Comparison of the new risk score (ABL) with the Glasgow Blatchford Score, AIMS65, and pre-endoscopic Rockall Score in patients with upper gastrointestinal bleeding admitted to the emergency department

Abstract

Background

Upper gastrointestinal bleeding (UGIB) continues to be a major global health concern, contributing substantially to both morbidity and mortality. This highlights the need for efficient and reliable risk assessment methods, particularly in emergency care settings. The primary objective of this study was to create a new risk scoring system that is easier to apply, more practical in clinical workflows, and highly effective for evaluating patients presenting to the emergency department with UGIB.

Methods

This retrospective observational study was conducted at a single center by analyzing records of patients aged 18 years and older who presented to the Emergency Medicine Department of Sakarya Training and Research Hospital with clinical signs and symptoms suggestive of upper gastrointestinal bleeding (UGIB) between January 2022 and June 2023. For analytical purposes, patients were categorized into six distinct subgroups. Those assigned to transfusion, intervention, intensive care unit (ICU), readmission, or mortality groups were collectively defined as high-risk patients. Based on the collected clinical data, a novel scoring system—referred to as the ABL score—was developed. The diagnostic performance of this new score in identifying high-risk patients and each outcome subgroup was then evaluated and compared to existing scoring tools: the Glasgow Blatchford Score (GBS), AIMS65, and the pre-endoscopic Rockall Score (Pre-RS).

Results

A total of 589 patients were included, with a median age of 67 years, with a male ratio of 66.2%. ABL score, which includes Age, systolic Blood pressure, Laboratory parameters (hemoglobin, BUN/creatinine ratio, and international normalized ratio/albümin) was found to be more effective in predicting high-risk groups compared to the GBS, AIMS65, and Pre-RS scores ([AUROC]: 0.86, 0.806, 0.71, and 0.704, respectively; p < 0.05). The ABL score also performed better in predicting transfusion and readmission subgroups. (AUROC: 0.886 and 0.719, respectively).

Conclusion

The ABL scoring system demonstrated higher predictive performance than GBS, AIMS65, and Pre-RS, particularly in identifying high-risk patients, transfusion requirements, and the likelihood of readmission. However, confirmation of these findings requires validation through larger, prospective studies.