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ABC score: a new risk score that accurately predicts mortality in acute upper and lower gastrointestinal bleeding: an international multicentre study
  1. Stig Borbjerg Laursen1,2,
  2. Kathryn Oakland3,
  3. Loren Laine4,
  4. Vered Bieber5,
  5. Riccardo Marmo6,
  6. Eduardo Redondo-Cerezo7,
  7. Harry R Dalton8,
  8. Jeffrey Ngu9,
  9. Michael Schultz10,11,
  10. Marco Soncini12,
  11. Ian Gralnek5,
  12. Vipul Jairath13,
  13. Iain A Murray8,
  14. Adrian J Stanley14
  1. 1Department of Medical Gastroenterology and Hepatology, Odense University Hospital, Odense, Denmark
  2. 2Department of Clinical Research, University of Southern Denmark, Odense, Denmark
  3. 3Digestive Diseases and Renal Department, HCA Healthcare UK, London, UK
  4. 4Digestive Diseases, Yale University School of Medicine, New Haven, Connecticut, USA
  5. 5Institute of Gastroenterology and Hepatology, Emek Medical Center, Afula, Israel
  6. 6Gastroenterology Unit, Azienda Sanitaria Locale Salerno, Polla Sa, Italy
  7. 7Department of Gastroenterology, University Hospital Centre Virgen de las Nieves, Granada, Spain
  8. 8Gastroenterology Unit, Royal Cornwall Hospital, Truro, UK
  9. 9Department of Gastroenterology & Hepatology, Singapore General Hospital, Singapore
  10. 10Department of Medicine, University of Otago Dunedin School of Medicine, Dunedin, New Zealand
  11. 11Gastroenterology Unit, Dunedin Hospital, Dunedin, New Zealand
  12. 12Department of Internal Medicine, Alessandro Manzoni Hospital, Lecco, Italy
  13. 13Department of Medicine, Western University & London Health Sciences Centre, London, Ontario, Canada
  14. 14Gastroenterology Unit, Glasgow Royal Infirmary, Glasgow, UK
  1. Correspondence to Associate Professor Stig Borbjerg Laursen, Department of Medical Gastroenterology and Hepatology, Odense University Hospital, Odense 5000, Denmark; stig.laursen{at}


Objectives Existing scores are not accurate at predicting mortality in upper (UGIB) and lower (LGIB) gastrointestinal bleeding. We aimed to develop and validate a new pre-endoscopy score for predicting mortality in both UGIB and LGIB.

Design and setting International cohort study. Patients presenting to hospital with UGIB at six international centres were used to develop a risk score for predicting mortality using regression analyses. The score’s performance in UGIB and LGIB was externally validated and compared with existing scores using four international datasets. We calculated areas under receiver operating characteristics curves (AUROCs), sensitivities, specificities and outcome among patients classified as low risk and high risk.

Participants and results We included 3012 UGIB patients in the development cohort, and 4019 UGIB and 2336 LGIB patients in the validation cohorts. Age, Blood tests and Comorbidities (ABC) score was closer associated with mortality in UGIB and LGIB (AUROCs: 0.81–84) than existing scores (AUROCs: 0.65–0.75; p≤0.02). In UGIB, patients with low ABC score (≤3), medium ABC score (4–7) and high ABC score (≥8) had 30-day mortality rates of 1.0%, 7.0% and 25%, respectively. Patients classified low risk using ABC score had lower mortality than those classified low risk with AIMS65 (threshold ≤1) (1.0 vs 4.5%; p<0.001). In LGIB, patients with low, medium and high ABC scores had in-hospital mortality rates of 0.6%, 6.3% and 18%, respectively.

Conclusions In contrast to previous scores, ABC score has good performance for predicting mortality in both UGIB and LGIB, allowing early identification and targeted management of patients at high or low risk of death.

  • gastrointestinal bleeding
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  • Contributors The study was designed by SBL and AS. VB collected data. SBL and AS wrote the paper with considerable input from KO, LL, IG, VJ, IAM, JN, ER-C, RM, HRD and MS. All coauthors approved the final manuscript. SBL is the study guarantor.

  • Funding This study was sponsored by NHS Greater Glasgow and Clyde Health Board, Scotland, UK. Data collection in Glasgow, Singapore, and Dunedin was funded by a health board endowment, hospital research, and guthealthnetwork grant, respectively. The Italian validation cohort was sponsored by the three Italian scientific societies: AIGO, SIED, and SIGE. KO was supported by funding from NHS Blood and Transplant, Bowel Disease Research Foundation and a Research Fellowship from the Royal College of Surgeons of England.

  • Disclaimer The funders had no input to the study design, data collection, or interpretation, writing of report, or submission for publication.

  • Competing interests IG is a consultant, has a financial interest and is a member of the Medical Advisory Board of MOTUS GI. IG is a consultant for Boston Scientific, Symbionix and GI View. KO has received editorial fees for reviews on the same topic.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

  • Patient consent for publication Not required.

  • Ethics approval Ethical approval was obtained from West of Scotland Ethics committee, San Carlo Borromeo Hospital Milan and the Helsinki Committee at Emek Medical Center. Furthermore, each participating centre obtained approval from their local research committee or review board. Due to the observational, non-interventional nature of the study, the ethical committee (and local committees and boards) agreed that individual patient consent was not required. The UK LGIB cohort data were collected as part of a national audit that collected no patient identifiers and involved no clinical interventions; thus, ethical approval was not required for the primary study nor for subsequent use of data.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available on reasonable request. Relevant anonymised patient-level data are available from the corresponding author SBL. Consent was not obtained but the presented data are anonymised and risk of identification is low.

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