Gastroenterol Res

Gastroenterology Research, ISSN 1918-2805 print, 1918-2813 online, Open Access

Article copyright, the authors; Journal compilation copyright, Gastroenterol Res and Elmer Press Inc

Journal website http://www.gastrores.org

Original Article

Volume 8, Number 2, April 2015, pages 186-192

Gastrointestinal Hemorrhage Severity Triage: Locally Derived Score May Outperform Existing Scoring Systems

Figure 1. Discrimination of upper gastrointestinal hemorrhage patients into mild, moderate and severe, by the Blatchford score, the pre-endoscopic Rockall score, and the local UGIH score. Original scores were transformed into the same scaled standardized score from 0 to 100.

**Table 1.** Scoring Scheme for the Blatchford Score
Item indicators		Categories	Score
BUN (mg/dL)		< 18.2	0
	18.2 - 22.3	2
	22.4 - 27.9	3
	28 - 69.9	4
	≥ 70	6
Hemoglobin (g/dL)	Male	> 13	0
12.0 - 12.9	1
10.0 - 11.9	3
< 10.0	6
Female	> 12	0
10.0 - 11.9	1
< 10.0	6
Systolic blood pressure (mm Hg)		≥ 110	0
	100 - 109	1
	90 - 99	2
	< 90	3
Pulse rate (/min)		< 100	0
	≥ 100	1
Melena		Yes	1
	No	0
Syncope		Yes	2
	No	0
Hepatic diseases		Yes	2
	No	0
Cardiac failure		Yes	2
	No	0

Table 1. Scoring Scheme for the Blatchford Score

Item indicators

**Table 2.** Scoring Scheme for the Pre-Endoscopic Rockall Score
Item indicators	Categories	Criteria	Score
Age (years)	< 60		0
60 - 79		1
≥ 80		2
Shock	No shock	SBP > 100 mm Hg	0
Pulse < 100/min
Tachycardia	SBP > 100 mm Hg	1
Pulse > 100/min
Hypotension	SBP < 100 mm Hg	2
Comorbidity	No major comorbidity		0
Cardiac failure		2
Ischemic heart disease
Any major comorbidity
Renal or liver failure		3
Disseminated malignancy

**Table 3.** Scoring Scheme for the Local UGIH Score
Item indicators	Categories	Score
Age (years)	≥ 60	1
< 60	0
Pulse (/min)	≥ 100	1
< 100	0
Systolic blood pressure (mm Hg)	< 100	10.5
≥ 100	0
Hemoglobin (g/dL)	< 10	6
≥ 10	0
BUN (mg/dL)	≥ 35	2
< 35	0
Cirrhosis	Yes	2
No	0
Hepatic failure	Yes	4.5
No	0

Categories

Score

Age (years)

≥ 60

< 60

Pulse (/min)

≥ 100

< 100

Systolic blood pressure (mm Hg)

< 100

10.5

≥ 100

Hemoglobin (g/dL)

< 10

≥ 10

BUN (mg/dL)

≥ 35

< 35

Cirrhosis

Yes

Hepatic failure

Yes

4.5

**Table 4.** Characteristics of Patients With Upper Gastrointestinal Hemorrhage and Score Distributions
Characteristics	UGIH severity	P-value
Demographic and presentations
Age (years)	53.0 ± 18.3	61.2 ± 14.5	58.7 ± 14.6	< 0.001
Hematemesis, n (%)	164 (49.4)	360 (42.5)	113 (49.6)	0.738
Coffee ground vomiting, n (%)	85 (25.6)	140 (16.5)	47 (20.6)	0.054
Hematochezia, n (%)	22 (6.6)	53 (6.3)	23 (10.1)	0.168
Melena, n (%)	141 (42.5)	531 (62.7)	129 (56.6)	< 0.001
Syncope, n (%)	39 (11.8)	172 (20.3)	54 (23.7)	< 0.001
Vital signs and biochemicals
Pulse (/min)	90.2 ± 16.3	91.5 ± 15.7	93.2 ± 16.6	0.094
Systolic blood pressure (mm Hg)	129.6 ± 20.3	123.8 ± 19.4	90.7 ± 15.8	< 0.001
Hemoglobin (g/dL)	11.7 ± 2.4	6.9 ± 2.1	7.3 ± 2.6	< 0.001
BUN (mg/dL)	23.4 ± 16.4	37.0 ± 22.1	38.5 ± 22.7	< 0.001
Co-morbidity
Cirrhosis, n (%)	20 (6.0)	123 (14.5)	53 (23.2)	< 0.001
Hepatic failure, n (%)	2 (0.6)	8 (0.9)	6 (2.6)	0.038
Cardiac failure, n (%)	1 (0.3)	6 (0.7)	5 (2.2)	0.024
Renal failure, n (%)	5 (1.5)	82 (9.7)	32 (14.0)	< 0.001
Clinical outcomes
Re-bleeding, n (%)	7 (2.1)	44 (5.19)	27 (11.8)	< 0.001
Dead, n (%)	0 (0)	2 (0.24)	38 (16.7)	< 0.001
Score types
The Blatchford score	5.0 ± 3.8	10.3 ± 2.7	12.0 ± 2.7	< 0.001
The pre-endoscopic Rockall score	0.7 ± 0.8	1.2 ± 1.2	2.7 ± 1.3	< 0.001
The local UGIH score	3.3 ± 4.1	9.0 ± 4.2	16.7 ± 4.0	< 0.001

