title: Evaluation of scoring models for identifying the need for therapeutic intervention of upper gastrointestinal bleeding: A new prediction score model for Japanese patients.
abstract: OBJECTIVE
  Multiple scoring systems have been developed to predict outcomes in patients with upper gastrointestinal bleeding. We determined how well these and a newly established scoring model predict the need for therapeutic intervention, excluding transfusion, in Japanese patients with upper gastrointestinal bleeding.
  
  
  METHODS
  We reviewed data from 212 consecutive patients with upper gastrointestinal bleeding. Patients requiring endoscopic intervention, operation, or interventional radiology were allocated to the therapeutic intervention group. Firstly, we compared areas under the curve for the Glasgow-Blatchford, Clinical Rockall, and AIMS65 scores. Secondly, the scores and factors likely associated with upper gastrointestinal bleeding were analyzed with a logistic regression analysis to form a new scoring model. Thirdly, the new model and the existing model were investigated to evaluate their usefulness.
  
  
  RESULTS
  Therapeutic intervention was required in 109 patients (51.4%). The Glasgow-Blatchford score was superior to both the Clinical Rockall and AIMS65 scores for predicting therapeutic intervention need (area under the curve, 0.75 [95% confidence interval, 0.69-0.81] vs 0.53 [0.46-0.61] and 0.52 [0.44-0.60], respectively). Multivariate logistic regression analysis retained seven significant predictors in the model: systolic blood pressure <100 mmHg, syncope, hematemesis, hemoglobin <10 g/dL, blood urea nitrogen ≥22.4 mg/dL, estimated glomerular filtration rate ≤ 60 mL/min per 1.73 m2, and antiplatelet medication. Based on these variables, we established a new scoring model with superior discrimination to those of existing scoring systems (area under the curve, 0.85 [0.80-0.90]).
  
  
  CONCLUSIONS
  We developed a superior scoring model for identifying therapeutic intervention need in Japanese patients with upper gastrointestinal bleeding.
authors.affiliation: Department of Internal Medicine, Hirosaki Municipal Hospital, Hirosaki, Japan. chikaran0601@yahoo.co.jp.|Department of Gastroenterology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan. chikaran0601@yahoo.co.jp.
authors.forename: Chikara
authors.initials: C
authors.lastname: Iino
authors.affiliation: Department of Internal Medicine, Hirosaki Municipal Hospital, Hirosaki, Japan.|Division of Endoscopy, Hirosaki University Hospital, Hirosaki, Japan.
authors.forename: Tatsuya
authors.initials: T
authors.lastname: Mikami
authors.affiliation: Department of Internal Medicine, Hirosaki Municipal Hospital, Hirosaki, Japan.|Department of Gastroenterology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan.
authors.forename: Takasato
authors.initials: T
authors.lastname: Igarashi
authors.affiliation: Department of Internal Medicine, Hirosaki Municipal Hospital, Hirosaki, Japan.
authors.forename: Tomoyuki
authors.initials: T
authors.lastname: Aihara
authors.affiliation: Department of Internal Medicine, Hirosaki Municipal Hospital, Hirosaki, Japan.
authors.forename: Kentaro
authors.initials: K
authors.lastname: Ishii
authors.affiliation: Department of Internal Medicine, Hirosaki Municipal Hospital, Hirosaki, Japan.
authors.forename: Jyuichi
authors.initials: J
authors.lastname: Sakamoto
authors.affiliation: Department of Internal Medicine, Hirosaki Municipal Hospital, Hirosaki, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Tono
authors.affiliation: Department of Gastroenterology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan.
authors.forename: Shinsaku
authors.initials: S
authors.lastname: Fukuda
mesh_terms: D001803:Blood Transfusion; D004724:Endoscopy; D006471:Gastrointestinal Hemorrhage / Q000145:classification*; D006801:Humans; D018570:Risk Assessment; D012720:Severity of Illness Index
keywords: AIMS65 score; Glasgow-Blatchford score; clinical Rockall score; gastrointestinal hemorrhage; predictive value of test