predicting mortality, but not applicable for predicting rebleeding events, the need for endoscopic therapy, blood transfusion, and ICU admission. It enhances early decision-making and triage for UGIB patients.

Background: This study aimed to determine the performance of the Oakland, Glasgow‐Blatchford, and AIMS65 scores in predicting the clinical outcomes of acute lower gastrointestinal bleeding (LGIB). Methods: This prospective cohort study was conducted from July 2020 to July 2021. Patients admitted with acute lower gastrointestinal bleeding were enrolled. The Oakland, Glasgow‐Blatchford, and AIMS65 scores were calculated. The primary outcome was validating the performance of the scores in predicting severe LGIB; secondary outcomes were comparing the performance of the scores in predicting the need for blood transfusion, hemostatic interventions, in‐hospital rebleeding, and mortality. Receiver operating characteristic curves were calculated for all outcomes. The associations between all three scores and the primary outcomes were calculated using multivariate logistic regression analysis. Results: Patients with acute LGIB (n = 150) were enrolled (88 [58.7%] men and mean age: 63.6 ± 17.3 years). The rates of severe LGIB, need for blood transfusion, hemostatic intervention, in‐hospital rebleeding, and in‐hospital mortality were 54.7%, 79.3%, 10.7%, and 3.3%, respectively. The Oakland and Glasgow‐Blatchford scores had comparable performance in predicting severe LGIB, need for blood transfusion, and mortality, outperforming the AIMS65 score. All scores were suboptimal for predicting hemostatic interventions and rebleeding. Conclusions: Our results demonstrate the predictive performances of the Oakland score and the GBS are excellent and comparable for severe LGIB, the need for blood transfusion, and in‐hospital mortality in patients with acute LGIB. Thus, GBS could be considered as an alternative predictive score for stratification of the patients with acute LGIB. [ABSTRACT FROM AUTHOR]

Objective:We had validation of H3B2 scoring on Turkish patients in this study. In addition, it was compared with Glasgow-Blatchford and AIMS65 scoring.Method:This study was conducted retrospectively and single centered. It was continued by scanning of tertial education hospital datum in 07-2021 to 07-2022. Patients were the adults who was made endoscopic intervention during initial 24 hours. Glasgow-Blatchford, AIMS65 and H3B2 scoring were calculated according to initial parameters.Results:The study included 116 patients. Median age was 60 (45,53) years. H3B2, AIMS65 and Glasgow-Blatchford scoring were significantly higher in non-survivor group than survivor group (p=0.005,

Copyright of Bagcilar Medical Bulletin / Bağcılar Tıp Bülteni is the property of Galenos Yayinevi Tic. LTD. STI and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Several risk scores have attempted to risk stratify patients with acute upper gastrointestinal bleeding (UGIB) who are at a lower risk of requiring hospital-based interventions or negative outcomes including death. This systematic review and meta-analysis aimed to compare predictive abilities of pre-endoscopic scores in prognosticating the absence of adverse events in patients with UGIB. Methods: We searched MEDLINE, EMBASE, Central, and ISI Web of knowledge from inception to February 2023. All fully published studies assessing a pre-endoscopic score in patients with UGIB were included. The primary outcome was a composite score for the need of a hospital-based intervention (endoscopic therapy, surgery, angiography, or blood transfusion). Secondary outcomes included: mortality, rebleeding, or the individual endpoints of the composite outcome. Both proportional and comparative analyses were performed. Results: Thirty-eight studies were included from 2153 citations, (n = 36,215 patients). Few patients with a low Glasgow-Blatchford score (GBS) cutoff (0, ≤1 and ≤2) required hospital-based interventions (0.02 (0.01, 0.05), 0.04 (0.02, 0.09) and 0.03 (0.02, 0.07), respectively). The proportions of patients with clinical Rockall (CRS = 0) and ABC (≤3) scores requiring hospital-based intervention were 0.19 (0.15, 0.24) and 0.69 (0.62, 0.75), respectively. GBS (cutoffs 0, ≤1 and ≤2), CRS (cutoffs 0, ≤1 and ≤2), AIMS65 (cutoffs 0 and ≤1) and ABC (cutoffs ≤1 and ≤3) scores all were associated with few patients (0.01–0.04) dying. The proportion of patients suffering other secondary outcomes varied between scoring systems but, in general, was lowest for the GBS. GBS (using cutoffs 0, ≤1 and ≤2) showed excellent discriminative ability in predicting the need for hospital-based interventions (OR 0.02, (0.00, 0.16), 0.00 (0.00, 0.02) and 0.01 (0.00, 0.01), respectively). A CRS cutoff of 0 was less discriminative. For the other secondary outcomes, discriminative abilities varied between scores but, in general, the GBS (using cutoffs up to 2) was clinically useful for most outcomes. Conclusions: A GBS cut-off of one or less prognosticated low-risk patients the best. Expanding the GBS cut-off to 2 maintains prognostic accuracy while allowing more patients to be managed safely as outpatients. The evidence is limited by the number, homogeneity, quality, and generalizability of available data and subjectivity of deciding on clinical impact. Additional, comparative and, ideally, interventional studies are needed. [ABSTRACT FROM AUTHOR]

