Scoring systems for peptic ulcer bleeding: which one to use?

AIM To compare the Glasgow-Blatchford score(GBS), Rockall score(RS) and Baylor bleeding score(BBS) in predicting clinical outcomes and need for interventions in patients with bleeding peptic ulcers. METHODS Between January 2008 and December 2013, 1012consecutive patients admitted with peptic ulcer bleeding(PUB) were prospectively followed. The pre-endoscopic RS, BBS and GBS, as well as the post-endoscopic diagnostic scores(RS and BBS) were calculated for all patients according to their urgent upper endoscopy findings. Area under the receiver-operating characteristics(AUROC) curves were calculated for the prediction of lethal outcome, rebleeding, needs for blood transfusion and/or surgical intervention, and the optimal cutoff values were evaluated.RESULTS PUB accounted for 41.9% of all upper gastrointestinal tract bleeding, 5.2% patients died and 5.4% patients underwent surgery. By comparing the AUROC curves of the aforementioned pre-endoscopic scores, the RS best predicted lethal outcome(AUROC 0.82 vs 0.67 vs0.63, respectively), but the GBS best predicted need for hospital-based intervention or 30-d mortality(AUROC0.84 vs 0.57 vs 0.64), rebleeding(AUROC 0.75 vs 0.61 vs 0.53), need for blood transfusion(AUROC 0.83 vs0.63 vs 0.58) and surgical intervention(0.82 vs 0.63 vs 0.52) The post-endoscopic RS was also better than the post-endoscopic BBS in predicting lethal outcome(AUROC 0.82 vs 0.69, respectively).CONCLUSION The RS is the best predictor of mortality and the GBS is the best predictor of rebleeding, need for blood transfusion and/or surgical intervention in patients with PUB. There is no one 'perfect score' and we suggest that these two tests be used concomitantly.

Evaluation of CRUSADE and ACUITY-HORIZONS Scores for Predicting Long-term Out-of-Hospital Bleeding after Percutaneous Coronary Interventions

Background：There is scanty evidence concerning the ability of Can Rapid Risk Stratification of Unstable Angina Patients Suppress Adverse Outcomes with Early Implementation of the ACC/AHA Guidelines （CRUSADE） and Acute Catheterization and Urgent Intervention Triage Strategy and Harmonizing Outcomes with Revascularization and Stents in Acute Myocardial Infarction （ACUITY-HORIZONS） scores to predict out-of-hospital bleeding risk after percutaneous coronary interventions （PCIs） with drug-eluting stents （DES） in patients receiving dual antiplatelet therapy.We aimed to assess and compare the long-term prognostic value of these scores regarding out-of-hospital bleeding risk in such patients.Methods：We performed a prospective observational study of 10,724 patients undergoing PCI between January and December 2013 in Fuwai Hospital,China.All patients were followed up for 2 years and evaluated through the Fuwai Hospital Follow-up Center.Major bleeding was defined as Types 2,3,and 5 according to Bleeding Academic Research Consortium Definition criteria.Results：During a 2-year follow-up,245 of 9782 patients （2.5%） had major bleeding （MB）.CRUSADE （21.00 [12.00,29.75] vs.18.00 [11.00,26.00],P 〈 0.001） and ACUITY-HORIZONS （9.00 [3.00,14.00] vs.6.00 [3.00,12.00],P 〈 0.001） risk scores were both significantly higher in the MB than non-MB groups.Both scores showed a moderate predictive value for MB in the whole study cohort （area under the receiver-operating characteristics curve [AUROC],0.565;95% confidence interval [CI],0.529-0.601,P =0.001;AUROC,0.566;95% CI,0.529-0.603,P 〈 0.001,respectively） and in the acute coronary syndrome （ACS） subgroup （AUROC：0.579,95% CI：0.531-）.627,P =0.001;AUROC,0.591;95% CI,0.544-0.638,P 〈 0.001,respectively）.However,neither score was a significant predictor in the non-ACS subgroup （P 〉 0.05）.The value of CRUSADE and ACUITY-HORIZONS scores did not differ significantly （P 〉 0.05） in the whole cohort,ACS subgroup,or non-ACS subgroup.Conclusions：CRUSADE and ACUITY-HORIZONS scores showed statistically significant but relatively limited long-term prognostic value for out-of-hospital MB after PCI with DES in a cohort of Chinese patients.The value of CRUSADE and ACUITY-HORIZONS scores did not differ significantly （P 〉 0.05） in the whole cohort,ACS subgroup,or non-ACS subgroup.