Korean J Intern Med.  2022 Nov;37(6):1176-1185. 10.3904/kjim.2022.099.

Clinical outcomes of acute upper gastrointestinal bleeding according to the risk indicated by Glasgow-Blatchford risk score-computed tomography score in the emergency room

• Lee HA
• Jung HK
• Kim TO
• Byeon JR
• Jeong ES
• Cho HJ
• Tae CH
• Moon CM
• Kim SE
• Shim KN
• Jung SA

• KMID: 2535983
• DOI: http://doi.org/10.3904/kjim.2022.099

Abstract

Background/Aims
Acute upper gastrointestinal (UGI) bleeding is a significant emergency situation with a mortality rate of 2% to 10%. Therefore, initial risk stratification is important for proper management. We aimed to evaluate the role of contrast-enhanced multidetector computed tomography (MDCT) for risk stratification in patients with acute UGI bleeding in the emergency room (ER).
Methods
This retrospective study included patients with UGI bleeding in the ER. Glasgow-Blatchford risk score-computed tomography (GBS-CT) was assessed using a combination of GBS and the MDCT scan scoring system.
Results
Of the 297 patients with UGI bleeding, 124 (41.8%) underwent abdominal MDCT. Among them, 90.3% were classified as high-risk by GBS, and five patients died (4.0%). Rebleeding occurred in nine patients (7.3%). The high-risk GBS-CT group had significantly higher in-hospital mortality (10.5% in high-risk vs. 1.4% in moderate risk vs. 0% in low-risk, p = 0.049), transfusion amount (p < 0.001), and endoscopic hemostasis (p < 0.001) compared to the moderate- and low-risk groups.
Conclusions
Adding MDCT scans to the existing validated prognosis model when predicting the risk of UGI bleeding in patients in the ER plays a significant role in determining in-hospital mortality, transfusions, and the need for endoscopic hemostasis.

Keyword

Gastrointestinal hemorrhage; Upper gastrointestinal tract; Multidetector computed tomography; Risk assessment