Background: Albumin, international normalized ratio (INR), mental status, systolic blood pressure, age >65 years (AIMS65), Glasgow-Blatchford bleeding score (GBS) and modified GBS (mGBS) are three pre-endoscopy scoring systems used in the risk stratification of upper gastrointestinal bleeding (UGIB). The utility of such scoring systems in a population is estimated by their accuracy and calibration in the population. We aimed at validating and comparing the accuracy of the three scoring systems in predicting clinical outcomes including in-hospital mortality, need for blood transfusion, endoscopic treatment and rebleeding risk. Method: We conducted a single-center, retrospective cohort study on patients with UGIB at a tertiary care center in India over 12 months. Clinical and laboratory data was collected from all patients admitted with UGIB. All patients were risk stratified using AIMS65, GBS and mGBS. The clinical outcome examined were: in-hospital mortality, requirement of blood transfusion, need for endoscopic treatment and rebleeding during hospital stay. The area under receiver-operating curve (AUROC) was calculated to assess the performance and calibration curves (Hosmer–Lemeshow goodness of fit curve) were plotted to examine how accurately the model describes the data of all three scoring systems. Results: Total 260 patients were included in the study, of which 236 (90.8%) were males. As many as 144 (55.4%) patients required blood transfusion and 64 (30.8%) required endoscopic treatment. While the incidence of rebleeding was 7.7%, in hospital mortality was 15.4%. Of 208 who underwent endoscopy, the most common causes identified were varices (49%) and gastritis (18.2%), followed by ulcer (11%), Mallory-Weiss tear (8.1%), portal hypertensive gastropathy (6.7%), malignancy (4.8%) and esophageal candidiasis (1.9%). The median AIMS65 score was 1, GBS 7 and mGBS 6. The area under curve (AUROC) for AIMS65, GBS and mGBS was (0.77, 0.73,0.70), (0.75, 0.82,0.83), (0.56, 0.58,0.83), (0.81, 0.94,0.53) for in-hospital mortality, blood transfusion requirement, endoscopic treatment and rebleeding prediction, respectively. Conclusion: GBS and mGBS are superior to AIMS65 in predicting the requirement of blood transfusion and rebleeding risk, whereas in-hospital mortality was better predicted by AIMS 65. Both scores performed poorly in predicting the need of endoscopic treatment. An AIMS65 of 0,1 and a GBS of ≤ 1 are not associated with significant adverse events. A poor calibration of the scores in our population points to the lack of generalizability of these scoring systems. [ABSTRACT FROM AUTHOR]

Background Acute upper gastrointestinal bleeding (UGIB) is a common medical emergency presented to the emergency department that requires early assessment and management. Many risk stratification scores have been developed to predict the clinical outcomes in patients with UGIB. The commonly used risk scores the Rockall scoring systems (PRS and FRS), Glasgow--Blatchford score (GBS) and AIMS65 score. Aim The aim of the present study was to assess and compare the ability of the wildly used risk scores the RS, GBS, and AIMS65 to predict the clinical outcomes in UGIB patients Patients and methods One hundred patients (age >18 years) with acute UGIB in the emergency department of Alexandria Main University Hospital were prospectively studied. All the study scores were calculated and compared using the area under the receiver operating characteristic curve (AUC) method to evaluate the performance of each score to predict the mortality, blood transfusion, endoscopic intervention, ICU admission, rebleeding, and length of hospital stay. Results Among the one hundred patients included in the study, 65% were males with a median of age 58 years. 56% had esophageal varices and 63% with liver disease. All the used scores were statistically significant in predicting all clinical outcomes. GBS had the best AUC among the AIMS65, PRS, and FRS scores in predicting mortality with (AUC= 0.80 vs. 0.76, 0.69), blood transfusion need with (AUC= 0.92 vs. 0.88, 0.87), ICU admission with (AUC= 0.86 vs. 0.83, 0.81), rebleeding with (AUC= 0.81 vs. 0.77, 0.69), and length of hospital stay with (AUC= 0.81 vs. 0.75. 0.79). Conclusion All the study scores (GBS, AIMS65, PRS, and FRS) were able to predict the clinical outcomes in the UGIB patients. GBS was the best performing risk score among the four scores for predicting all the clinical outcomes (mortality, blood transfusion, rebleeding, ICU admission, and length of hospital stay) except the prediction of endoscopic intervention in our study population. [ABSTRACT FROM AUTHOR]

Background: Upper gastrointestinal (GI) hemorrhage, caused by acute esophageal variceal bleeding, is a common complication and a leading cause of death in patients with cirrhosis. Therefore, predicting the risk in order to employ an active management to prevent rebleeding and death is crucial. Currently, there are many prognostic scoring systems that have been proposed, but research is needed to find a valid score which can be applied in clinical practice in each country and population. Aims: To compare the value of ALBI (Albumin-Bilirubin), PALBI (Platelet Albumin-Bilirubin), AIMS65, model for end-stage liver disease (MELD), and Child–Pugh scores (CPS) approaches in predicting early rebleeding and in-hospital mortality of acute variceal bleeding in patients with cirrhosis. Subjects and methods: We performed a cross-sectional descriptive study on cirrhotic patients with acute variceal bleeding who were being treated at the Department of Gastroenterology, Intensive care unit—Military Hospital 103 and the Institute for Treatment of Digestive Diseases—108 Military Central Hospital from September 2020 to May 2022. We calculated ALBI, PALBI, AIMS65, MELD, Child–Pugh values and compared them with the rates of early rebleeding and in-hospital mortality. Then, determined and compared the prognostic value through an analysis of the area under the curve (AUC). Results: 222 patients with acute esophageal variceal bleeding were eligible for inclusion in the study. The rates of rebleeding and in-hospital mortality were 9.0% and 6.8%, respectively. Regarding the prognosis of early rebleeding, the ALBI and PALBI scores have good prognostic value (AUROC 0.74; 95% CI: 0.63–0.85 and AUROC 0.7; 95% CI: 0.59–0.81; p = 0.004, respectively), while the Child–Pugh, MELD, AIMS65 scores have little prognostic value, with AUROC < 0.70. Regarding prognosis of in-hospital mortality: the ALBI, PALBI, MELD and AIMS65 all have good value in predicting in-hospital mortality, with AUROC of 0.81 (95% CI: 0.68–0.93, respectively; p < 0.001); 0.8 (95% CI: 0.69–0.91; p p < 0.001); and 0.82 (95% CI: 0.76–0.87, p < 0.001), respectively. While Child–Pugh score only has medium prognostic value, with AUROC 0.79 (95% CI: 0.66–0.92; p < 0.05). However, there was no significant difference between these prognostic scoring systems. Conclusion: the ALBI, PALBI, MELD and AIMS65 scores all had similar good value in predicting in-hospital mortality, but with early rebleeding prognosis, only ALBI and PALBI had good value. CPS does not show prognostic value like other scores, both in predicting early rebleeding and in-hospital mortality.

