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 6, Number 2, April 2013, pages 56-62

Upper Gastrointestinal Hemorrhage: Validation of the Severity Score

Figure 1. Score predicted probability of severity/urgency levels in the development data (solid lines) and the validation data (dash lines). Vertical dotted lines represent boundaries (cut-off points) for classifying patients into non-urgent, urgent and emergent groups.

**Table 1.** Score Assignment Scheme for Classifying UGIH Severity
Clinical characteristics	Criteria	Assigned score
Modified from the original scoring chart (with permission).
Age (year)	< 60	0
≥ 60	1
Pulse (/min)	< 100	0
≥ 100	1
Systolic pressure (mmHg)	< 100	10.5
≥ 100	0
Hemoglobin (g/dL)	< 10	6
≥ 10	0
BUN (mg/dL)	≤ 35	0
> 35	2
Cirrhosis	no	0
yes	2
Hepatic failure	no	0
yes	4.5

Table 1. Score Assignment Scheme for Classifying UGIH Severity

Clinical characteristics

Criteria

Assigned score

Modified from the original scoring chart (with permission).

Age (year)

< 60

≥ 60

Pulse (/min)

< 100

≥ 100

Systolic pressure (mmHg)

< 100

10.5

≥ 100

Hemoglobin (g/dL)

< 10

≥ 10

BUN (mg/dL)

≤ 35

> 35

Cirrhosis

yes

Hepatic failure

yes

4.5

**Table 2.** Clinical Characteristics of UGIH Patients in the Development and the Validation Data
Characteristics	Development (n = 984)	Validation (n = 423)	P-value
SD: standard deviation.
Demographics
Male (n, %)	651	66.2	298	70.4	0.121
Age (year)	58.6	± 15.6	59.4	± 16.5	0.407
Mode of presentation (n, %)
Hematemesis	455	46.2	183	43.3	0.321
Coffee ground vomiting	196	19.9	76	18.0	0.419
Hematochezia	65	6.6	33	7.8	0.425
Melena	574	58.3	227	53.7	0.113
Syncope	192	19.5	73	17.3	0.335
Hemodynamics
Pulse (/min)	91.4	± 16.0	91.5	± 16.0	0.879
SBP (mmHg)	119.0	± 23.0	121.3	± 23.3	0.078
Biochemicals
Hemoglobin (g/dL)	8.1	± 2.9	8.0	± 2.9	0.511
BUN (mg/dL)	33.6	± 21.3	35.1	± 23.0	0.223
Co-morbidities (n, %)
Cirrhosis	141	14.3	55	13.0	0.557
Hepatic failure	8	0.8	8	1.9	0.099
Cardiac failure	9	0.9	3	0.7	0.999
Renal failure	69	7.0	49	11.6	0.006
Criterion-classified severity (n, %)
Mild	241	24.5	99	23.4	0.408
Moderate	631	64.1	268	63.4
Severe	112	11.4	56	13.2
Clinical outcomes (n, %)
Re-bleeding	64	6.5	14	3.3	0.016
Dead	20	2.0	20	4.7	0.008

Table 2. Clinical Characteristics of UGIH Patients in the Development and the Validation Data

Characteristics

Development (n = 984)

Validation (n = 423)

P-value

mean

± SD

mean

± SD

SD: standard deviation.

Demographics

Male (n, %)

651

66.2

298

70.4

0.121

Age (year)

58.6

± 15.6

59.4

± 16.5

0.407

Mode of presentation (n, %)

Hematemesis

455

46.2

183

43.3

0.321

Coffee ground vomiting

196

19.9

18.0

0.419

Hematochezia

6.6

7.8

0.425

Melena

574

58.3

227

53.7

0.113

Syncope

192

19.5

17.3

0.335

Hemodynamics

Pulse (/min)

91.4

± 16.0

91.5

± 16.0

0.879

SBP (mmHg)

119.0

± 23.0

121.3

± 23.3

0.078

Biochemicals

Hemoglobin (g/dL)

