The Clinical Impact of Rockall and Glasgow-Blatchford Scores in Nonvariceal Upper Gastrointestinal Bleeding

Detalhes bibliográficos
Autor(a) principal: Maia,Susana
Data de Publicação: 2021
Outros Autores: Falcão,Daniela, Silva,Joana, Pedroto,Isabel
Tipo de documento: Artigo
Idioma: eng
Título da fonte: Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)
Texto Completo: http://scielo.pt/scielo.php?script=sci_arttext&pid=S2341-45452021000400243
Resumo: Abstract: Introduction : Risk stratification in patients with nonvariceal upper gastrointestinal bleeding (NVUGIB) is crucial for proper management. Rockall score (RS; pre-endoscopic and complete) and Glasgow-Blatchford score (GBS) are some of the most used scoring systems. This study aims to analyze these scores’ ability to predict various clinical outcomes and possible cutoff points to identify low- and high-risk patients. Secondarily, this study intents to evaluate the appropriateness of patients’ transfers to our facility, which provides a specialized emergency endoscopy service. Methods: This study was retrospectively conducted at Centro Hospitalar Universitário do Porto and included patients admitted to the Emergency Department with acute manifestations of NVUGIB between January 2016 and December 2018. Receiver operating characteristic (ROC) curves and corresponding areas under the curve (AUC) were calculated. Transferred patients from other institutions and nontransferred (directly admitted to this institution) patients were also compared. Results: Of a total of 420 patients, 23 (5.9%) died, 34 (8.4%) rebled, 217 (51.7%) received blood transfusion, 153 (36.3%) received endoscopic therapy, 22 (5.7%) had surgery, and 171 (42.3%) required hospitalization in the Intermediate or Intensive Care Unit. Regarding mortality prediction, both complete RS (AUC 0.756, p < 0.001) and pre-endoscopic RS (AUC 0.711, p = 0.001) showed good performance. In the prediction of rebleeding, only complete RS (AUC 0.735, p < 0.001) had discriminative ability. GBS had good performance in the prediction of transfusion (AUC 0.785, p < 0.001). No score showed discriminative capability in the prediction of other outcomes. Transferred and nontransferred patients had similar pre-endoscopic RS (3.41 vs. 3.34, p = 0.692) and GBS (13.29 vs. 12.29, p = 0.056). Only patients with GBS ≥6 were transferred to our facility. There were no adverse outcomes recorded in any group when GBS was ≤3. Discussion/Conclusion: Complete RS and pre-endoscopic RS are effective at predicting mortality, but only complete RS showed good performance at predicting rebleeding. GBS is better at predicting transfusion requirement. Our study suggests that a transfer can possibly be reconsidered if GBS is ≤3, although current recommendations only propose outpatient care when GBS is 0 or 1. Patients’ transfers were appropriate, considering the high GBS scores and the outcomes of these patients.
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spelling The Clinical Impact of Rockall and Glasgow-Blatchford Scores in Nonvariceal Upper Gastrointestinal BleedingNonvariceal upper gastrointestinal bleedingUrgent endoscopyEndoscopyAbstract: Introduction : Risk stratification in patients with nonvariceal upper gastrointestinal bleeding (NVUGIB) is crucial for proper management. Rockall score (RS; pre-endoscopic and complete) and Glasgow-Blatchford score (GBS) are some of the most used scoring systems. This study aims to analyze these scores’ ability to predict various clinical outcomes and possible cutoff points to identify low- and high-risk patients. Secondarily, this study intents to evaluate the appropriateness of patients’ transfers to our facility, which provides a specialized emergency endoscopy service. Methods: This study was retrospectively conducted at Centro Hospitalar Universitário do Porto and included patients admitted to the Emergency Department with acute manifestations of NVUGIB between January 2016 and December 2018. Receiver operating characteristic (ROC) curves and corresponding areas under the curve (AUC) were calculated. Transferred patients from other institutions and nontransferred (directly admitted to this institution) patients were also compared. Results: Of a total of 420 patients, 23 (5.9%) died, 34 (8.4%) rebled, 217 (51.7%) received blood transfusion, 153 (36.3%) received endoscopic therapy, 22 (5.7%) had surgery, and 171 (42.3%) required hospitalization in the Intermediate or Intensive Care Unit. Regarding mortality prediction, both complete RS (AUC 0.756, p < 0.001) and pre-endoscopic RS (AUC 0.711, p = 0.001) showed good performance. In the prediction of rebleeding, only complete RS (AUC 0.735, p < 0.001) had discriminative ability. GBS had good performance in the prediction of transfusion (AUC 0.785, p < 0.001). No score showed discriminative capability in the prediction of other outcomes. Transferred and nontransferred patients had similar pre-endoscopic RS (3.41 vs. 3.34, p = 0.692) and GBS (13.29 vs. 12.29, p = 0.056). Only patients with GBS ≥6 were transferred to our facility. There were no adverse outcomes recorded in any group when GBS was ≤3. Discussion/Conclusion: Complete RS and pre-endoscopic RS are effective at predicting mortality, but only complete RS showed good performance at predicting rebleeding. GBS is better at predicting transfusion requirement. Our study suggests that a transfer can possibly be reconsidered if GBS is ≤3, although current recommendations only propose outpatient care when GBS is 0 or 1. Patients’ transfers were