Abstract Background Upper gastrointestinal bleeding (UGIB) is a common complication in renal transplant recipients. However, the risk stratification value of bleeding scoring systems in these patients is unclear, and data regarding risk factors are limited. Methods Clinical data of renal transplant recipients in The Third Xiangya hospital were collected. The predictive ability of Glasgow Blatchford score (GBS), pre-endoscopy Rockall score (pRS), and AIMS65 score were assessed by the area under the receiver operating characteristic curve (AUROC). Risk factors of UGIB were analyzed using binary logistic regression analysis. Results A total of 220 patients were enrolled, of which 55 with UGIB. Endoscopy improved the overall survival rate of patients. Glasgow Blatchford score (AUROC 0.868) performed best at predicting UGIB patients who need intervention or death, with a threshold of 10, sensitivity and specificity were 82.4% and 70%, respectively. In terms of predicting mortality, the GBS score was comparable with AIMS65 score (p = 0.30) and pRS score (p = 0.42). Viral hepatitis, intravenous hormone usage, low platelet count, and low albumin level were significant factors associated with UGIB. Conclusions The Glasgow Blatchford score (AUROC 0.868) was best at predicting the need for intervention or death. However, their ability to predict mortality was limited, with AUROC less than 0.8. Our study also identified four independent risk factors for renal transplant recipients with UGIB.

Introduction: Upper gastrointestinal bleeding is a common reason for hospitalization across the world, with a Pakistan frequency of 17.5% and a death rate of 19%. Several risk assessment scores have been created to predict clinically relevant outcomes like survival the requirement for hospital-based care, re-bleeding and hospital stay length. Objective: To determine frequency of mortality in patients with high AIMS65 score presenting with upper gastrointestinal bleeding. Setting: Gastroenterology Department (Center of liver and digestive diseases), Holy Family Hospital Rawalpindi. Materials & Methods: It was a cross-sectional, prospective, observational research study. Patients having a high AIMS score were recruited in the study. The patient's medical history, physical examination, and biochemical data were all properly recorded. Patients were observed for the outcome variable, which was hospital mortality. Results: 119 patients fulfilling the inclusion criteria were included. There were 77 (64.7%) males and 42 (35.3%) females. The mean age was 43.10 ± 14.213 years. Mortality was observed in 15 (12.60%) patients. Table: 2 Mean serum albumin level was 3.42 ± 0.39 g/dl with majority of the patients 95 (79.83%) with =1.3 g/dl of serum albumin level. Majority of the patients 100 (84.03%) were presented with >1.5 INR. Mean systolic blood pressure was 90.23 ± 2.99 mm/Hg with majority of the patients 102 (85.7%) with =90 mm/Hg of systolic blood pressure. Conclusion: The conclusion of the study that mortality from UGIB is well predicted by the AIMS65 score. Mortality increases with increase of AIMS65 scores. [ABSTRACT FROM AUTHOR]

ABSTRACT BACKGROUND: Traditionally peptic ulcer disease was the most common cause of upper gastrointestinal (UGI) bleed but with the changing epidemiology; other etiologies of UGI bleed are emerging. Many scores have been described for predicting outcomes and the need for intervention in UGI bleed but prospective comparison among them is scarce. OBJECTIVE: This study was planned to determine the etiological pattern of UGI bleed and to compare Glasgow Blatchford score, Pre-Endoscopy Rockall score, AIMS65, and Modified Early Warning Score (MEWS) as predictors of outcome. METHODS: In this prospective cohort study 268 patients of UGI bleed were enrolled and followed up for 8 weeks. Glasgow Blatchford score, Endoscopy Rockall score, AIMS65, and MEWS were calculated for each patient, and the area under the receiver operating characteristic (AUC-ROC) curve for each score was compared. RESULTS: The most common etiology for UGI bleed were gastroesophageal varices 150 (63.55%) followed by peptic ulcer disease 29 (12.28%) and mucosal erosive disease 27 (11.44%). Total 38 (15.26%) patients had re-bleed and 71 (28.5%) patients died. Overall, 126 (47%) patients required blood component transfusion, 25 (9.3%) patients required mechanical ventilation and 2 (0.74%) patients required surgical intervention. Glasgow Blatchford score was the best in predicting the need for transfusion (cut off - 10, AUC-ROC= 0.678). Whereas AIMS65 with a score of ≥2 was best in predicting re-bleed (AUC-ROC=0.626) and mortality (AUC-ROC=0.725). CONCLUSION: Gastrointestinal bleed was most commonly of variceal origin at our tertiary referral center in Northern India. AIMS65 was the best & simplest score with a score of ≥2 for predicting re-bleed and mortality.

Background: Upper gastrointestinal bleeding (UGIB) is a common complication in renal transplant recipients. However, the risk stratification value of bleeding scoring systems in these patients is unclear, and data regarding risk factors are limited.Methods: Clinical data of renal transplant recipients in The Third Xiangya hospital were collected. The predictive ability of Glasgow Blatchford score (GBS), pre-endoscopy Rockall score (pRS), and AIMS65 score were assessed by the area under the receiver operating characteristic curve (AUROC). Risk factors of UGIB were analyzed using binary logistic regression analysis.Results: A total of 220 patients were enrolled, of which 55 with UGIB. Endoscopy improved the overall survival rate of patients. Glasgow Blatchford score (AUROC 0.868) performed best at predicting UGIB patients who need intervention or death, with a threshold of 10, sensitivity and specificity were 82.4% and 70%, respectively. In terms of predicting mortality, the GBS score was comparable with AIMS65 score (p = 0.30) and pRS score (p = 0.42). Viral hepatitis, intravenous hormone usage, low platelet count, and low albumin level were significant factors associated with UGIB.Conclusions: The Glasgow Blatchford score (AUROC 0.868) was best at predicting the need for intervention or death. However, their ability to predict mortality was limited, with AUROC less than 0.8. Our study also identified four independent risk factors for renal transplant recipients with UGIB. [ABSTRACT FROM AUTHOR]

