Clin Endosc.  2022 Mar;55(2):240-247. 10.5946/ce.2021.115.

Risk Stratification in Cancer Patients with Acute Upper Gastrointestinal Bleeding: Comparison of Glasgow-Blatchford, Rockall and AIMS65, and Development of a New Scoring System

• Franco MC
• Jang S
• Martins BdC
• Stevens T
• Jairath V
• Lopez R
• Vargo JJ
• Barkun A
• Maluf-Filho F

• KMID: 2527568
• DOI: http://doi.org/10.5946/ce.2021.115

Abstract

Background/Aims
Few studies have measured the accuracy of prognostic scores for upper gastrointestinal bleeding (UGIB) among cancer patients. Thereby, we compared the prognostic scores for predicting major outcomes in cancer patients with UGIB. Secondarily, we developed a new model to detect patients who might require hemostatic care.
Methods
A prospective research was performed in a tertiary hospital by enrolling cancer patients admitted with UGIB. Clinical and endoscopic findings were obtained through a prospective database. Multiple logistic regression analysis was performed to gauge the power of each score.
Results
From April 2015 to May 2016, 243 patients met the inclusion criteria. The AIMS65 (area under the curve [AUC] 0.85) best predicted intensive care unit admission, while the Glasgow-Blatchford score best predicted blood transfusion (AUC 0.82) and the low-risk group (AUC 0.92). All scores failed to predict hemostatic therapy and rebleeding. The new score was superior (AUC 0.74) in predicting hemostatic therapy. The AIMS65 (AUC 0.84) best predicted in-hospital mortality.
Conclusions
The scoring systems for prognostication were validated in the group of cancer patients with UGIB. A new score was developed to predict hemostatic therapy. Following this result, future prospective research should be performed to validate the new score.

Keyword

Cancers; Gastrointestinal; Hemorrhage; In-hospital mortality; Prognostic factors

Figure

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  Fig. 1. Prediction of in-hospital mortality. The AIMS65 was superior to the other scoring systems.

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  Fig. 2. Identification of low-/high-risk groups among cancer patients with upper gastrointestinal bleeding by score. GBS, Glasgow-Blatchford score.

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  Fig. 3. The new scoring system for predicting the need for hemostatic therapy at admission after upper gastrointestinal bleeding in cancer patients. ln is the natural logarithm of hemoglobin. Using the formula, the value of z is then converted into a score with values ranging from 0 to 100. GI, gastrointestinal; INR, international normalized ratio.

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  Fig. 4. Comparison of the scores for predicting hemostatic therapy in patients with cancer. The predictive accuracy of this newly developed score is significantly better than that of the clinical Rockall score (p<0.001), AIMS65 (p=0.001), and the Glasgow-Blatchford score (p=0.027).

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  Fig. 5. The box plot of cancer patients with upper gastrointestinal bleeding demonstrated that the patients who needed hemostatic therapy had significantly higher scores in the new scoring system compared with those who did not require hemostatic therapy (p<0.001). Boxes represent interquartile ranges with bars representing minimum to maximum.

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