The effect of the shock index and scoring systems for predicting mortality among geriatric patients with upper gastrointestinal bleeding
a prospective cohort study
Keywords:
Emergencies, Geriatrics, MortalityAbstract
BACKGROUND: Gastrointestinal (GI) bleeding is an important cause of mortality and morbidity among geriatric patients. OBJECTIVE: To investigate whether the shock index and other scoring systems are effective predictors of mortality and prognosis among geriatric patients presenting to the emergency department with complaints of upper GI bleeding. DESIGN AND SETTING: Prospective cohort study in an emergency department in Bursa, Turkey. METHODS: Patients over 65 years admitted to a single-center, tertiary emergency service between May 8, 2019, and April 30, 2020, and diagnosed with upper GI bleeding were analyzed. 30, 180 and 360-daymortality prediction performances of the shock index and the Rockall, Glasgow-latchford and AIMS-65 scores were evaluated. RESULTS: A total of 111 patients who met the criteria were included in the study. The shock index (P < 0.001) and AIMS-65 score (P < 0.05) of the patients who died within the 30-day period were found to be significantly different, while the shock index (P < 0.001), Rockall score (P < 0.001) and AIMS-65 score (P < 0.05) of patients who died within the 180-day and 360-day periods were statistically different. In the receiver operating characteristic (ROC) analysis for predicting 360-day mortality, the area under the curve (AUC) value was found to be 0.988 (95% confidence interval, CI, 0.971-1.000; P < 0.001). CONCLUSION: The shock index measured among geriatric patients with upper G bIleeding at admission seems to be a more effective predictor of prognosis than other scoring systems.
Downloads
References
Nable JV, Graham AC. Gastrointestinal Bleeding. Emergency medicine clinics of North America. 2016;34(2):309-25. PMID: 27133246; https://doi.org/10.1016/j.emc.2015.12.001.
Tielleman T, Bujanda D, Cryer B. Epidemiology and Risk Factors for Upper Gastrointestinal Bleeding. Gastrointest Endosc Clin N Am. 2015;25(3):415-28. PMID: 26142028; https://doi.org/10.1016/j.giec.2015.02.010.
Kamboj AK, Hoversten P, Leggett CL. Upper Gastrointestinal Bleeding: Etiologies and Management. Mayo Clin Proc. 2019;94(4):697-703. PMID: 30947833; https://doi.org/10.1016/j.mayocp.2019.01.022.
Antunes C, Copelin IE. Upper Gastrointestinal Bleeding. StatPearls. Treasure Island (FL): StatPearls Publishing Copyright © 2021, StatPearls Publishing LLC.; 2021.
Wilkins T, Wheeler B, Carpenter M. Upper Gastrointestinal Bleeding in Adults: Evaluation and Management. Am Fam Physician. 2020;101(5):294-300. PMID: 32109037. Erratum in: Am Fam Physician. 2021;103(2):70.
Rady MY, Smithline HA, Blake H, Nowak R, Rivers E. A comparison of the shock index and conventional vital signs to identify acute, critical illness in the emergency department. Ann Emerg Med. 1994;24(4):685-90. PMID: 8092595; https://doi.org/10.1016/s0196-0644(94)70279-9. Erratum in: Ann Emerg Med 1994;24(6):1208.
Rady MY, Nightingale P, Little RA, Edwards JD. Shock index: a re-evaluation in acute circulatory failure. Resuscitation. 1992;23(3):227-34. PMID: 1321482; https://doi.org/10.1016/0300-9572(92)90006-x.
Allgöwer M, Burri C. “Schockindex” [“Shock index”]. Dtsch Med Wochenschr. 1967;92(43):1947-50. PMID: 5299769; https://doi.org/10.1055/s-0028-1106070.
Rassameehiran S, Teerakanok J, Suchartlikitwong S, Nugent K. Utility of the Shock Index for Risk Stratification in Patients with Acute Upper Gastrointestinal Bleeding. South Med J. 2017;110(11):738-43. PMID: 29100227; https://doi.org/10.14423/SMJ.0000000000000729.
Jung DH, Ko BS, Kim YJ, Kim WY. Comparison of risk scores and shock index in hemodynamically stable patients presenting to the emergency department with nonvariceal upper gastrointestinal bleeding. Eur J Gastroenterol Hepatol. 2019;31(7):781-5. PMID: 31008809; https://doi.org/10.1097/MEG.0000000000001422.
Rockall TA, Logan RF, Devlin HB, Northfield TC. Selection of patients for early discharge or outpatient care after acute upper gastrointestinal haemorrhage. National Audit of Acute Upper Gastrointestinal Haemorrhage. Lancet. 1996;347(9009):1138-40. PMID: 8609747; https://doi.org/10.1016/s0140-6736(96)90607-8.
