AIMS65 better predicted mortality and Glasgow-Blatchford better predicted the need for transfusion, but both scoring systems can be helpful in identifying high-risk patients with UGIB.

Investigators recently derived and validated AIMS65 — a new scoring system to predict outcomes for patients with acute upper gastrointestinal bleeding (UGIB) — using a large population of patients from 187 U.S. hospitals (JW Gastroenterol Dec 9 2011).

Now, the researchers have revalidated AIMS65 using data on 278 UGIB patients from a tertiary-care hospital who had a higher severity of disease than that observed in the original population. They also compared the performance of AIMS65 with that of the Glasgow-Blatchford system (GBS; JW Gastroenterol Jul 29 2011) in predicting the primary outcome of inpatient mortality and several secondary outcomes: the composite endpoint of mortality, rebleeding, and endoscopic, radiologic, or surgical intervention; transfusion requirement; intensive care unit admission; rebleeding; length of hospital stay; and the timing of endoscopy.

Overall inpatient mortality was 6.5%. The composite endpoint was seen in 35%. AIMS65 was superior to GBS for predicting mortality (area under the receiver operating curve, 0.93 vs. 0.68; P<0.001), but GBS was superior for predicting the need for transfusion (AUROC, 0.85 vs. 0.65; P<0.01). The two systems were similarly accurate for predicting and other secondary outcomes. GBS values of 10 and 12 maximized the accuracy for predicting mortality and rebleeding, respectively. AIMS65 values of 2 maximized the accuracy for predicting both outcomes.

Comment: Results of this study from a tertiary-care hospital with expertise in treating patients with upper gastrointestinal bleeding might not be generalizable to other settings. What seems clear from the evidence regarding UGIB scoring systems is that shock, advanced age, and comorbid conditions used in any scoring system can identify patients at high risk for adverse outcomes. However, the issue is not about which system is better; rather, it is about ensuring that some system is used to identify high-risk patients, who will benefit from urgent endoscopy, endoscopic therapy, and more aggressive care, and low-risk patients, who can be treated as outpatients.

Source: Journal Watch Gastroenterology