Table 4. Characteristics of Patients With Upper Gastrointestinal Hemorrhage and Score Distributions

Characteristics

UGIH severity

P-value

Mild (mean ± SD)

Moderate (mean ± SD)

Severe (mean ± SD)

Demographic and presentations

Age (years)

53.0 ± 18.3

61.2 ± 14.5

58.7 ± 14.6

< 0.001

Hematemesis, n (%)

164 (49.4)

360 (42.5)

113 (49.6)

0.738

Coffee ground vomiting, n (%)

85 (25.6)

140 (16.5)

47 (20.6)

0.054

Hematochezia, n (%)

22 (6.6)

53 (6.3)

23 (10.1)

0.168

Melena, n (%)

141 (42.5)

531 (62.7)

129 (56.6)

< 0.001

Syncope, n (%)

39 (11.8)

172 (20.3)

54 (23.7)

< 0.001

Vital signs and biochemicals

Pulse (/min)

90.2 ± 16.3

91.5 ± 15.7

93.2 ± 16.6

0.094

Systolic blood pressure (mm Hg)

129.6 ± 20.3

123.8 ± 19.4

90.7 ± 15.8

< 0.001

Hemoglobin (g/dL)

11.7 ± 2.4

6.9 ± 2.1

7.3 ± 2.6

< 0.001

BUN (mg/dL)

23.4 ± 16.4

37.0 ± 22.1

38.5 ± 22.7

< 0.001

Co-morbidity

Cirrhosis, n (%)

20 (6.0)

123 (14.5)

53 (23.2)

< 0.001

Hepatic failure, n (%)

2 (0.6)

8 (0.9)

6 (2.6)

0.038

Cardiac failure, n (%)

1 (0.3)

6 (0.7)

5 (2.2)

0.024

Renal failure, n (%)

5 (1.5)

82 (9.7)

32 (14.0)

< 0.001

Clinical outcomes

Re-bleeding, n (%)

7 (2.1)

44 (5.19)

27 (11.8)

< 0.001

Dead, n (%)

0 (0)

2 (0.24)

38 (16.7)

< 0.001

Score types

The Blatchford score

5.0 ± 3.8

10.3 ± 2.7

12.0 ± 2.7

< 0.001

The pre-endoscopic Rockall score

0.7 ± 0.8

1.2 ± 1.2

2.7 ± 1.3

< 0.001

The local UGIH score

3.3 ± 4.1

9.0 ± 4.2

16.7 ± 4.0

< 0.001

**Table 5.** Discriminative and Diagnostic Indices of Bradford Score, Rockall Score and UGIH Score
Indices	Score types	P-value
Discrimination: AuROC (%)
Mild vs. rest	87.3	70.0	86.8	0.693	< 0.001
Severe vs. rest	74.6	86.1	90.5	< 0.001	< 0.001
Diagnostic
Sensitivity (%)
Mild vs. rest	96.8	100	95.7	0.125	< 0.001
Severe vs. rest	9.2	16.2	62.3	< 0.001	< 0.001
Specificity (%)
Mild vs. rest	59.0	0	68.7	< 0.001	< 0.001
Severe vs. rest	99.7	94.1	92.0	< 0.001	0.029
PPV (%)
Mild vs. rest	88.4	76.4	90.8	0.037	< 0.001
Severe vs. rest	84.0	34.9	60.2	< 0.001	< 0.001
NPV (%)
Mild vs. rest	85.2	-	83.2	0.146	-
Severe vs. rest	85.0	85.3	92.7	< 0.001	< 0.001
Correctly classified (%)
Mild vs. rest	87.9	76.4	89.3	0.243	< 0.001
Severe vs. rest	85.0	81.2	87.2	0.092	< 0.001

Table 5. Discriminative and Diagnostic Indices of Bradford Score, Rockall Score and UGIH Score

Indices

Score types

P-value

Bradford
score¹

Rockall
score²

UGIH
score³

3 vs. 1

3 vs. 2

Discrimination: AuROC (%)

Mild vs. rest

87.3

70.0

86.8

0.693

< 0.001

Severe vs. rest

74.6

86.1

90.5

< 0.001

Diagnostic

Sensitivity (%)

Mild vs. rest

96.8

100

95.7

0.125

< 0.001

Severe vs. rest

9.2

16.2

62.3

< 0.001

Specificity (%)

Mild vs. rest

59.0

68.7

< 0.001

Severe vs. rest

99.7

94.1

92.0

< 0.001

0.029

PPV (%)

Mild vs. rest

88.4

76.4

90.8

0.037

< 0.001

Severe vs. rest

84.0

34.9

60.2

< 0.001

NPV (%)

Mild vs. rest

85.2

83.2

0.146

Severe vs. rest

85.0

85.3

92.7

< 0.001

Correctly classified (%)

Mild vs. rest

87.9

76.4

89.3

0.243

< 0.001

Severe vs. rest

85.0

81.2

87.2

0.092

< 0.001