Evaluation of Six Preendoscopy Scoring Systems to Predict Outcomes for Older Adults with Upper Gastrointestinal Bleeding
Yajie Li, Qin Lu, Kexuan Wu, Xilong Ou
Abstract
Objectives. To compare the ability of six preendoscopic scoring systems (ABC, AIMS65, Glasgow Blatchford score (GBS), MAP(ASH), pRS, and <a:math xmlns:a="http://www.w3.org/1998/Math/MathML" id="M1"> <a:mi>T</a:mi> </a:math> -score) to predict outcomes of upper gastrointestinal bleeding (UGIB) in older adults. Methods. This was a retrospective study of 602 older adults ( <c:math xmlns:c="http://www.w3.org/1998/Math/MathML" id="M2"> <c:mtext>age</c:mtext> <c:mo>≥</c:mo> <c:mn>65</c:mn> </c:math> ) presenting with UGIB at Zhongda Hospital Southeast University from January 2015 to June 2021. Six scoring systems were used to analyze all patients. Results. ABC had the largest area under the curve (AUC) (0.833; 95% confidence interval (CI): 0.801–0.862) and was significantly higher than pRS 0.696 (95% CI: 0.658–0.733, <e:math xmlns:e="http://www.w3.org/1998/Math/MathML" id="M3"> <e:mi>p</e:mi> <e:mo><</e:mo> <e:mn>0.01</e:mn> </e:math> ) and <g:math xmlns:g="http://www.w3.org/1998/Math/MathML" id="M4"> <g:mi>T</g:mi> </g:math> -score 0.667 (95% CI: 0.628–0.704, <i:math xmlns:i="http://www.w3.org/1998/Math/MathML" id="M5"> <i:mi>p</i:mi> <i:mo><</i:mo> <i:mn>0.01</i:mn> </i:math> ) in predicting mortality. MAP(ASH) (0.783; 95% CI: 0.748–0.815) performs the best in predicting intervention and was similar to GBS, <k:math xmlns:k="http://www.w3.org/1998/Math/MathML" id="M6"> <k:mi>T</k:mi> </k:math> -score, ABC, and AIMS65. The AUCs for MAP(ASH) (0.732; 95% CI: 0.698–0.770), AIMS65 (0.711; 95% CI: 0.672–0.746), and ABC (0.718; 95% CI: 0.680–0.754) were fair for rebleeding, while those of GBS (0.662; 95% CI: 0.617–0.694), <m:math xmlns:m="http://www.w3.org/1998/Math/MathML" id="M7"> <m:mi>T</m:mi> </m:math> -score (0.641; 95% CI: 0.606–0.684), and pRS (0.609; 95% CI: 0.569–0.648) were performed poorly. MAP(ASH) performs the best in predicting ICU admission (0.784; 95% CI: 0.749–0.816). All the five scores were significantly higher than pRS ( <o:math xmlns:o="http://www.w3.org/1998/Math/MathML" id="M8"> <o:mi>p</o:mi> <o:mo><</o:mo> <o:mn>0.05</o:mn> </o:math> for ABC, AIMS65 and <q:math xmlns:q="http://www.w3.org/1998/Math/MathML" id="M9"> <q:mi>T</q:mi> </q:math> -score, <s:math xmlns:s="http://www.w3.org/1998/Math/MathML" id="M10"> <s:mi>p</s:mi> <s:mo><</s:mo> <s:mn>0.01</s:mn> </s:math> for GBS and MAP). Conclusions. Mortality, intervention, rebleeding, and ICU admission in UGIB for older adults can be predicted well using MAP(ASH). ABC is the most accurate for predicting mortality. Except for rebleeding, GBS has an acceptable performance in predicting ICU admission, mortality, and intervention. AIMS65 and <u:math xmlns:u="http://www.w3.org/1998/Math/MathML" id="M11"> <u:mi>T</u:mi> </u:math> -score performed moderately, and pRS may not be suitable for the target cohort.