The Evaulation of Risk Scorings in Non-variceal Upper Gastrointestinal Bleedings

Abstract

Objective:Upper gastrointestinal (GI) bleeding is a major reason of mortality and morbidity today, and patients’ follow-up and treatment costs are still high. In our study, the values of risk scorings of the patients with upper GI bleeding in estimation of mortality and morbidity were evaluated.Method:One hundred sixty-nine patients who were admitted to emergency internal medicine in University of Health Sciences Turkey, İstanbul Bağcılar Training and Research Hospital Clinic of Internal Medicine due to the diagnosis of upper GI bleeding were reviewed retrospectively between January 2015 and January 2016 in the study. Patients with upper GI bleeding due to varices (esophageal and gastric) endoscopically were excluded from the study. Forrest scoring’s classification was made according to the endoscopic findings. Classification of bleeding ulcers according to their appearance is as follows; Forrest 1a; ‘‘gushing active bleeding’’, Forrest 1b; ‘‘oozing active bleeding’’, Forrest 2a; ‘‘visible non-bleeding vein’’, Forrest 2b; ‘‘adherent clot’’, Forrest 2c; ‘‘flat pigmented lesion’’, Forrest 3; ‘‘no evidence of bleeding’’. Rockall scoring’s classification uses clinical criteria (pulse, age, systolic blood pressure, comorbidity) in addition to endoscopic findings (diagnosis, hemorrhage). Accordingly, a score less than 3 carries good prognosis. Glasgow-Blatchford scoring’s classification was calculated according to the situation of urea nitrogen, hemoglobin, systolic blood pressure, pulse, melena occurrence, syncope, and hepatic or cardiac problems. In this scoring, patients may be in the range of 0-23 points and the need for endoscopic intervention increases according to rising in the score.Results:The average age of the participants in the study was 57.39±19.14 years. 72% of the cases (n=121) were male. While the presence of melena was observed in 88.7% of the cases, it was seen that 61.9% of the cases had peptic ulcer and 12.5% of the general surgery consultation was performed. It was determined that there was no statistically significant difference in the Forrest classifications of the cases in terms of hospitalization duration and blood transfusion (p>0.05). Rockall and Glasgow-Blatchford scores were statistically remarkably higher in patients with hospitalization duration, need for blood transfusion, rebleeding, intensive care follow-up, surgical intervention, and mortality (p<0.05).Conclusion:The association of Rockall and Glasgow-Blatchford risk scores with morbidity and mortality rates showed that patients should not be interpreted solely according to their endoscopic images. These scorings can be used in approach toward patients with Upper GI bleeding in comprehensive prospective studies.

Keywords

• risk assesment
• risk scores
• upper gi bleeding