Upper gastrointestinal bleeding risk stratification: Difference between revisions

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==Overview==
==Overview==
==Risk stratification==
==Risk stratification==
Two scoring systems identify those at risk for adverse outcomes from UGIB:<ref name="pmid28286843">{{cite journal |vauthors=Ebrahimi Bakhtavar H, Morteza Bagi HR, Rahmani F, Shahsavari Nia K, Ettehadi A |title=Clinical Scoring Systems in Predicting the Outcome of Acute Upper Gastrointestinal Bleeding; a Narrative Review |journal=Emerg (Tehran) |volume=5 |issue=1 |pages=e36 |year=2017 |pmid=28286843 |pmc=5325906 |doi= |url=}}</ref>
*The Glasgow Blatchford Score (GBS)
*The Rockall score
==The Glasgow Blatchford Score (GBS)==
*The Glasgow Blatchford Score (GBS) helps in identifying low-risk patients with UGIB who can be managed safely as outpatients without an urgent endoscopy.<ref name="pmid11073021">{{cite journal |vauthors=Blatchford O, Murray WR, Blatchford M |title=A risk score to predict need for treatment for upper-gastrointestinal haemorrhage |journal=Lancet |volume=356 |issue=9238 |pages=1318–21 |year=2000 |pmid=11073021 |doi=10.1016/S0140-6736(00)02816-6 |url=}}</ref><ref name="pmid22719181">{{cite journal |vauthors=Stanley AJ |title=Update on risk scoring systems for patients with upper gastrointestinal haemorrhage |journal=World J. Gastroenterol. |volume=18 |issue=22 |pages=2739–44 |year=2012 |pmid=22719181 |pmc=3374976 |doi=10.3748/wjg.v18.i22.2739 |url=}}</ref>
*GBS parameters include
**Blood urea nitrogen level
**Hematocrit level
**Heart rate
**Systolic blood pressure
**Presence of syncope or melena, as well as presence of comorbid heart and liver disease.
*GBS is the more effective system for predicting the need for transfusion in patients with UGIB.
{| border="1" cellpadding="5" cellspacing="0" align="center" |class="wikitable"
! colspan="4" style="background:#efefef;" |The Glasgow Blatchford Score (GBS)
|-
! colspan="3" style="background:#efefef;" |'''Admission risk markers'''
! style="background:#efefef;" |'''Score'''
|-
| colspan="2" rowspan="4" |'''Blood urea nitrogen level (mg/dl)'''
|  ≥ 18.2 to < 22.4
|2
|-
|  ≥ 22.4 to < 28
|3
|-
|≥ 28 to < 70
|4
|-
|  ≥ 70
|6
|-
| rowspan="5" |'''Hemoglobin level (g/dl)'''
| rowspan="3" |'''Men'''
|   ≥ 12 to < 13
|1
|-
|  ≥ 10 to < 12
|3
|-
|< 10
|6
|-
| rowspan="2" |'''Women'''
|   ≥ 10 to < 12
|1
|-
| < 10
|6
|-
| colspan="2" rowspan="3" |'''Systolic blood pressure (mmHg)'''
|   ≥ 100 to < 109
|1
|-
| ≥ 90 to < 99
|2
|-
|  < 90
|3
|-
| colspan="2" rowspan="5" |'''Other markers'''
|Pulse rate ≥ 100 beats/min
|1
|-
|Presentation with melena
|1
|-
|Presentation with syncope
|2
|-
|Hepatic disease
|2
|-
|Heart failure
|2
|-
| colspan="4" |
Scores of 0-2 -Low-risk group<br>
Score of >6- High risk group
|}
===The Rockall score===
*The complete Rockall score identifies those patients with evidence of acute UGIB on endoscopy who are at low risk for further bleeding or death.<ref name="pmid">{{cite journal |vauthors=Monteiro S, Gonçalves TC, Magalhães J, Cotter J |title=Upper gastrointestinal bleeding risk scores: Who, when and why? |journal=World J Gastrointest Pathophysiol |volume=7 |issue=1 |pages=86–96 |year=2016 |pmid= |pmc=4753192 |doi=10.4291/wjgp.v7.i1.86 |url=}}</ref><ref name="pmid18346681">{{cite journal |vauthors=Atkinson RJ, Hurlstone DP |title=Usefulness of prognostic indices in upper gastrointestinal bleeding |journal=Best Pract Res Clin Gastroenterol |volume=22 |issue=2 |pages=233–42 |year=2008 |pmid=18346681 |doi=10.1016/j.bpg.2007.11.004 |url=}}</ref>
*The score is based upon
**Age
**Presence of shock
**Comorbidity diagnosis
**Endoscopic ulcer characteristics
**Stigmata of recent hemorrhage.
{| border="1" cellpadding="5" cellspacing="0" align="center" |class="wikitable"
! colspan="4" style="background:#efefef;" |The Rockall score
|-
! colspan="3" style="background:#efefef;" |Markers
! style="background:#efefef;" |Score
|-
| colspan="2" rowspan="3" |'''Age'''
|<60
|0
|-
|60 - 79
|1
|-
|≥ 80
|2
|-
| rowspan="5" |'''Shock stage'''
| rowspan="3" |Blood pressure
|>120
|0
|-
|100-119
|1
|-
|<100
|2
|-
| rowspan="2" |Heart rate
|>100
|0
|-
|<100
|1
|-
| colspan="2" rowspan="3" |'''Comorbidity'''
|No major comorbidity
|0
|-
|Cardiac failure
Ischemic heart disease
Any major comorbidity
|2
|-
|Renal failure
Liver failure
Disseminated malignancy
|3
|-
| colspan="2" rowspan="3" |'''Diagnosis'''
|Mallory-Weiss tear, no lesion identified and no SRH
|0
|-
|All other diagnosis
|1
|-
|Malignancy of upper GI tract
|2
|-
| colspan="2" rowspan="2" |'''Major SRH'''
|None or dark spot only
|0
|-
|Blood in upper GI tract, adherent clot,<br> visible or spurting vessel
|2
|-
| colspan="4" |GI: Gastrointestinal, SRH: Signs of recent hemorrhage.
Range of score is 0-11.
Score of ≤ 3 predicts low mortality risk, while ≥ 8 is a predictor of high mortality risk.
|}
==References==
==References==
{{reflist|2}}
{{reflist|2}}

