Upper gastrointestinal bleeding risk stratification
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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 | ||
| Interpratation of score | 0-2 | Low-risk group | |
| >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 | ||
| Interpratation of score
(Range of score is 0-11) |
Score of ≤ 3 | Low mortality risk | |
| Score of ≥ 8 | High mortality risk | ||
| GI: Gastrointestinal, SRH: Signs of recent hemorrhage | |||
References
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.