Original article
Clinical endoscopy
The AIMS65 score compared with the Glasgow-Blatchford score in predicting outcomes in upper GI bleeding

Preliminary results were presented at the American College of Gastroenterology 2010 Annual Scientific Meeting, October 15-20, 2010; San Antonio, Texas (Am J Gastroenterol 2010;105:S394 [abstract]).
https://doi.org/10.1016/j.gie.2012.11.022Get rights and content

Introduction

We previously derived and validated the AIMS65 score, a mortality prognostic scale for upper GI bleeding (UGIB).

Objective

To validate the AIMS65 score in a different patient population and compare it with the Glasgow-Blatchford risk score (GBRS).

Patients

Adults with a primary diagnosis of UGIB.

Main Outcome Measurements

Primary outcome: inpatient mortality. Secondary outcomes: composite clinical endpoint of inpatient mortality, rebleeding, and endoscopic, radiologic or surgical intervention; blood transfusion; intensive care unit admission; rebleeding; length of stay; timing of endoscopy. The area under the receiver-operating characteristic curve (AUROC) was calculated for each score.

Results

Of the 278 study patients, 6.5% died and 35% experienced the composite clinical endpoint. The AIMS65 score was superior in predicting inpatient mortality (AUROC, 0.93 vs 0.68; P < .001), whereas the GBRS was superior in predicting blood transfusions (AUROC, 0.85 vs 0.65; P < .01) The 2 scores were similar in predicting the composite clinical endpoint (AUROC, 0.62 vs 0.68; P = .13) as well as the secondary outcomes. A GBRS of 10 and 12 or more maximized the sum of the sensitivity and specificity for inpatient mortality and rebleeding, respectively. The cutoff was 2 or more for the AIMS65 score for both outcomes.

Limitations

Retrospective, single-center study.

Conclusion

The AIMS65 score is superior to the GBRS in predicting inpatient mortality from UGIB, whereas the GBRS is superior for predicting blood transfusion. Both scores are similar in predicting the composite clinical endpoint and other outcomes in clinical care and resource use.

Section snippets

Database and patient selection

The Research Patient Data Registry at Brigham and Women's Hospital was used to identify patients who presented to the emergency department with UGIB between 2004 and 2009. The Research Patient Data Registry is a centralized clinical data registry that gathers clinical and laboratory data on each patient admitted to the Partners Healthcare System, which includes Brigham and Women's Hospital. The initial query was performed by using any ICD-9-CM (International Classification of Diseases, Ninth

Patient characteristics

There were 5252 patients with any ICD-9-CM code indicating a diagnosis of UGIB in the Partners network, of whom 325 patients were treated at our institution and had UGIB as the main diagnosis (retrospectively determined at the end of the admission). Complete records were available for 278 of the 325 patients. These patients comprised the study cohort. Table 2 shows the patient characteristics. Fifty-four percent of the patients were male; 10 patients had UGIB as inpatients. The median age was

Discussion

This study confirms that the AIMS65 score accurately predicts inpatient mortality in patients with UGIB. In addition, the AIMS65 score was superior to the GBRS for predicting inpatient and in and out of ICU mortality, whereas the GBRS is superior to the AIMS65 score for predicting PRBC transfusion. The 2 scores had similar predictive ability when a composite clinical endpoint of inpatient mortality, rebleeding, and endoscopic, radiologic, or surgical intervention was considered as well as

Conclusions

In this study, we validate the AIMS65 score as a predictor of inpatient mortality in a different patient population from that used in the original derivation study, with comparable results. We have also demonstrated that the AIMS65 score is superior to the GBRS in predicting inpatient mortality, whereas the GBRS is superior to the AIMS65 score in predicting PRBC transfusion. In addition, we show that both scores are equivalent in predicting several clinically useful outcomes including hospital

References (20)

There are more references available in the full text version of this article.

DISCLOSURE: The authors disclosed no financial relationships relevant to this publication.

If you would like to chat with an author of this article, you may contact Dr Saltzman at [email protected].

Drs Hyett and Abougergi contributed equally to this article.

View full text