Aims:
The aim of this study was to compare the accuracy of Oakland score (OakS) with haemoglobin alone (Hb) for predicting outcomes after lower gastrointestinal bleeding (LGB).
Methods:
Safe discharge was the main outcome predicted by OakS. It was defined as the absence of the following: a) rebleeding; b) red blood cell transfusion; c) therapeutic intervention; d) readmission with further LGB within 28 days and e) in-hospital death.
A retrospective study was performed 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. OakS was retrospectively calculated according to clinical reports data. Area under the curve (AUROC), were calculated for OakS and Hb value. AUROCs were compared with the DeLong method by using STATA 14.1 software (StataCorp.2015).
Results:
A total of 258 patients with acute LGB were identified retrospectively. Median age was 76.4 years (range 31.7 – 96.5), 178 (69%) of patients were older than 70 years, 54.3% were men. 154 (57.7%) patients were safely discharged. Six patients (2,3%) died, 50 (19.4%) rebleed, 84 (32.6%) needed transfusion, 20 (7.8%) were readmitted, 28 (11.2%) needed endoscopic treatment and 3 (0.8%) transcatheter arterial embolization. No patient required surgery.
The comparison of the AUROC for OakS and Hb are shown in table 1.
Tab. 1
|
|
Oakland Score AUROC (95% IC)
|
Haemoglobin AUROC (95% IC)
|
P value
|
|
Safe discharge. n = 154; 59.7%
|
0.80 (0.74 – 0.86)
|
0.82 (0.77 – 0.88)
|
0.1516
|
|
Rebleeding. n = 50; 19,4%
|
0.76 (0.68 – 0.83)
|
0.81 (0.75 – 0.87)
|
0.0409
|
|
Haemostatic intervention. n = 31; 12%
|
0.67 (0.55 – 0.77)
|
0.70 (0.61 – 0.80)
|
0.3852
|
Conclusions:
Hb seems non-inferior or even superior to OakS for predicting safe discharge, transfussion, rebleeding, haemostatic intervention or dead. OakS was better only for predicting readmission, but the predictive value for this outcome was low for both Hb and OakS.
