A simple scoring system to assess the need for an endoscopic intervention in suspected upper gastrointestinal bleeding: A prospective cohort study

Masayasu Horibe, Tetsuji Kaneko, Naoto Yokogawa, Takuya Yokota, Osamu Okawa, Yukihiro Nakatani, Yuki Ogura, Juntaro Matsuzaki, Eisuke Iwasaki, Naoki Hosoe, Tatsuhiro Masaoka, John M. Inadomi, Hidekazu Suzuki, Takanori Kanai, Shin Namiki

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Background Assessment of the emergent endoscopy for upper gastrointestinal bleeding (UGIB) patients has important clinical implications. There is no validated criterion to triage. Aims To develop a simple score predicting an endoscopic intervention. Methods A prospective cohort study was conducted at a tertiary care centre. Primary outcome was the high-risk stigmata which were well-established endoscopic findings to determine the need for an endoscopic intervention. We created a simple score by multivariable logistic regression and compared with the Glasgow Blatchford Score (GBS). External validation was performed in a second cohort. Results 284 of consecutive 568 patients with suspected UGIB had the high-risk stigmata. Three variables were selected: “no daily use of proton pump inhibitors during one week before examination (+1 point)”, “shock index (heart rate/systolic blood pressure) ≥ 1 (+1 point)” and “urea/creatinine ≥ 140 (blood urea nitrogen/creatinine ≥ 30) (+1 point)”. The accumulating score (range 0–3) achieved an area under the receiver–operating characteristic curve (AUC) of 0.74 (95% confidence interval [CI], 0.70–0.78), which was superior to the GBS (AUC, 0.63; 95% CI, 0.59–0.68; p < 0.001). Validation in an external cohort demonstrated superiority to the GBS (AUC, 0.78 vs. 0.59; p < 0.001). Conclusions The simple score has greater accuracy than the GBS for assessing the need for an endoscopic intervention in cases of suspected UGIB. Further external validation should be performed to verify generalizability.

Original languageEnglish
Pages (from-to)1180-1186
Number of pages7
JournalDigestive and Liver Disease
Volume48
Issue number10
DOIs
Publication statusPublished - 2016 Oct 1

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Area Under Curve
Christianity
Cohort Studies
Prospective Studies
Hemorrhage
Confidence Intervals
Blood Pressure
Gastrointestinal Endoscopy
Proton Pump Inhibitors
Triage
Blood Urea Nitrogen
Tertiary Care Centers
Urea
Shock
Heart Rate
Logistic Models

Keywords

  • Endoscopic therapy
  • Non-variceal bleeding
  • Variceal bleeding

ASJC Scopus subject areas

  • Hepatology
  • Gastroenterology

Cite this

A simple scoring system to assess the need for an endoscopic intervention in suspected upper gastrointestinal bleeding : A prospective cohort study. / Horibe, Masayasu; Kaneko, Tetsuji; Yokogawa, Naoto; Yokota, Takuya; Okawa, Osamu; Nakatani, Yukihiro; Ogura, Yuki; Matsuzaki, Juntaro; Iwasaki, Eisuke; Hosoe, Naoki; Masaoka, Tatsuhiro; Inadomi, John M.; Suzuki, Hidekazu; Kanai, Takanori; Namiki, Shin.

In: Digestive and Liver Disease, Vol. 48, No. 10, 01.10.2016, p. 1180-1186.

Research output: Contribution to journalArticle

Horibe, M, Kaneko, T, Yokogawa, N, Yokota, T, Okawa, O, Nakatani, Y, Ogura, Y, Matsuzaki, J, Iwasaki, E, Hosoe, N, Masaoka, T, Inadomi, JM, Suzuki, H, Kanai, T & Namiki, S 2016, 'A simple scoring system to assess the need for an endoscopic intervention in suspected upper gastrointestinal bleeding: A prospective cohort study', Digestive and Liver Disease, vol. 48, no. 10, pp. 1180-1186. https://doi.org/10.1016/j.dld.2016.07.009
Horibe, Masayasu ; Kaneko, Tetsuji ; Yokogawa, Naoto ; Yokota, Takuya ; Okawa, Osamu ; Nakatani, Yukihiro ; Ogura, Yuki ; Matsuzaki, Juntaro ; Iwasaki, Eisuke ; Hosoe, Naoki ; Masaoka, Tatsuhiro ; Inadomi, John M. ; Suzuki, Hidekazu ; Kanai, Takanori ; Namiki, Shin. / A simple scoring system to assess the need for an endoscopic intervention in suspected upper gastrointestinal bleeding : A prospective cohort study. In: Digestive and Liver Disease. 2016 ; Vol. 48, No. 10. pp. 1180-1186.
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abstract = "Background Assessment of the emergent endoscopy for upper gastrointestinal bleeding (UGIB) patients has important clinical implications. There is no validated criterion to triage. Aims To develop a simple score predicting an endoscopic intervention. Methods A prospective cohort study was conducted at a tertiary care centre. Primary outcome was the high-risk stigmata which were well-established endoscopic findings to determine the need for an endoscopic intervention. We created a simple score by multivariable logistic regression and compared with the Glasgow Blatchford Score (GBS). External validation was performed in a second cohort. Results 284 of consecutive 568 patients with suspected UGIB had the high-risk stigmata. Three variables were selected: “no daily use of proton pump inhibitors during one week before examination (+1 point)”, “shock index (heart rate/systolic blood pressure) ≥ 1 (+1 point)” and “urea/creatinine ≥ 140 (blood urea nitrogen/creatinine ≥ 30) (+1 point)”. The accumulating score (range 0–3) achieved an area under the receiver–operating characteristic curve (AUC) of 0.74 (95{\%} confidence interval [CI], 0.70–0.78), which was superior to the GBS (AUC, 0.63; 95{\%} CI, 0.59–0.68; p < 0.001). Validation in an external cohort demonstrated superiority to the GBS (AUC, 0.78 vs. 0.59; p < 0.001). Conclusions The simple score has greater accuracy than the GBS for assessing the need for an endoscopic intervention in cases of suspected UGIB. Further external validation should be performed to verify generalizability.",
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T1 - A simple scoring system to assess the need for an endoscopic intervention in suspected upper gastrointestinal bleeding

