Rhemitt Score: Predicting the Risk of Rebleeding for Patients with Mid-Gastrointestinal Bleeding Submitted to Small Bowel Capsule Endoscopy: A Prospective Validation

Aims Mid gastrointestinal rebleeding rates are high, but difficult to predict. We created the first score to accurately predict the individual risk of small bowel rebleeding after capsule endoscopy (SBCE) – the RHEMITT score (Renal disease; Heart failure; Endoscopic findings; Major bleeding; Incomplete SBCE; Tobacco; Treatment by endoscopy), subdividing patients in 3 subgroups according to the risk of rebleeding: low risk (0-3 points); intermediate risk (4-10 points) and high risk (11-18 points).

Prospective internal validation of the RHEMITT score.

Methods Cohort of consecutive patients submitted to SBCE and followed prospectively, during at least 12 months, since 2017 until 2020. The follow up consisted in trimestral appointments and laboratorial tests during the first-year. Rebleeding was defined as overt bleeding event (melaena or haematochezia) or a haemoglobin decrease of at least 2 g/dL. The RHEMITT score was calculated for each patient and the rebleeding rates compared. The homogeneity of the population was assessed by a univariate analysis including the same variables assessed in the initial score’s manuscript. The performance of the score was tested by calculating the area under curve (AUC) of the ROC curve towards the outcome rebleeding.

Results We included 162 patients, 102 (62.9 %) female gender, with a mean age of 64 years old. The sensitivities and specificities of the score grades for predicting the occurrence of rebleeding were as following: for low risk patients, 0 % [0-10 %] and 28.8 % [21.1-36.5 %]; for intermediate risk patients, 23.3 % [8.2-38.4 %] and 72 % [64.3-79.7 %]; for high risk patients, 76.7 % [61.6-91.8 %] and 99.2 % [97.7-100 %], corresponding to an AUC of the ROC of 0.988 (95 %CI=0.975-1.000; p<0.001).

Conclusions The RHEMITT score performed with excellent discriminative power in predicting rebleeding risk. The score is ready for daily practice, being a promising tool in identifying patients at a higher risk of rebleeding, that would benefit for a stricter surveillance.

Citation: de Sousa Magalhães R, Sousa-Pinto B, Cúrdia Gonçalves T et al. OP7 RHEMITT SCORE: PREDICTING THE RISK OF REBLEEDING FOR PATIENTS WITH MID-GASTROINTESTINAL BLEEDING SUBMITTED TO SMALL BOWEL CAPSULE ENDOSCOPY: A PROSPECTIVE VALIDATION. Endoscopy 2021; 53: S7.

Publication History

Article published online:
19 March 2021