Introduction: Acute Gastrointestinal (GI) bleeding results in 5% of admissions to an Emergency Department/Room (ER), with mortality rates ranging from 2 to 15%. To predict the outcomes of these patients, multiple scoring systems have been developed. Early detection of individuals at high risk of mortality could allow for more targeted care including specialised care and early therapies, which could improve outcomes. Glasgow Blatchford Score (GBS), Pre-endoscopy and Rockall score, AIMS65 (Albumin, International Normalized Ratio, Altered Mental status, Systolic blood pressure, Age >65 years), and the recently proposed ABC (Age, Blood parameters, Co-morbidities) score are some of the risk scores that have been devised for risk stratification. According to recent studies, the discriminative performance of these current scores for predicting patient mortality is relatively weak. Aim: To compare the risk scores for predicting in-hospital mortality among patients presenting with acute upper gastrointestinal bleed. Materials and Methods: A retrospective observational study was conducted on patients referred to the Emergency Department/Room of a tertiary care hospital, Chennai, Tamil Nadu, India, with an acute upper GI bleed (characterised as haematemesis, coffee-colored vomitus, or melena) from July 2018 to June 2020. Data collected from medical records included detailed clinical history, vitals, relevant blood investigations, patient requirement for blood transfusion, endoscopic therapy, surgical procedures, radiological intervention along with mortality. The data was analysed using appropriate biostatistics Statistical Package for Social Sciences (SPSS) version 26.0, paired t-tests were performed to calculate the p-values and a p-value <0.05 was considered significant. Results: The study comprised a total of 112 patients. The study population's median age was 53 years, with a male predominance (83.92%). The presenting complaint was haematemesis in 76.79% of the patients and melena in 23.21%. Ischaemic heart disease (10.71%), cirrhosis (25%), and malignancy (2.68%) were the most common co-morbidities. American Society of Anesthesiologists (ASA) grade III accounted for 45.3%, ASA grade II for 25.6%, and ASA grade I for 28.6%. Following endoscopy, the source of upper gastrointestinal bleed was noted to be variceal in 39.3% of cases, gastric/duodenal ulcers in 25.9%, erosive changes in 16.1%, and tumour bleed in 2.7% of cases. Endoscopic mode of treatment was performed in 44.6% and 0.9% required surgical intervention. Mortality occurred in 11 patients (9.82%). Based on Area Under the Receiver Operating Characteristics (AUROC), AIMS65 excelled over other scores in predicting mortality {AIIMS-65 (AUROC; 95% CI) 0.908 (0.85 to 0.97); p-value <0.001, Glasgow-Blatchford score (GBS) 0.818 (0.71-0.93) p-value <0.001, Pre-Rockall 0.756 (0.63-0.89) p-value <0.001, Rockall 0.894 (0.82-0.97) p-value <0.001, ABC 0.778 (0.65-0.90) p-value=0.003}. Conclusion: Systolic blood pressure, heart rate, blood urea, International Normalized Ratio (INR), and albumin showed significant association with mortality. Risk scores encompassing albumin have better mortality prediction. AIMS65 outperformed other risk scores in predicting mortality, even outperforming the postendoscopy rockall score. Hence, AIMS65 can be used to stratify patients in the emergency room early to reduce mortality. [ABSTRACT FROM AUTHOR]

Copyright of Turkish Journal of Trauma & Emergency Surgery / Ulusal Travma ve Acil Cerrahi Dergisi is the property of KARE Publishing and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background Upper gastrointestinal bleeding (UGIB) is a serious medical emergency. Many scoring systems have been developed to predict bleeding outcomes for patients with UGIB. Recently, the guidelines recommend use of risk scores in UGIB to facilitate accurate triage and assist in clinical decisions. The aim of this study was to compare the AIMS65 with the Glasgow–Blatchford score (GBS) and the pre-endoscopy Rockall score (PRS) for risk stratification among Egyptian patients with UGIB. Patients and methods This prospective study involved 74 adult patients with UGIB. Clinical data, biochemical data, transfusion requirements, endoscopic interventions, and duration of hospitalization were collected. AIMS65, GBS, and PRS scores were calculated for each patient. The ability of these scores to predict clinical outcomes was determined. Results In receiver operating characteristic curve analysis, AIMS65 and GBS were better than PRS when predicting in-hospital mortality (0.95 vs 0.88 vs 0.83). However, the three scoring systems were similar in the prediction of the need for blood transfusion (0.74 vs 0.77 vs 0.69). They had less predictive values regarding endoscopic intervention (0.59 vs 0.57 vs 0.65) and duration of hospitalization (0.57 vs 0.57 vs 0.65). AIMS65 less than or equal to 2 can predict low-risk patients with sensitivity of 100% but with low specificity of 31%. AIMS65 score less than or equal to 2 with hemoglobin greater than 8 g/dl and no history of Chronic Liver Disease was able to detect the low-risk patients with specificity of 82% and 100% sensitivity. Conclusion Among Egyptian patients with UGIB, AIMS65 is comparable to GBS and better than pre-endoscopic Rockall score in detecting in-hospital mortality. The three scoring systems are similar in detecting the need for blood transfusion but they had less predictive values regarding endoscopic intervention and duration of hospitalization. In addition, AIMS65 score less than or equal to 2 with hemoglobin greater than 8 g/dl and no history of CLD can detect the low-risk patients who can be managed as outpatient and do endoscopy in scheduled time with specificity of 82% and 100% sensitivity. This finding needs more studies on a large number of patients to validate our assumption.

We aimed to investigate the use and superiority of AIMS65 (Albumin, INR, Alteration in mental status, Systolic blood pressure, age) and Glasgow- Blatchford scores (GBS) in predicting hospital health costs in patients admitted to emergency department with upper gastrointestinal bleeding. Patients above the age of 18 who were admitted to the Emergency Department of Ümraniye Training and Research Hospital between 01.06.2018 and 31.05.2019, who were diagnosed with upper gastrointestinal bleeding were included in the study. Patients' calculations of AIMS65 and GBS were recorded. Pearson's Chi-square test was used, and statistical significance was assessed. A total of 151 patients included in the study, 109 (72.2%) were male. Of the patients 2(1.3%) were discharged from the emergency department and 7 (4.6%) were exitus. According to AIMS65 risk scoring, costs of emergency department and inpatient clinics and total clinical costs were higher in high risk group compared to the low risk group (p=0.007, p=0.007 and p=0.003 respectively). The costs of emergency department and inpatient clinic and total costs were found statistically significantly different between GBS groups (p<0.001, p=0.019, and p=0.001 respectively). AIMS65 risk score and GBS have been revealed to be useful in predicting the costs of emergency department and inpatient clinics and total clinical costs for patients with upper gastrointestinal bleeding [ABSTRACT FROM AUTHOR]

Introduction. Management of upper gastrointestinal bleeding (UGIB) is of great importance. In this way, we aimed to evaluate the performance of three well known scoring systems of AIMS65, Glasgow-Blatchford Score (GBS) and Full Rockall Score (FRS) in predicting adverse outcomes in patients with UGIB as well as their ability in identifying low risk patients for outpatient management. We also aimed to assess whether changing albumin cutoff in AIMS65 and addition of albumin to GBS add predictive value to these scores.