Blatchford O, Murray WR, Blatchford M. A risk score to predict need for treatment for upper-gastrointestinal haemorrhage. Lancet. 2000;356(9238):1318-21. PMID: 11073021; https://doi.org/10.1016/S0140-6736(00)02816-6.
Saltzman JR, Tabak YP, Hyett BH, et al. A simple risk score accurately predicts in-hospital mortality, length of stay, and cost in acute upper GI bleeding. Gastrointest Endosc. 2011;74(6):1215-24. PMID: 21907980; https://doi.org/10.1016/j.gie.2011.06.024.
Loperfido S, Baldo V, Piovesana E, et al. Changing trends in acute upper-GI bleeding: a population-based study. Gastrointest Endosc. 2009;70(2):212-24. PMID: 19409558; https://doi.org/10.1016/j.gie.2008.10.051.
Laursen SB, Hansen JM, Schaffalitzky de Muckadell OB. The Glasgow Blatchford score is the most accurate assessment of patients with upper gastrointestinal hemorrhage. Clin Gastroenterol Hepatol. 2012;10(10):1130-1135.e1. PMID: 22801061; https://doi.org/10.1016/j.cgh.2012.06.022.
Palmer ED. The vigorous diagnostic approach to upper-gastrointestinal tract hemorrhage. A 23-year prospective study of 1,4000 patients. JAMA. 1969;207(8):1477-80. PMID: 5304356.
Köksal Ö, Özeren G, Özdemır F, et al. Prospective validation of the Glasgow Blatchford scoring system in patients with upper gastrointestinal bleeding in the emergency department. Turk J Gastroenterol. 2012;23(5):448-55. PMID: 23161321; https://doi.org/10.4318/tjg.2012.0385.
Stanley AJ, Laine L, Dalton HR, et al. Comparison of risk scoring systems for patients presenting with upper gastrointestinal bleeding: international multicentre prospective study. BMJ. 2017;356:i6432. PMID: 28053181; https://doi.org/10.1136/bmj.i6432.
Robertson M, Majumdar A, Boyapati R, et al. Risk stratification in acute upper GI bleeding: comparison of the AIMS65 score with the Glasgow-Blatchford and Rockall scoring systems. Gastrointest Endosc. 2016;83(6):1151-60. PMID: 26515955; https://doi.org/10.1016/j.gie.2015.10.021.
Budimir I, Stojsavljević S, Baršić N, et al. Scoring systems for peptic ulcer bleeding: Which one to use? World J Gastroenterol. 2017;23(41):7450-8. PMID: 29151699; https://doi.org/10.3748/wjg.v23.i41.7450.
Yaka E, Yılmaz S, Doğan NÖ, Pekdemir M. Comparison of the Glasgow-Blatchford and AIMS65 scoring systems for risk stratification in upper gastrointestinal bleeding in the emergency department. Acad Emerg Med. 2015;22(1):22-30. PMID: 25556538; https://doi.org/10.1111/acem.12554.
Bryant RV, Kuo P, Williamson K, et al. Performance of the Glasgow-Blatchford score in predicting clinical outcomes and intervention in hospitalized patients with upper GI bleeding. Gastrointest Endosc. 2013;78(4):576-83. PMID: 23790755; https://doi.org/10.1016/j.gie.2013.05.003.
Wang CH, Chen YW, Young YR, Yang CJ, Chen IC. A prospective comparison of 3 scoring systems in upper gastrointestinal bleeding. Am J Emerg Med. 2013;31(5):775-8. PMID: 23465874; https://doi.org/10.1016/j.ajem.2013.01.007.
Tang Y, Shen J, Zhang F, et al. Scoring systems used to predict mortality in patients with acute upper gastrointestinal bleeding in the ED. Am J Emerg Med. 2018;36(1):27-32. PMID: 28673695; https://doi.org/10.1016/j.ajem.2017.06.053.
Ramaekers R, Mukarram M, Smith CA, Thiruganasambandamoorthy V. The Predictive Value of Preendoscopic Risk Scores to Predict Adverse Outcomes in Emergency Department Patients With Upper Gastrointestinal Bleeding: A Systematic Review. Acad Emerg Med. 2016;23(11):1218-27. PMID: 27640399; https://doi.org/10.1111/acem.13101.
Saffouri E, Blackwell C, Laursen SB, et al. The Shock Index is not accurate at predicting outcomes in patients with upper gastrointestinal bleeding. Aliment Pharmacol Ther. 2020;51(2):253-60. PMID: 31642558; https://doi.org/10.1111/apt.15541.
