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Case Studies | Medicine | India | Volume 12 Issue 7, July 2023

Identification of Risk Factors for Adverse Outcomes and Comparison of Clinical Scoring Systems in Acute Lower GI Bleeding

R Santhosh ^[2] | K Muthu Kumaran | Ratnakar Kini ^[3] | Shubha Immineni | A. Chezhian ^[2]

Abstract: Aims: To identify risk factors for adverse outcomes in acute lower GI bleeding and compare the efficacy of existing validated clinical scores in predicting severe disease. Methods: A single center prospective observational study of 160 patients admitted with LGIB who underwent colonoscopy between November 2022 and October 2023. The risk of severe LGIB was determined via univariable and multivariable logistic regression. Area under receiver operating characteristic curve analysis was used to compare the scores. Seven clinical scores were calculated at admission (Oakland, SALGIB, Birmingham, NOBLADS, AIM65, Blatchford and Charlson Comorbidity Index). Results: We had included 160 patients with acute LGIB requiring colonoscopy. Fifty four percent (n= 86) fit the criteria for severe bleeding. Patients with severe bleeding were more likely to have chronic renal failure (32% vs 18%; p =.05), lower admission hemoglobin levels (8.4 g/dl vs 10.9g/dl; P=.0001), and lower albumin values (3.2 g/dl vs 3.85g/dl; P<.0001. Those with severe bleeding were more likely to require blood transfusion (87% vs 34%; P<.0001), receive more units of packed red blood cells (3 vs 1; P<.0001), require ICU stays (51% vs 16%; P<.0001). Best predictor of severe bleeding was the Oakland score (AUC,.74 P<.0001). Blatchford was most discriminative for in - hospital recurrent bleeding. The discriminative score for in hospital death was SALGIB (AUC,.74; P<.0001). Conclusion: No singular clinical risk tool had the best predictive ability across all outcomes. Admission albumin and hemoglobin levels were the strongest predictors of severe bleeding. Oakland score performed better for predicting ability of severe bleeding.

Keywords: LGIB, Oakland, Severe bleeding, SALGIB, Albumin, Clinical Score

Edition: Volume 12 Issue 7, July 2023,

Pages: 1181 - 1185