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
Two scoring systems identify those at risk for adverse outcomes from UGIB which include Glasgow Blatchford Score (GBS) and Rockall score. Glasgow Blatchford score is most commonly used and is more accurate.
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
Any major comorbidity |
2 | ||
| Renal 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.