Key result
Novel risk score accurately predicts 1-year mortality in acute GI bleeding with 0.82 AUC.
Why the study?
The study aimed to develop and validate a novel 1-year mortality risk-scoring system incorporating antithrombotic drug use against existing scoring systems in acute gastrointestinal bleeding.
Does a novel risk score including antithrombotic use accurately predict 1-year mortality in patients with acute gastrointestinal bleeding compared to existing scores?
Cohort (n=576)
Does a novel risk score including antithrombotic use accurately predict 1-year mortality in patients with acute gastrointestinal bleeding compared to existing scores?
A novel risk score incorporating comorbidities, blood transfusion need, and aspirin use accurately predicts 1-year mortality in patients with acute gastrointestinal bleeding, outperforming existing scores.
May aid 1-year mortality stratification in acute GI bleeding; hypothesis-generating and requires prospective validation before practice change.
GOALS AND BACKGROUND: We aimed to develop a novel 1-year mortality risk-scoring system that includes use of antithrombotic (AT) drugs and to validate it against other scoring systems in patients with acute gastrointestinal bleeding (GIB). STUDY: We developed a risk-scoring system from prospectively collected data on patients admitted with GIB between January 2013 and August 2020, who had at least 1- year of follow-up. Independent predictors of 1-year mortality were determined after adjusting for the following confounders: the age-adjusted Charlson Comorbidity Index (CCI) (divided into 4 groups: CCI-0=0, CCI-1=1 to 3, CCI-2=4 to 6, CCI-3 ≥7), need for blood transfusion, GIB severity, need for endoscopic therapy, and type of AT. The risk score was based on independent predictors. RESULTS: Five hundred seventy-six patients were included and 123 (21%) died at 1-year follow-up. Our risk -score was based on the following: CCI-2 (2 points), CCI-3 (4 points), need for blood transfusion (1 point), and no use of aspirin (1 point), as aspirin use was protective (maximum score=6). Patients with higher risk scores had higher mortality. The model had a better predictive accuracy [AUC=0.82, 95% confidence interval (0.78-0.86), P <0.0001] than the Rockall score for upper GIB (Area Under the Curve (AUC)=0.68, P <<0.0001), the Oakland score for lower GIB (AUC=0.69, p =0.004), or the Shock Index for all (AUC=0.54, P <0.0001). CONCLUSION: A simple and novel score that includes use of AT upon admission accurately predicts 1-year mortality in patients with GIB. This scoring system may help guide follow-up decisions and inform the prognosis of patients with GIB.
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Nammour et al. (2022) conducted a cohort in acute gastrointestinal bleeding (GIB) (n=576). Novel 1-year mortality risk score vs. Rockall score, Oakland score, and Shock Index was evaluated on 1-year mortality predictive accuracy (AUC) (AUC 0.82, 95% CI 0.78-0.86, p=<0.0001). A novel risk score including comorbidities, blood transfusion need, and aspirin use accurately predicted 1-year mortality in acute gastrointestinal bleeding patients (AUC 0.82; 95% CI 0.78-0.86).
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