8.1

± 2.9

8.0

± 2.9

0.511

BUN (mg/dL)

33.6

± 21.3

35.1

± 23.0

0.223

Co-morbidities (n, %)

Cirrhosis

141

14.3

13.0

0.557

Hepatic failure

0.8

1.9

0.099

Cardiac failure

0.9

0.7

0.999

Renal failure

7.0

11.6

0.006

Criterion-classified severity (n, %)

Mild

241

24.5

23.4

0.408

Moderate

631

64.1

268

63.4

Severe

112

11.4

13.2

Clinical outcomes (n, %)

Re-bleeding

6.5

3.3

0.016

Dead

2.0

4.7

0.008

**Table 3.** Score-Derived UGIH Urgency Levels in the Development and the Validation Data
Score-classified urgency levels	Development (n = 984)	Validation (n = 423)	P-value
SD: standard deviation.
Mean score (± SD)	9.1	± 5.9	8.5	± 5.7	0.064
Urgency level (n, %)
Non-urgent	188	19.1	84	19.9	0.082
Urgent	578	58.7	269	63.6
Emergent	218	22.2	70	16.5

Table 3. Score-Derived UGIH Urgency Levels in the Development and the Validation Data

Score-classified urgency levels

Development (n = 984)

Validation (n = 423)

P-value

SD: standard deviation.

Mean score (± SD)

9.1

± 5.9

8.5

± 5.7

0.064

Urgency level (n, %)

Non-urgent

188

19.1

19.9

0.082

Urgent

578

58.7

269

63.6

Emergent

218

22.2

16.5

**Table 4.** Score-Classified Urgency, and Criterion-Classified UGIH Severity in the Validation Data
Score-classified urgency levels	Score range	Criterion-classified severity levels	Risk estimation validity
*Inter-quartile range; SD: standard deviation.
Mean ± SD			2.9 ± 4.0	9.0 ± 4.1	16.1 ± 4.9
IQR*			0 - 4	7 - 9	12.0 - 19.5
Non-urgen	(n = 84)	< 4	73	10	1	-	17.3	2.6
Urgent	(n = 269)	4 - 16	26	227	16	6.1	53.7	3.8
Emergent	(n = 70)	> 16	0	31	39	7.3	9.2	-
					Total	13.4	80.2	6.4

Table 4. Score-Classified Urgency, and Criterion-Classified UGIH Severity in the Validation Data

Score-classified urgency levels

Score range

Criterion-classified severity levels

Risk estimation validity

Mild (n = 99)

Moderate (n = 268)

Severe (n = 56)

Over

Correct

Under

*Inter-quartile range; SD: standard deviation.

Mean ± SD

2.9 ± 4.0

9.0 ± 4.1

16.1 ± 4.9

IQR*

0 - 4

7 - 9

12.0 - 19.5

Non-urgen

(n = 84)

< 4

17.3

2.6

Urgent

(n = 269)

4 - 16

227

6.1

53.7

3.8

Emergent

(n = 70)

> 16

7.3

9.2

Total

13.4

80.2

6.4

**Table 5.** Discriminative Performance of the UGIH Severity Score in the Development and the Validation Data
Prediction/discrimination	Development (n = 984)	Validation (n = 423)	P-value
AuROC: area under receiver operating characteristic curve; CI: confidence interval.
Mild vs rest	84.11	81.71 - 86.37	86.92	83.41 - 90.05	0.360
Severe vs rest	86.56	84.30 - 88.65	88.11	84.72 - 91.10	0.589

Table 5. Discriminative Performance of the UGIH Severity Score in the Development and the Validation Data

Prediction/discrimination

Development (n = 984)

Validation (n = 423)

P-value

AuROC (%)

95%CI

AuROC (%)

95%CI

AuROC: area under receiver operating characteristic curve; CI: confidence interval.

Mild vs rest

84.11

81.71 - 86.37

86.92

83.41 - 90.05

0.360

Severe vs rest

86.56

84.30 - 88.65

88.11

84.72 - 91.10

0.589