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Research Paper | Medical Science | India | Volume 12 Issue 9, September 2023
ABC Score: An Innovative Pre Endoscopic Risk Stratification Index for Anticipation of Mortality in Cases of Acute Upper and Lower Gastrointestinal Bleeding
Paila Ramesh | A. Chezhian [2] | P. Ratnakar Kini [2]
Abstract: Background: Numerous prognostic risk scores have been created to forecast outcomes in individuals dealing with acute upper and lower gastrointestinal bleeding. When evaluating patients with gastrointestinal bleeding, distinguishing between upper gastrointestinal bleeding (UGIB) and lower gastro intestinal bleeding can pose challenges. Cases of hematochezia characterized by bright red blood in stools, might originate from upper gastrointestinal tract, while instances of melena characterized by dark tarry stools could stem from lower gastrointestinal tract (such as bleeding from the right colon). Given these complexities clinicians would greatly benefit from utilizing a single scoring system that is applicable to both acute UGIB and LGIB cases. Aim: To appraise the recently introduced ABC risk score's ability to predict mortality in both instances of acute upper and lower gastrointestinal bleeding. Methods: A comprehensive analysis was conducted on a cohort of 250 patients who sought medical attention at our institution due to acute upper gastrointestinal (UGI) and lower gastrointestinal (LGI) bleeding over the span of one year. During their admission, we computed the AIM65, GBS, OAKLAND, and ABC scores for these patients. Subsequently, we compared the outcomes in terms of 30 - day mortality and rebleeding rates. To evaluate the predictive performance, we calculated the areas under the receiver operating characteristic curves (AUROC) for each of these scores. Results: The mean age of the patients was 51 years, with a standard deviation of ?11.12 years. Among the 250 patients, 157 (62.8%) were male, and 93 (37.2%) were female. The low - risk group (ABC score ? 3) constituted 111 patients (44.4%), the medium - risk group (ABC score 4 - 7) included 116 patients (46.4%), and the high - risk group (ABC score ? 8) encompassed 23 patients (9.2%). Throughout the study duration, eight patients passed away. In the context of upper gastrointestinal bleeding (UGIB), the ABC score exhibited robust predictive performance for 30 - day mortality, achieving an AUROC of 0.852. This outperformed both the AIMS - 65 score (AUROC 0.752, p < 0.001) and the GBS score (AUROC 0.742, p < 0.001). Concerning lower gastrointestinal bleeding (LGIB), the ABC score also showcased strong performance, comparable to the OAKLAND score (AUROC: 0.8 vs.0.654, p = 0.473). For the prediction of rebleeding, the AUROC values were 0.833 for AIM65, 0.871 for GBS, 0.514 for OAKLAND, and notably higher at 0.959 for the ABC score. These findings underscore the ABC score's effective prognostic capability across various aspects of gastrointestinal bleeding. Conclusions: In our group of patients, the ABC score exhibited strong predictive capabilities for 30 - day mortality & rebleeding rate among individuals with both upper and lower gastrointestinal bleeding, surpassing the performance of other well - established risk scores. This finding holds the potential to significantly influence clinical management choices. This straightforward and innovative scoring system offers valuable insights into prognosis for individuals presenting with gastrointestinal bleeding, and its consistency across different patient populations adds to its reliability.
Keywords: ABC Score, Pre Endoscopic Risk Stratification Index, Mortality
Edition: Volume 12 Issue 9, September 2023,
Pages: 95 - 99