T2 - A prospective cohort study

AU - Horibe, Masayasu

AU - Kaneko, Tetsuji

AU - Yokogawa, Naoto

AU - Yokota, Takuya

AU - Okawa, Osamu

AU - Nakatani, Yukihiro

AU - Ogura, Yuki

AU - Matsuzaki, Juntaro

AU - Iwasaki, Eisuke

AU - Hosoe, Naoki

AU - Masaoka, Tatsuhiro

AU - Inadomi, John M.

AU - Suzuki, Hidekazu

AU - Kanai, Takanori

AU - Namiki, Shin

PY - 2016/10/1

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N2 - Background Assessment of the emergent endoscopy for upper gastrointestinal bleeding (UGIB) patients has important clinical implications. There is no validated criterion to triage. Aims To develop a simple score predicting an endoscopic intervention. Methods A prospective cohort study was conducted at a tertiary care centre. Primary outcome was the high-risk stigmata which were well-established endoscopic findings to determine the need for an endoscopic intervention. We created a simple score by multivariable logistic regression and compared with the Glasgow Blatchford Score (GBS). External validation was performed in a second cohort. Results 284 of consecutive 568 patients with suspected UGIB had the high-risk stigmata. Three variables were selected: “no daily use of proton pump inhibitors during one week before examination (+1 point)”, “shock index (heart rate/systolic blood pressure) ≥ 1 (+1 point)” and “urea/creatinine ≥ 140 (blood urea nitrogen/creatinine ≥ 30) (+1 point)”. The accumulating score (range 0–3) achieved an area under the receiver–operating characteristic curve (AUC) of 0.74 (95% confidence interval [CI], 0.70–0.78), which was superior to the GBS (AUC, 0.63; 95% CI, 0.59–0.68; p < 0.001). Validation in an external cohort demonstrated superiority to the GBS (AUC, 0.78 vs. 0.59; p < 0.001). Conclusions The simple score has greater accuracy than the GBS for assessing the need for an endoscopic intervention in cases of suspected UGIB. Further external validation should be performed to verify generalizability.

AB - Background Assessment of the emergent endoscopy for upper gastrointestinal bleeding (UGIB) patients has important clinical implications. There is no validated criterion to triage. Aims To develop a simple score predicting an endoscopic intervention. Methods A prospective cohort study was conducted at a tertiary care centre. Primary outcome was the high-risk stigmata which were well-established endoscopic findings to determine the need for an endoscopic intervention. We created a simple score by multivariable logistic regression and compared with the Glasgow Blatchford Score (GBS). External validation was performed in a second cohort. Results 284 of consecutive 568 patients with suspected UGIB had the high-risk stigmata. Three variables were selected: “no daily use of proton pump inhibitors during one week before examination (+1 point)”, “shock index (heart rate/systolic blood pressure) ≥ 1 (+1 point)” and “urea/creatinine ≥ 140 (blood urea nitrogen/creatinine ≥ 30) (+1 point)”. The accumulating score (range 0–3) achieved an area under the receiver–operating characteristic curve (AUC) of 0.74 (95% confidence interval [CI], 0.70–0.78), which was superior to the GBS (AUC, 0.63; 95% CI, 0.59–0.68; p < 0.001). Validation in an external cohort demonstrated superiority to the GBS (AUC, 0.78 vs. 0.59; p < 0.001). Conclusions The simple score has greater accuracy than the GBS for assessing the need for an endoscopic intervention in cases of suspected UGIB. Further external validation should be performed to verify generalizability.

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KW - Variceal bleeding

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