Revision as of 23:50, 7 November 2017

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] ; Associate Editor(s)-in-Chief: Aditya Ganti M.B.B.S. [2]

Overview

Risk stratification

Two scoring systems identify those at risk for adverse outcomes from UGIB:[1]

  • The Glasgow Blatchford Score (GBS)
  • The Rockall score

The Glasgow Blatchford Score (GBS)

  • The Glasgow Blatchford Score (GBS) helps in identifying low-risk patients with UGIB who can be managed safely as outpatients without an urgent endoscopy.[2][3]
  • GBS parameters include
    • Blood urea nitrogen level
    • Hematocrit level
    • Heart rate
    • Systolic blood pressure
    • Presence of syncope or melena, as well as presence of comorbid heart and liver disease.
  • GBS is the more effective system for predicting the need for transfusion in patients with UGIB.
The Glasgow Blatchford Score (GBS)
Admission risk markers Score
Blood urea nitrogen level (mg/dl)   ≥ 18.2 to < 22.4 2
  ≥ 22.4 to < 28 3
≥ 28 to < 70 4
  ≥ 70 6
Hemoglobin level (g/dl) Men    ≥ 12 to < 13 1
  ≥ 10 to < 12 3
< 10 6
Women    ≥ 10 to < 12 1
 < 10 6
Systolic blood pressure (mmHg)    ≥ 100 to < 109 1
 ≥ 90 to < 99 2
  < 90 3
Other markers Pulse rate ≥ 100 beats/min 1
Presentation with melena 1
Presentation with syncope 2
Hepatic disease 2
Heart failure 2

Scores of 0-2 -Low-risk group
Score of >6- High risk group

The Rockall score

  • The complete Rockall score identifies those patients with evidence of acute UGIB on endoscopy who are at low risk for further bleeding or death.[4][5]
  • The score is based upon
    • Age
    • Presence of shock
    • Comorbidity diagnosis
    • Endoscopic ulcer characteristics
    • Stigmata of recent hemorrhage.
The Rockall score
Markers Score
Age <60 0
60 - 79 1
≥ 80 2
Shock stage Blood pressure >120 0
100-119 1
<100 2
Heart rate >100 0
<100 1
Comorbidity No major comorbidity 0
Cardiac failure

Ischemic heart disease

Any major comorbidity

2
Renal failure

Liver failure

Disseminated malignancy

3
Diagnosis Mallory-Weiss tear, no lesion identified and no SRH 0
All other diagnosis 1
Malignancy of upper GI tract 2
Major SRH None or dark spot only 0
Blood in upper GI tract, adherent clot,
visible or spurting vessel 		2
GI: Gastrointestinal, SRH: Signs of recent hemorrhage.

Range of score is 0-11.

Score of ≤ 3 predicts low mortality risk, while ≥ 8 is a predictor of high mortality risk.

References

  1. ↑ Ebrahimi Bakhtavar H, Morteza Bagi HR, Rahmani F, Shahsavari Nia K, Ettehadi A (2017). "Clinical Scoring Systems in Predicting the Outcome of Acute Upper Gastrointestinal Bleeding; a Narrative Review". Emerg (Tehran). 5 (1): e36. PMC 5325906. PMID 28286843.
  2. ↑ Blatchford O, Murray WR, Blatchford M (2000). "A risk score to predict need for treatment for upper-gastrointestinal haemorrhage". Lancet. 356 (9238): 1318–21. doi:10.1016/S0140-6736(00)02816-6. PMID 11073021.
  3. ↑ Stanley AJ (2012). "Update on risk scoring systems for patients with upper gastrointestinal haemorrhage". World J. Gastroenterol. 18 (22): 2739–44. doi:10.3748/wjg.v18.i22.2739. PMC 3374976. PMID 22719181.
  4. ↑ Monteiro S, Gonçalves TC, Magalhães J, Cotter J (2016). "Upper gastrointestinal bleeding risk scores: Who, when and why?". World J Gastrointest Pathophysiol. 7 (1): 86–96. doi:10.4291/wjgp.v7.i1.86. PMC 4753192.
  5. ↑ Atkinson RJ, Hurlstone DP (2008). "Usefulness of prognostic indices in upper gastrointestinal bleeding". Best Pract Res Clin Gastroenterol. 22 (2): 233–42. doi:10.1016/j.bpg.2007.11.004. PMID 18346681.
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