title: Risk stratification in acute upper GI bleeding: comparison of the AIMS65 score with the Glasgow-Blatchford and Rockall scoring systems.
abstract: OBJECTIVE
  The American College of Gastroenterology recommends early risk stratification in patients presenting with upper GI bleeding (UGIB). The AIMS65 score is a risk stratification score previously validated to predict inpatient mortality. The aim of this study was to validate the AIMS65 score as a predictor of inpatient mortality in patients with acute UGIB and to compare it with established pre- and postendoscopy risk scores.
  
  
  METHODS
  ICD-10 (International Classification of Diseases, Tenth Revision) codes identified patients presenting with UGIB requiring endoscopy. All patients were risk stratified by using the AIMS65, Glasgow-Blatchford score (GBS), pre-endoscopy Rockall, and full Rockall scores. The primary outcome was inpatient mortality. Secondary outcomes were a composite endpoint of inpatient mortality, rebleeding, and endoscopic, radiologic, or surgical intervention; blood transfusion requirement; intensive care unit (ICU) admission; rebleeding; and hospital length of stay. The area under the receiver-operating characteristic curve (AUROC) was calculated for each score.
  
  
  RESULTS
  Of the 424 study patients, 18 (4.2%) died and 69 (16%) achieved the composite endpoint. The AIMS65 score was superior to both the GBS (AUROC, 0.80 vs 0.76, P < .027) and the pre-endoscopy Rockall score (0.74, P = .001) and equivalent to the full Rockall score (0.78, P = .18) in predicting inpatient mortality. The AIMS65 score was superior to all other scores in predicting the need for ICU admission and length of hospital stay. AIMS65, GBS, and full Rockall scores were equivalent (AUROCs, 0.63 vs 0.62 vs 0.63, respectively) and superior to pre-endoscopy Rockall (AUROC, 0.55) in predicting the composite endpoint. GBS was superior to all other scores for predicting blood transfusion.
  
  
  CONCLUSIONS
  The AIMS65 score is a simple risk stratification score for UGIB with accuracy superior to that of GBS and pre-endoscopy Rockall scores in predicting in-hospital mortality and the need for ICU admission.
authors.affiliation: Department of Gastroenterology and Liver Transplant Unit, Austin Hospital, Heidelberg, Victoria, Australia.
authors.forename: Marcus
authors.initials: M
authors.lastname: Robertson
authors.affiliation: Department of Gastroenterology and Liver Transplant Unit, Austin Hospital, Heidelberg, Victoria, Australia.
authors.forename: Avik
authors.initials: A
authors.lastname: Majumdar
authors.affiliation: Department of Gastroenterology and Liver Transplant Unit, Austin Hospital, Heidelberg, Victoria, Australia.
authors.forename: Ray
authors.initials: R
authors.lastname: Boyapati
authors.affiliation: Department of Gastroenterology and Liver Transplant Unit, Austin Hospital, Heidelberg, Victoria, Australia.
authors.forename: William
authors.initials: W
authors.lastname: Chung
authors.affiliation: Department of Gastroenterology and Liver Transplant Unit, Austin Hospital, Heidelberg, Victoria, Australia.
authors.forename: Tom
authors.initials: T
authors.lastname: Worland
authors.affiliation: Department of Gastroenterology and Liver Transplant Unit, Austin Hospital, Heidelberg, Victoria, Australia.
authors.forename: Ryma
authors.initials: R
authors.lastname: Terbah
authors.affiliation: Department of Gastroenterology and Liver Transplant Unit, Austin Hospital, Heidelberg, Victoria, Australia.
authors.forename: James
authors.initials: J
authors.lastname: Wei
authors.affiliation: Department of Gastroenterology and Liver Transplant Unit, Austin Hospital, Heidelberg, Victoria, Australia.
authors.forename: Steve
authors.initials: S
authors.lastname: Lontos
authors.affiliation: Department of Gastroenterology and Liver Transplant Unit, Austin Hospital, Heidelberg, Victoria, Australia; Department of Medicine, The University of Melbourne, Austin Health, Heidelberg, Victoria, Australia.
authors.forename: Peter
authors.initials: P
authors.lastname: Angus
authors.affiliation: Department of Gastroenterology and Liver Transplant Unit, Austin Hospital, Heidelberg, Victoria, Australia; Department of Medicine, The University of Melbourne, Austin Health, Heidelberg, Victoria, Australia.
authors.forename: Rhys
authors.initials: R
authors.lastname: Vaughan
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D019540:Area Under Curve; D001794:Blood Pressure; D001803:Blood Transfusion / Q000706:statistics & numerical data; D001806:Blood Urea Nitrogen; D015897:Comorbidity; D016145:Endoscopy, Digestive System; D004935:Esophageal Diseases / Q000401:mortality* / Q000628:therapy; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000401:mortality* / Q000628:therapy; D006454:Hemoglobins / Q000378:metabolism; D017052:Hospital Mortality; D006760:Hospitalization; D006801:Humans; D007362:Intensive Care Units; D019934:International Normalized Ratio; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012372:ROC Curve; D012008:Recurrence; D018570:Risk Assessment; D012709:Serum Albumin / Q000378:metabolism; D012720:Severity of Illness Index; D013272:Stomach Diseases / Q000401:mortality* / Q000628:therapy
chemical_list: D006454:Hemoglobins; D012709:Serum Albumin