appropriate, considering the high GBS scores and the outcomes of these patients.Sociedade Portuguesa de Gastrenterologia2021-08-01info:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/articletext/htmlhttp://scielo.pt/scielo.php?script=sci_arttext&pid=S2341-45452021000400243GE-Portuguese Journal of Gastroenterology v.28 n.4 2021reponame:Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)instname:Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãoinstacron:RCAAPenghttp://scielo.pt/scielo.php?script=sci_arttext&pid=S2341-45452021000400243Maia,SusanaFalcão,DanielaSilva,JoanaPedroto,Isabelinfo:eu-repo/semantics/openAccess2024-02-06T17:34:11Zoai:scielo:S2341-45452021000400243Portal AgregadorONGhttps://www.rcaap.pt/oai/openaireopendoar:71602024-03-20T02:36:15.228200Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) - Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãofalse
dc.title.none.fl_str_mv The Clinical Impact of Rockall and Glasgow-Blatchford Scores in Nonvariceal Upper Gastrointestinal Bleeding
title The Clinical Impact of Rockall and Glasgow-Blatchford Scores in Nonvariceal Upper Gastrointestinal Bleeding
spellingShingle The Clinical Impact of Rockall and Glasgow-Blatchford Scores in Nonvariceal Upper Gastrointestinal Bleeding
Maia,Susana
Nonvariceal upper gastrointestinal bleeding
Urgent endoscopy
Endoscopy
title_short The Clinical Impact of Rockall and Glasgow-Blatchford Scores in Nonvariceal Upper Gastrointestinal Bleeding
title_full The Clinical Impact of Rockall and Glasgow-Blatchford Scores in Nonvariceal Upper Gastrointestinal Bleeding
title_fullStr The Clinical Impact of Rockall and Glasgow-Blatchford Scores in Nonvariceal Upper Gastrointestinal Bleeding
title_full_unstemmed The Clinical Impact of Rockall and Glasgow-Blatchford Scores in Nonvariceal Upper Gastrointestinal Bleeding
title_sort The Clinical Impact of Rockall and Glasgow-Blatchford Scores in Nonvariceal Upper Gastrointestinal Bleeding
author Maia,Susana
author_facet Maia,Susana
Falcão,Daniela
Silva,Joana
Pedroto,Isabel
author_role author
author2 Falcão,Daniela
Silva,Joana
Pedroto,Isabel
author2_role author
author
author
dc.contributor.author.fl_str_mv Maia,Susana
Falcão,Daniela
Silva,Joana
Pedroto,Isabel
dc.subject.por.fl_str_mv Nonvariceal upper gastrointestinal bleeding
Urgent endoscopy
Endoscopy
topic Nonvariceal upper gastrointestinal bleeding
Urgent endoscopy
Endoscopy
description Abstract: Introduction : Risk stratification in patients with nonvariceal upper gastrointestinal bleeding (NVUGIB) is crucial for proper management. Rockall score (RS; pre-endoscopic and complete) and Glasgow-Blatchford score (GBS) are some of the most used scoring systems. This study aims to analyze these scores’ ability to predict various clinical outcomes and possible cutoff points to identify low- and high-risk patients. Secondarily, this study intents to evaluate the appropriateness of patients’ transfers to our facility, which provides a specialized emergency endoscopy service. Methods: This study was retrospectively conducted at Centro Hospitalar Universitário do Porto and included patients admitted to the Emergency Department with acute manifestations of NVUGIB between January 2016 and December 2018. Receiver operating characteristic (ROC) curves and corresponding areas under the curve (AUC) were calculated. Transferred patients from other institutions and nontransferred (directly admitted to this institution) patients were also compared. Results: Of a total of 420 patients, 23 (5.9%) died, 34 (8.4%) rebled, 217 (51.7%) received blood transfusion, 153 (36.3%) received endoscopic therapy, 22 (5.7%) had surgery, and 171 (42.3%) required hospitalization in the Intermediate or Intensive Care Unit. Regarding mortality prediction, both complete RS (AUC 0.756, p < 0.001) and pre-endoscopic RS (AUC 0.711, p = 0.001) showed good performance. In the prediction of rebleeding, only complete RS (AUC 0.735, p < 0.001) had discriminative ability. GBS had good performance in the prediction of transfusion (AUC 0.785, p < 0.001). No score showed discriminative capability in the prediction of other outcomes. Transferred and nontransferred patients had similar pre-endoscopic RS (3.41 vs. 3.34, p = 0.692) and GBS (13.29 vs. 12.29, p = 0.056). Only patients with GBS ≥6 were transferred to our facility. There were no adverse outcomes recorded in any group when GBS was ≤3. Discussion/Conclusion: Complete RS and pre-endoscopic RS are effective at predicting mortality, but only complete RS showed good performance at predicting rebleeding. GBS is better at predicting transfusion requirement. Our study suggests that a transfer can possibly be reconsidered if GBS is ≤3, although current recommendations only propose outpatient care when GBS is 0 or 1. Patients’ transfers were appropriate, considering the high GBS scores and the outcomes of these patients.
publishDate 2021
dc.date.none.fl_str_mv 2021-08-01
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dc.identifier.uri.fl_str_mv http://scielo.pt/scielo.php?script=sci_arttext&pid=S2341-45452021000400243
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dc.language.iso.fl_str_mv eng
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dc.publisher.none.fl_str_mv Sociedade Portuguesa de Gastrenterologia
publisher.none.fl_str_mv Sociedade Portuguesa de Gastrenterologia
dc.source.none.fl_str_mv GE-Portuguese Journal of Gastroenterology v.28 n.4 2021
reponame:Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)
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