Background: Upper gastrointestinal bleeding (UGIB) while being hospitalized is common, resulting in increased disability and mortality. Using the clinical risk scoring system to assess these patients is, therefore, important in assessing the necessity for endoscopic intervention, predicting rebleeding rate, and 30-day mortality rate. Objective: To assess the effectiveness of the clinical risk scoring system in terms of predicting the need of endoscopic intervention, rebleeding rate, and 30-day mortality in in-hospital UGIB patients. Materials and Methods: The patients with in-hospital UGIB who were admitted during August 2014 to August 2018 and underwent esophagogastroduodenoscopy within 72 hours after bleeding onset were included. The data were retrospectively collected. A comparison of the effectiveness of the clinically significant bleeding criteria, Glasgow-Blatchford score, and AIMS65 score was done. Results: One hundred and sixteen patients were included into the study. The main cause of UGIB was stress-related mucosal disease (SRMD) (88.8%). The effective system of predicting the necessity for endoscopic intervention was the clinically significant bleeding criteria (sensitivity 84%, specificity 74%). The effective scoring system for predicting rebleeding rate and 30-day mortality was the AIMS65 score (sensitivity 83%, specificity 59%). Conclusion: In-hospital UGIB is a common condition, mostly associated with SRMD. Patients with clinically significant bleeding would benefit from endoscopic intervention. [ABSTRACT FROM AUTHOR]

Background and Aim: Risk stratification for upper gastrointestinal bleeding (UGIB) is recommended. However, scoring system accuracy is suboptimal, and score calculation can be complex. Our aim was to develop a new score, the MAP(ASH) score, with information available in the emergency room and to validate it. Methods: The score was built from a prospective database of patients with UGIB and validated in an international database of 3012 patients from six hospitals. Outcomes were 30‐day mortality, endoscopic intervention, any intervention (red blood transfusion, endoscopic treatment, interventional radiology, surgery, or death), and rebleeding. Accuracy to predict outcomes was assessed by the area under the receiver operating characteristic curve (AUROC). Results: Five hundred forty‐seven patients were included in the development cohort. Impaired mental status, albumin < 2.5 g/dL, pulse > 100, American Society of Anesthesiologists score > 2, systolic blood pressure < 90 mmHg, and hemoglobin < 10 g/dL were included in the score. The model had a good predictive accuracy for intervention (AUROC = 0.83; 95% confidence interval [CI]: 0.79–0.88) and fair for mortality (AUROC = 0.74; 95% CI: 0.68–0.81). Regarding endoscopic intervention, AUROC was 0.61 (95% CI: 0.56–0.66) in the original cohort and 0.69 (95% CI: 0.66–0.71) in the validation cohort, showing a poor performance, similar to other scores. For rebleeding, the MAP(ASH) (AUROC 0.73; 95% CI: 0.69–0.77) was similar to Glasgow Blatchford score (AUROC = 0.72; 95% CI: 0.67–0.76) but superior to AIMS65 (AUROC = 0.64; 95% CI: 0.59–0.68). Conclusion: MAP(ASH) is a simple pre‐endoscopy risk score to predict intervention after UGIB, with fair discrimination at predicting mortality. Because of its applicability, it could be an option in clinical practice. [ABSTRACT FROM AUTHOR]

Aim: Acute upper gastrointestinal system hemorrhage is a common and life-threatening condition, and its mortality may reach 10% despite developing medical facilities. In this study, we aimed to compare the efficacy of the AIMS65 risk scoring and Rockall scoring in the non-variceal upper gastrointestinal hemorrhage patients and investigate the relationship between C-reactive protein/albumin ratio and these scoring systems. Materials and Methods: Forty-two inpatients diagnosed with upper gastrointestinal system hemorrhage in our hospital's Internal Medicine Department between January 2018 and July 2018 included to study. For each patient, AIMS65 scoring according to the first evaluation results in the emergency department and Rockall scoring after the endoscopy were performed. Results: Mortality was observed in 2 (4.8%) patients. Both scoring systems were not statistically significant in determining the need for transfusion and predicting the hospitalization duration. The mean C-reactive protein/albumin ratio of the patients was found to be 0.94 (0.48-77.83), and C-reactive protein/albumin levels were higher in patients with high AIMS65 score (p=0.005). Conclusion: Upper gastrointestinal hemorrhage is a common emergency problem, and it constitutes 80% of all gastrointestinal system hemorrhages. In our study, the C-reactive protein/albumin ratio was consistent with the AIMS65 score and suggested that it could be a parameter that could be used in patients with upper gastrointestinal system hemorrhage, but more extensive studies are needed on this subject. [ABSTRACT FROM AUTHOR]

Objective: Upper gastrointestinal bleeding (UGIB) is a frequent medical emergency and several scoring systems are developed to help risk-stratify patients. We aimed to investigate if elevated arterial lactate (AL) was associated with 30-day mortality, need for hospital-based intervention, or rebleeding. Furthermore, we compared the performance of AL with existing scoring systems and examined if incorporation of AL could improve their predictive ability. Materials and methods: Retrospective cohort study of 331 consecutive patients admitted with UGIB during a one-year period. Multivariate analyses were performed to evaluate the association between AL and outcomes. Receiver operating characteristic curves were used to compare AL with existing scoring systems and to test if incorporation of AL could significantly increase their performance. Results: AL was significantly associated with mortality (p = .001), need for hospital-based intervention (p = .005), and rebleeding (p = .031). In predicting mortality and rebleeding, AL performed equally to existing scoring systems, however, inferior to all, in predicting need for intervention. Two of the scoring systems were marginally improved in predicting mortality if AL was included. Conclusions: AL is associated with adverse outcomes in patients with UGIB, but has only similar or inferior ability to predict relevant clinical outcomes compared to existing scoring systems. Although AL could enhance performance of two scorings systems in predicting mortality, it does not have an apparent clinical significance. Thus, our data does not support routine measurement of AL in patients with UGIB. [ABSTRACT FROM AUTHOR]

