Aims:
The aim of this study was to compare the accuracy of Glasgow-Blachford score (GBS)
with thre risk scores (State, Velayos and Newman) for predicting the need of clinical
intervention (endoscopic therapy, vascular embolization and surgery or transfusion)
in patients admitted for acute LGB.
Methods:
Retrospective study from January 2013 to December 2015 in a university tertiary care
hospital. Patients with acute LGB were identified using the International Classification
of Diseases (9th Revision) and Clinical Modification codes for admission diagnosis.
Scores were retrospectively calculated according to the clinical reports data. Area
under the receiver operating characteristic (AUROC) curve, sensitivity, specificity
and predictive values were calculated. Also the best cut-off of each score was chosen
from using the AUROC curve values.
Results:
A total of 298 consecutive patients were identified. Median age was 76.1 years (range
25.4 – 96.5), 201 (67.4%) of patients were older than 70 years, and 51% were men.
Five patients (1.7%) died, 18 (6%) developed recurrent bleeding, 89 (29.9%) needed
transfusion, 30 (12.1%) received endoscopic therapy, and 3 (1%) underwent transcatheter
arterial embolization.
GBS AUROC was 0.82 (95% CI:0.76 – 0.87) for the need clinical intervention. GBS was
significantly more accurate than Strate score and similar for Newman y Velayos for
predicting the need of clinical intervention. Accuracy values for each score are shown
in table 1.
Tab. 1:
CLINICAL INTERVENTION. Sensitivity, specificity and predictive values. *Best cut-off.
|
SCORE
|
SENSIVITY (%)
|
ESPECIFICITY (%)
|
POSITIVE PREDICTIVE VALUE (%)
|
NEGATIVE PREDICTIVE VALUE (%)
|
|
GLASGOW-BLACHFORD ≥4 *
|
89
|
59
|
50
|
91
|
|
STRATE ≥2 *
|
66
|
58
|
86
|
78
|
|
VELAYOS ≥1 *
|
90
|
46
|
44
|
90
|
|
NEWMAN ≥2 *
|
89
|
40
|
32
|
88
|
Conclusions:
The GBS may be an useful tool for risk stratification in LGB. It can be useful as
common score for predicting the need of clinical intervention in the upper and lower
gastrointestinal bleeding.
