Comparison of Three Risk Scores to Predict Outcomes of Severe Lower Gastrointestinal Bleeding

Abstract

Background and aims: Improved medical decisions by using a score at the initial patient triage level may lead to improvements in patient management, outcomes, and resource utilization. There is no validated score for management of lower gastrointestinal bleeding (LGIB) unlike for upper gastrointestinal bleeding. The aim of our study was to compare the accuracies of 3 different prognostic scores [Center for Ulcer Research and Education Hemostasis prognosis score, Charlson index, and American Society of Anesthesiologists (ASA) score] for the prediction of 30-day rebleeding, surgery, and death in severe LGIB.

Methods: Data on consecutive patients hospitalized with severe gastrointestinal bleeding from January 2006 to October 2011 in our 2 tertiary academic referral centers were prospectively collected. Sensitivities, specificities, accuracies, and area under the receiver operator characteristic curve were computed for 3 scores for predictions of rebleeding, surgery, and mortality at 30 days.

Results: Two hundred thirty-five consecutive patients with LGIB were included between 2006 and 2011. Twenty-three percent of patients rebled, 6% had surgery, and 7.7% of patients died. The accuracies of each score never reached 70% for predicting rebleeding or surgery in either. The ASA score had a highest accuracy for predicting mortality within 30 days (83.5%), whereas the Center for Ulcer Research and Education Hemostasis prognosis score and the Charlson index both had accuracies <75% for the prediction of death within 30 days.

Conclusions: ASA score could be useful to predict death within 30 days. However, a new score is still warranted to predict all 30 days outcomes (rebleeding, surgery, and death) in LGIB.

Figure 1

Boxplots of mean scores for 30 day rebleeding of severe LGIB (A: CURE Hemostasis Prognosis score, B: Charlson Index, C: ASA score) *P ≤ 0.05 **P ≤ 0.01 ***P ≤ 0.001

Figure 2

Boxplots of mean scores for 30 day surgery of severe LGIB (A: CURE Hemostasis Prognosis score, B: Charlson Index, C: ASA score) *P ≤ 0.05 **P ≤ 0.01

Figure 3

Boxplots of mean scores for 30 day mortality of severe LGIB (A: CURE Hemostasis Prognosis score, B: Charlson Index, C: ASA score) ***P ≤ 0.001