Aim Acute gastrointestinal bleeding is a potentially life-threatening condition that requires rapid assessment and dynamic management. Several scoring systems are used to predict mortality and rebleeding in such cases. The aim of the present study was to compare three scoring systems for predicting short-term mortality, rebleeding, duration of hospitalization and the need for blood transfusion in elderly patients with upper gastrointestinal bleeding. Methods The present study included 335 elderly patients with upper gastrointestinal bleeding. Pre- and post-endoscopic Rockall, Glasgow-Blatchford and AIMS65 scores were calculated. The ability of these scores to predict rebleeding, mortality, duration of hospitalization and the need for blood transfusion was determined. Results Pre- (4.5) and post-endoscopic (7.5) Rockall scores were superior to the Glasgow-Blatchford (12.5) score for predicting mortality ( P = 0.006 and P = 0.015). Likewise, pre- (4.5) and post-endoscopic Rockall scores were superior to the respective Glasgow-Blatchford scores for predicting rebleeding ( P = 0.013 and P = 0.03). There was an association between duration of hospitalization and mortality; as the duration of hospitalization increased the mortality rate increased. In all, 94% of patients hospitalized for a mean of 5 days were alive versus 56.1% of those hospitalized for 20 days, and 20.2% of those hospitalized for 40 days. Conclusions In elderly patients with upper gastrointestinal bleeding, the Rockall score is clinically more useful for predicting mortality and rebleeding than the Glasgow-Blatchford and AIMS65 scores; however, for predicting duration of hospitalization and the need for blood transfusion, the Glasgow-Blatchford score is superior to the Rockall and AIMS65 scores. Geriatr Gerontol Int 2017; 17: 575-583. [ABSTRACT FROM AUTHOR]

Objective To compare the performances of the AIMS65 and Glasgow Blatchford risk score (GBRS) as risk assessment tools in elderly patients with upper gastrointestinal bleeding (UGIB). Methods A retrospective study was performed in 293 elderly patients with UGIB in the gastroenterology department. The primary outcome was inpatient mortality. Secondary outcomes were rebleeding, blood transfusion and a composite clinical endpoint of inpatient mortality, rebleeding, and endoscopic, radiologic or surgical intervention. The GBRS and AIMS65 scores were respectively calculated for all elderly patients. And the area under the receiver operating characteristic curve (AUROC) was calculated to evaluate the predictive value of the two scoring systems. Results Of the 293 elderly patients, 27 (9.2%) died, 31 (10.6%) rebleeding, 164 (55.9%) received blood transfusion, and 100 (34.1%) experienced the composite clinical endpoint. The AUROCs of the AIMS65 score for inpatient mortality, rebleeding, blood transfusion and the composite clinical endpoint were 0.833 (95%CI: 0.785–0.874), 0.646 (95%CI: 0.588–0.700), 0.666 (95%CI: 0.609–0.720), 0.702 (95%CI: 0.645–0.754), respectively. The AUROCs of the GBRS were 0.681 (95%CI: 0.624–0.734), 0.746 (95%CI: 0.692–0.795), 0.753 (95%CI: 0.700–0.802), 0.744 (95%CI: 0.690–0.793), respectively. Conclusions For the elderly patients with UGIB, the AIMS65 score is superior to GBRS in predicting inpatient mortality, and the GBRS is superior in predicting rebleeding and blood transfusion. Both scores are similar in predicting the composite clinical endpoint. [ABSTRACT FROM AUTHOR]

Introduction: Despite advances in the management of patients with upper gastrointestinal bleeding (UGIB), associated morbidity and mortality remain significant. Most patients, however, will experience favorable outcomes without a need for hospital-based interventions. Risk assessment scores may assist in such early risk-stratification. These scales may optimize identification of low-risk patients, resulting in better resource utilization, including a reduced need for early endoscopy and fewer hospital admissions. The aim of this article is to provide an updated detailed review of risk assessment scores in UGIB., Area Covered: A literature review identified past and currently available pre-endoscopic risk assessment scores for UGIB, with a focus on low-risk prediction. Strengths and weaknesses of the different scales are discussed as well as their impact on clinical decision-making., Expert Opinion: The current evidence supports using the Glasgow Blatchford Score as it is the most accurate tool available when attempting to identify low-risk patients who can be safely managed on an outpatient basis. Currently, no risk assessment tool appears accurate enough in confidently classifying patients as high risk. Future research should utilize more standardized methodologies, while favoring interventional trial designs to better characterize the clinical impact attributable to the use of such risk stratification schemes.

Objective To compare the performances of the Glasgow-Blatchford score (GBS), modified GBS (mGBS) and AIMS65 in predicting clinical outcomes in patients with acute upper gastrointestinal bleeding (AUGIB). Methods This study enrolled 320 consecutive patients with AUGIB. Patients at high and low risks of developing adverse clinical outcomes (rebleeding, the need of clinical intervention and death) were categorized according to the GBS, mGBS and AIMS65 scoring systems. The outcome of the patients were the occurrences of adverse clinical outcomes. The areas under the receiver operating characteristics curve (AUROC) of three scoring systems were compared. Results Irrespective of the systems used, the high-risk groups showed higher rates of rebleeding, intervention and death compared with the low-risk groups ( P < 0.05). For the prediction of rebleeding, AIMS65 (AUROC 0.735, 95% CI 0.667-0.802) performed significantly better than GBS (AUROC 0.672, 95% CI 0.597-0.747; P < 0.01) and mGBS (AUROC 0.677, 95% CI 0.602-0.753; P < 0.01). For the prediction of interventions, there was no significant difference among the three systems (GBS: AUROC 0.769, 95% CI 0.668-0.870; mGBS: AUROC 0.745, 95% CI 0.643-0.847; AIMS65: AUROC 0.746, 95% CI 0.640-0.851). For the prediction of in-hospital mortality, there was no significant difference among the three systems (GBS: AUROC 0.796, 95% CI 0.694-0.898; mGBS: AUROC 0.803, 95% CI 0.703-0.904; AIMS65: AUROC 0.786, 95% CI 0.670-0.903). Conclusions The three scoring systems are reliable and accurate in predicting the rates of rebleeding, surgery and mortality in AUGIB. However, AIMS65 outperforms GBS and mGBS in predicting rebleeding. [ABSTRACT FROM AUTHOR]

