What is the clinical evidence from this study?

Study design: Cohort. Population: Gastrointestinal bleeding (n=310). Intervention: ABC score vs. AIMS-65 and Rockall scores (for UGIB); Oakland score (for LGIB). Primary outcome: 30-day mortality prediction in upper gastrointestinal bleeding (AUROC) (p=<0.001).

June 21, 2022BMC Gastroenterology25 citationsOpen Access

Validation of the new ABC score for predicting 30-day mortality in gastrointestinal bleeding

Q: What are the key findings of this study?

The ABC score demonstrated good performance in predicting 30-day mortality for patients with upper gastrointestinal bleeding (AUROC 0.79), significantly outperforming the AIMS-65 and Rockall scores.

MSMarie Christelle SaadéSouthwestern Medical Center AKAnthony KerbageCleveland Clinic SJSuha JabakAmerican University of Beirut Medical Center

Key Result

The ABC score demonstrated good performance in predicting 30-day mortality for patients with upper gastrointestinal bleeding (AUROC 0.79), significantly outperforming the AIMS-65 and Rockall scores.

Study Design

Type

Cohort (n=310)

Multicenter

Structured PICO

Does the ABC score predict 30-day mortality in adult patients with overt gastrointestinal bleeding?

Population

310 adult patients with overt gastrointestinal bleeding admitted to a tertiary care center in Lebanon, followed for 30 days to assess mortality.

Exposure

ABC score (Age, Blood tests and Comorbidities) for risk stratification

Comparator

Existing prognostic scores (AIMS-65 and Rockall for upper GIB; Oakland score for lower GIB)

Outcome

30-day mortalityhard clinical

The ABC score demonstrates good performance in predicting 30-day mortality for patients with upper and lower gastrointestinal bleeding, outperforming or matching established risk scores.

Main Result

Absolute Event Rate: 0.79% vs 0.67%

p-value: p=<0.001

Limitations

Single center study with a small number of patients
Missing albumin and INR levels reduced the sample size
Small number of patients with lower gastrointestinal bleeding
Used age-adjusted Charlson Comorbidity Index (CCI) as an equivalent instead of the ASA score
Missing albumin and INR levels led to exclusion of some patients, potentially introducing bias
Small number of patients with LGIB, limiting statistical power for this subgroup
ASA score was substituted by age-adjusted CCI

Abstract

BACKGROUND/AIM: The ABC score is a new pre-endoscopic scoring system that was recently developed to accurately predict one-month mortality in upper and lower gastrointestinal bleeding (GIB). We aim to validate this new score on a cohort of Lebanese patients treated in a tertiary care center and to compare it to currently existing scores. METHODS: Adult patients admitted to the American University of Beirut Medical Center (AUBMC) with overt GIB between January 2013 and August 2020 were included. The area under receiver operating characteristic (AUROC) curves of the ABC score in predicting 30-day mortality was calculated using the SPSS software. Other optimal existing scores for predicting mortality (the Oakland score for lower GIB, the AIMS-65 and the Rockall scores for upper GIB)s were also assessed and compared to the ABC score. RESULTS: A total of 310 patients were included in our study. For upper GIB, the ABC score showed good performance in predicting 30-day mortality (AUROC: 0.79), outperforming both the AIMS-65 score (AUROC 0.67, p < 0.001) and the Rockall score (AUROC: 0.62, p < 0.001). For lower GIB, the ABC score also had good performance which was comparable to the Oakland score (AUROC: 0.70 vs 0.56, p = 0.26). CONCLUSION: In our cohort of patients, the ABC score demonstrated good performance in predicting 30-day mortality for patients with upper and lower GIB compared to other established risk scores, which may help guide management decisions. This simple and novel score provides valuable prognostic information for patients presenting with GIB and appears to be reproducible in different patient populations.

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