High Glasgow Blatchford Score at admission is associated with recurrent bleeding after discharge for patients hospitalized with upper gastrointestinal bleeding.
OBJECTIVE
Upper gastrointestinal bleeding (UGIB) is associated with significant morbidity. The Glasgow Blatchford Score (GBS) can predict endoscopic intervention and in-hospital death, but the ability to predict post-discharge outcomes is unknown. The aims of the study were to determine whether the admission GBS is associated with post-discharge rebleeding and 30-day readmission following hospitalization for UGIB.


METHODS
In this prospective, observational, cohort study, consecutive patients who were hospitalized with UGIB were enrolled. Admission GBS scores were calculated, and patients with GBS > 7 were classified as high risk. Patients were contacted 30 days following discharge to determine: 1) rate of hospital readmission due to rebleeding, 2) all-cause readmissions, and 3) mortality. Multivariable Cox regression was used to determine associations between GBS, rebleeding, and readmission.


RESULTS
A total of 336 patients with UGIB were identified. Patients with high risk GBS were older (68 vs. 62 years; P = 0.01), and were more likely to receive blood (85 % vs. 39 %; P < 0.01) and require intensive care unit admission (64 % vs. 50 %; P = 0.02). Of the 309 patients who survived to discharge, 61 (20 %) were readmitted within 30 days, 25 (8 %) of whom had rebleeding. On multivariable analysis adjusting for the need for endoscopic intervention, high risk GBS patients had higher rebleeding rates (hazard ratio [HR] 3.32, 95 % confidence interval [CI] 1.26 - 11.4). On multivariable analysis, patients with more co-morbidities (HR 1.06, 95 %CI 1.01 - 1.11) and cirrhosis (HR 2.23, 95 %CI 1.19 - 4.04) had higher 30-day readmission rates.


CONCLUSIONS
High GBS scores were associated with higher rebleeding rates following discharge. Patients with high GBS scores (> 7) should be monitored following discharge as they have a high risk of rebleeding.
Division of Gastroenterology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States.
Neil
N
Sengupta
Division of Gastroenterology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States.
Elliot B
EB
Tapper
Division of Gastroenterology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States.
Vilas R
VR
Patwardhan
Division of Gastroenterology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States.
Gyanprakash A
GA
Ketwaroo
Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States.
Adarsh M
AM
Thaker
Division of Gastroenterology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States.
Daniel A
DA
Leffler
Division of Gastroenterology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States.
Joseph D
JD
Feuerstein
D000368:Aged; D004935:Esophageal Diseases / Q000175:diagnosis*; D005260:Female; D005500:Follow-Up Studies; D006471:Gastrointestinal Hemorrhage / Q000175:diagnosis*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010343:Patient Admission; D010351:Patient Discharge; D010359:Patient Readmission / Q000706:statistics & numerical data*; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012008:Recurrence; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D013272:Stomach Diseases / Q000175:diagnosis*