Background and Aim To evaluate the prognostic factors, including risk scores ( Glasgow- Blatchford score and AIMS65) in patients with acute upper or lower gastrointestinal bleeding. Methods The medical records of patients who had undergone emergency gastrointestinal endoscopy for suspected gastrointestinal bleeding during the past 5 years were retrospectively analyzed. Results A total of 232 endoscopies (130 esophagogastroduodenoscopies, 102 colonoscopies) for 192 patients met the inclusion criteria. Median age was 66 years, and 64% of patients were males. Endoscopy identified causes for bleeding in 173 patients (post-endoscopic interventions for neoplastic lesions in 36 cases, colonic diverticula in 34, gastroduodenal ulcers in 29, gastric erosions in 15, vascular ectasia in 14, post-biopsy bleeding in 13, malignant tumors in 10, inflammatory conditions in nine, esophagogastric varices in five, Mallory- Weiss tears in four, nasalbleeding in three, and injury by swallowed blister pack in one), whereas the source of bleeding remained obscure in 19 patients. Blood transfusion was given in 97 patients (51%), and 97 (51%) underwent endoscopic hemostasis. During the follow-up period, 49 patients (26%) experienced rebleeding, seven of whom were treated by interventional radiology. Thirty-nine patients (20%) died as a result of various diseases. The probabilities of overall survival ( OS) after 3 and 5 years were 71% and 67%, respectively. Cox multivariate analysis revealed blood transfusion, co-existing malignancy, absence of endoscopic hemostasis, and high AIMS65 score to be independent prognostic factors for poor OS. Conclusion The AIMS65 score is useful for predicting the prognosis of patients with acute gastrointestinal bleeding. [ABSTRACT FROM AUTHOR]

Introduction : Acute upper-gastrointestinal bleeding (AUGIB) is a common medical emergency, with an incidence of 103-172 per 100,000 in the United Kingdom (UK) and mortality of 2% to 10%. Early and accurate prediction of the severity of an AUGIB episode may help guide management, including in or outpatient management, level of care required, and timing of endoscopy. This article aims to address the clinical utility of the various pre-endoscopic risk assessment tools used in AUGIB. Areas covered : The authors undertook a literature review of the current evidence on the pre-endoscopic risk assessment scores. Additional the authors discuss the recently published novel risk assessment scores. Expert opinion : The evidence shows that GBS is the most clinically useful risk assessment score in correctly identifying very low-risk patients suitable for outpatient management. At present, research is ongoing to assess machine learning in the assessment of patients presenting with AUGIB. More research is needed but it shows promise for the future.

Background: The aim of our study was to compare the Age 65; International normalized ratio; Mental status; Shock (AIMS65) score with the Modifi ed Early Warning Score (MEWS), quick Sepsis Related Organ Failure Assessment (qSOFA) score, Glasgow-Blatchford score (GBS), and the complete Rockall score (CRS) in predicting clinical outcomes in cirrhotic patients with upper gastrointestinal bleeding (UGIB)., Methods: A total of 442 consecutive cirrhotic patients admitted with UGIB during a 17-month period were retrospectively investigated. The primary outcome was in-hospital mortality. The secondary outcomes were rebleeding, intensive care unit (ICU) admission and development of infection. The area under receiver operating characteristic curve (AUC) for each system was analyzed., Results: For prediction of mortality, the AUC of the AIMS65 score was greater than that of other scoring systems without statistical signifi cance. For the prediction of rebleeding, the AIMS65 score was superior to qSOFA (0.65 vs. 0.56, p = 0.020). For the prediction of ICU admission, the AIMS65 score was superior to the GBS and CRS (0.77 vs. 0.63, p = 0.005 and 0.77 vs. 0.63, p = 0.007, respectively). For the prediction of the development of infection, the AIMS65 score was superior to CRS (0.73 vs. 0.60, p = 0.010)., Conclusions: In predicting in-hospital mortality among cirrhotic patients with UGIB, the AIMS65 score showed a trend of better performance than the MEWS, qSOFA score, GBS, and CRS. The AUCs of the AIMS65 score were greater than other four systems in predicting rebleeding, ICU admission and the development of infection., Competing Interests: There are no conflicts of interest in this study., (Copyright © 2018 by Taiwan Society of Emergency Medicine & Ainosco Press. All Rights Reserved.)

Objective Although several pre-endoscopic scoring systems have been used to predict the mortality or the need for intervention for upper gastrointestinal bleeding, their usefulness to predict the failure of endoscopic hemostasis in bleeding gastroduodenal peptic ulcers has not yet been fully investigated. In this study, we evaluated the usefulness of the Glasgow-Blatchford score (GBS), the clinical Rockall score (CRS), and the AIMS65 score in predicting the failure of endoscopic hemostasis in patients with bleeding gastroduodenal peptic ulcers. Methods We retrospectively evaluated 226 consecutive emergency endoscopic cases with bleeding gastroduodenal peptic ulcers between April 2010 and September 2016. The study outcome was the failure of first endoscopic hemostasis. The GBS, CRS, and AIMS65 scores were assessed for their ability to predict the failure of endoscopic hemostasis using a receiver-operating characteristic curve. Results Eight cases (3.5%) failed to achieve first endoscopic hemostasis. Surgery was required in six cases, and interventional radiology was required in two cases. The GBS was superior to both the CRS and the AIMS65 score in predicting the failure of endoscopic hemostasis [area under the curve, 0.77 (95% confidence interval, 0.64-0.90), 0.65 (0.56-0.74) and 0.75 (0.56-0.95), respectively]. No failure of endoscopic hemostasis was noted in cases in which the patient scored less than GBS 10 and CRS 2. Conclusion The GBS was the most useful scoring system for the prediction of failure of endoscopic hemostasis in patients with bleeding gastroduodenal peptic ulcers. The GBS was also useful in identifying the patients who did not require surgery or interventional radiology.

The predictive role of lactate in patients with nonvariceal upper gastrointestinal bleeding (NVUGIB) has been suggested. This study evaluated several lactate parameters in terms of predicting outcomes of bleeding patients and sought to establish a new scoring model by combining lactate parameters and the AIMS65 score. A total of 114 patients with NVUGIB who underwent serum lactate level testing at least twice and endoscopic hemostasis within 24 hours after admission were retrospectively analyzed. The associations between five lactate parameters and clinical outcomes were evaluated and the predictive power of lactate parameter combined AIMS65s (L-AIMS65s) and AIMS56 scoring was compared. The most common cause of bleeding was gastric ulcer (48.2%). Lactate clearance rate (LCR) was associated with 30-day rebleeding (odds ratio [OR], 0.931; 95% confidence interval [CI], 0.872-0.994; P = 0.033). Initial lactate (OR, 1.313; 95% CI, 1.050-1.643; P = 0.017), maximal lactate (OR, 1.277; 95% CI, 1.037-1.573; P = 0.021), and average lactate (OR, 1.535; 95% CI, 1.137-2.072; P = 0.005) levels were associated with 30-day mortality. Initial lactate (OR, 1.213; 95% CI, 1.027-1.432; P = 0.023), maximal lactate (OR, 1.271; 95% CI, 1.074-1.504; P = 0.005), and average lactate (OR, 1.501; 95% CI, 1.150-1.959; P = 0.003) levels were associated with admission over 7 days. Although L-AIMS65s showed the highest area under the curve for prediction of each outcome, differences between L-AIMS65s and AIMS65 did not reach statistical significance. In conclusion, lactate parameters have a prognostic role in patients with NVUGIB. However, they do not increase the predictive power of AIMS65 when combined., Competing Interests: The authors have no potential conflicts of interest to disclose., (© 2017 The Korean Academy of Medical Sciences.)

Background: Peptic ulcer bleeding (PUB) is the main cause of non-variceal upper gastrointestinal bleeding (UGIB). Endoscopic treatment and acid suppression with proton-pump inhibitors (PPIs) are most important in the management of PUB and these treatments have reduced mortality. However, elderly patients sometimes have a poor prognostic outcome due to severe comorbidities., Methods: A retrospective study was performed on 504 cases with acute non-variceal UGIB who were examined in our hospital, in order to reveal the risk factor of a poor outcome in elderly patients., Results: Two hundred and thirty-four cases needed hemostasis; 11 cases had unsuccessful endoscopic treatments; 31 cases had re-bleeding after endoscopic hemostasis. Forty-three cases died within 30 days after the initial urgent endoscopy, but only seven cases died from bleeding. Elderly patients aged over 65 years had more severe comorbidities, and were prescribed non-steroidal anti-inflammatory drugs (NSAIDs), antiplatelet agents and/or anticoagulation agents, more frequently, compared with non-elderly patients. The significant risk factor of needing hemostatic therapy was the taking of two or more NSAIDs, antiplatelet agents and/or anticoagulation agents. The most important risk of a poor outcome in elderly patients was various kinds of severe comorbidities. And so, it is important to predict such an outcome in these cases. AIMS65 is a simple and relatively useful scoring system that predicts the risk of a poor outcome in UGIB. High-score patients via AIMS65 were associated with a high mortality rate because of death from comorbidities., Conclusions: The elderly patients in whom were prescribed two or more NSAIDs, antiplatelet agents and/or anticoagulation agents, should have UGIB prevented using a PPI. The most significant risk of a poor outcome in elderly patients was severe comorbidities. We recommend that elderly patients with UGIB should be estimated as having a poor outcome as soon as possible via the risk scoring system AIMS65., Competing Interests: Conflicts of Interest: The authors have no conflicts of interest to declare.

Objective: AIMS65 is a score designed to predict in-hospital mortality, length of stay, and costs of gastrointestinal bleeding. Our aims were to revalidate AIMS65 as predictor of inpatient mortality and to compare AIMS65's performance with that of Glasgow-Blatchford (GBS) and Rockall scores (RS) with regard to mortality, and the secondary outcomes of a composite endpoint of severity, transfusion requirements, rebleeding, delayed (6-month) mortality, and length of stay., Methods: The study included 309 patients. Clinical and biochemical data, transfusion requirements, endoscopic, surgical, or radiological treatments, and outcomes for 6 months after admission were collected. Clinical outcomes were in-hospital mortality, delayed mortality, rebleeding, composite endpoint, blood transfusions, and length of stay., Results: In receiver-operating characteristic curve analyses, AIMS65, GBS, and RS were similar when predicting inpatient mortality (0.76 vs. 0.78 vs. 0.78). Regarding endoscopic intervention, AIMS65 and GBS were identical (0.62 vs. 0.62). AIMS65 was useless when predicting rebleeding compared to GBS or RS (0.56 vs. 0.70 vs. 0.71). GBS was better at predicting the need for transfusions. No patient with AIMS65 = 0, GBS ≤ 6, or RS ≤ 4 died. Considering the composite endpoint, an AIMS65 of 0 did not exclude high risk patients, but a GBS ≤ 1 or RS ≤ 2 did. The three scores were similar in predicting prolonged in-hospital stay. Delayed mortality was better predicted by AIMS65., Conclusion: AIMS65 is comparable to GBS and RS in essential endpoints such as inpatient mortality, the need for endoscopic intervention and length of stay. GBS is a better score predicting rebleeding and the need for transfusion, but AIMS65 shows a better performance predicting delayed mortality.

Acute nonvariceal upper gastrointestinal bleeding remains an important cause of hospital admission with an associated mortality of 2-14%. Initial patient evaluation includes rapid hemodynamic assessment, large-bore intravenous catheter insertion and volume resuscitation. A hemoglobin transfusion threshold of 7 g/dL is recommended, and packed red blood cell transfusion may be necessary to restore intravascular volume and improve tissue perfusion. Patients should be risk stratified into low- and high-risk categories, using validated prognostic scoring systems such as the Glasgow-Blatchford, AIMS65 or Rockall scores. Effective early management of acute, nonvariceal upper gastrointestinal hemorrhage is critical for improving patient outcomes., (Copyright © 2015 Elsevier Inc. All rights reserved.)