Clinical Endoscopy

The Korean Society of Gastrointestinal Endoscopy (대한소화기내시경학회)
권호 표지
DOI QR코드

DOI QR Code

Risk Stratification in Cancer Patients with Acute Upper GastrointestinalBleeding: Comparison of Glasgow-Blatchford, Rockall and AIMS65, and Development of a New Scoring System

  • Matheus Cavalcante Franco (Hospital Sirio-Libanes) ;
  • Sunguk Jang (Department of Gastroenterology and Hepatology, Cleveland Clinic) ;
  • Bruno da Costa Martins (Endoscopy Unit, Cancer Institute of the University of Sao Paulo) ;
  • Tyler Stevens (Department of Gastroenterology and Hepatology, Cleveland Clinic) ;
  • Vipul Jairath (Western University) ;
  • Rocio Lopez (Department of Gastroenterology and Hepatology, Cleveland Clinic) ;
  • John J. Vargo (Department of Gastroenterology and Hepatology, Cleveland Clinic) ;
  • Alan Barkun (Division of Gastroenterology, McGill University and the McGill University Health Centre) ;
  • Fauze Maluf-Filho (Endoscopy Unit, Cancer Institute of the University of Sao Paulo)
  • Received : 2021.03.28
  • Accepted : 2021.08.29
  • Published : 2022.03.30
Download PDF
⟨ Previous Next ⟩

Abstract

Background/Aims: Few studies have measured the accuracy of prognostic scores for upper gastrointestinal bleeding (UGIB) among cancer patients. Thereby, we compared the prognostic scores for predicting major outcomes in cancer patients with UGIB. Secondarily, we developed a new model to detect patients who might require hemostatic care. Methods: A prospective research was performed in a tertiary hospital by enrolling cancer patients admitted with UGIB. Clinical and endoscopic findings were obtained through a prospective database. Multiple logistic regression analysis was performed to gauge the power of each score. Results: From April 2015 to May 2016, 243 patients met the inclusion criteria. The AIMS65 (area under the curve [AUC] 0.85) best predicted intensive care unit admission, while the Glasgow-Blatchford score best predicted blood transfusion (AUC 0.82) and the low-risk group (AUC 0.92). All scores failed to predict hemostatic therapy and rebleeding. The new score was superior (AUC 0.74) in predicting hemostatic therapy. The AIMS65 (AUC 0.84) best predicted in-hospital mortality. Conclusions: The scoring systems for prognostication were validated in the group of cancer patients with UGIB. A new score was developed to predict hemostatic therapy. Following this result, future prospective research should be performed to validate the new score.

Keywords

References

  1. Maluf-Filho F, Martins BC, de Lima MS, et al. Etiology, endoscopic management and mortality of upper gastrointestinal bleeding in patients with cancer. United European Gastroenterol J 2013;1:60-67. 
  2. Targownik LE, Nabalamba A. Trends in management and outcomes of acute nonvariceal upper gastrointestinal bleeding: 1993-2003. Clin Gastroenterol Hepatol 2006;4:1459-1466. 
  3. Garcia-Tsao G, Bosch J. Management of varices and variceal hemorrhage in cirrhosis. N Engl J Med 2010;362:823-832. 
  4. Franco MC, Nakao FS, Rodrigues R, Maluf-Filho F, Paulo GA de, Libera ED. Proposal of a clinical care pathway for the management of acute upper gastrointestinal bleeding. Arq Gastroenterol 2015;52:283-292. 
  5. Barkun AN, Almadi M, Kuipers EJ, et al. Management of nonvariceal upper gastrointestinal bleeding: guideline recommendations from the International Consensus Group. Ann Intern Med 2019;171:805-822. 
  6. Rockall TA, Logan RF, Devlin HB, Northfield TC. Risk assessment after acute upper gastrointestinal haemorrhage. Gut 1996;38:316-321. 
  7. Vreeburg EM, Terwee CB, Snel P, et al. Validation of the Rockall risk scoring system in upper gastrointestinal bleeding. Gut 1999;44:331-335. 
  8. Blatchford O, Murray WR, Blatchford M. A risk score to predict need for treatment for upper-gastrointestinal haemorrhage. Lancet 2000;356:1318-1321. 
  9. Saltzman JR, Tabak YP, Hyett BH, Sun X, Travis AC, Johannes RS. A simple risk score accurately predicts in-hospital mortality, length of stay, and cost in acute upper GI bleeding. Gastrointest Endosc 2011;74:1215-1224. 
  10. Hyett BH, Abougergi MS, Charpentier JP, et al. The AIMS65 score compared with the Glasgow-Blatchford score in predicting outcomes in upper GI bleeding. Gastrointest Endosc 2013;77:551-557. 
  11. Martins BC, Wodak S, Gusmon CC, et al. Argon plasma coagulation for the endoscopic treatment of gastrointestinal tumor bleeding: a retrospective comparison with a non-treated historical cohort. United European Gastroenterol J 2016;4:49-54. 
  12. Kim YI, Choi IJ, Lee JY, Kim CG, Kim HK, Park YL. Comparison of the performance of risk scoring systems for tumor bleeding in patients with inoperable gastric cancer. Endoscopy 2020;52:359-367. 
  13. Ahn S, Lim KS, Lee YS, Lee JL. Blatchford score is a useful tool for predicting the need for intervention in cancer patients with upper gastrointestinal bleeding. J Gastroenterol Hepatol 2013;28:1288-1294. 
  14. Laine L, Spiegel B, Rostom A, et al. Methodology for randomized trials of patients with nonvariceal upper gastrointestinal bleeding: recommendations from an international consensus conference. Am J Gastroenterol 2010;105:540-550. 
  15. DeLong ER, DeLong DM, Clarke-Pearson DL. Comparing the areas under two or more correlated receiver operating characteristic curves: a nonparametric approach. Biometrics 1988;44:837-845. 
  16. Youden WJ. Index for rating diagnostic tests. Cancer 1950;3:32-35. 
  17. Robertson M, Majumdar A, Boyapati R, et al. Risk stratification in acute upper GI bleeding: comparison of the AIMS65 score with the Glasgow-Blatchford and Rockall scoring systems. Gastrointest Endosc 2016;83:1151-1160. 
  18. Martinez-Cara JG, Jimenez-Rosales R, Ubeda-Munoz M, de Hierro ML, de Teresa J, Redondo-Cerezo E. Comparison of AIMS65, Glasgow-Blatchford score, and Rockall score in a European series of patients with upper gastrointestinal bleeding: performance when predicting in-hospital and delayed mortality. United European Gastroenterol J 2016;4:371-379. 
  19. Hwang JH, Fisher DA, Ben-Menachem T, et al. The role of endoscopy in the management of acute non-variceal upper GI bleeding. Gastrointest Endosc 2012;75:1132-1138. 
  20. Chen YI, Barkun AN, Soulellis C, Mayrand S, Ghali P. Use of the endoscopically applied hemostatic powder TC-325 in cancer-related upper GI hemorrhage: preliminary experience (with video). Gastrointest Endosc 2012;75:1278-1281. 
  21. Shin J, Cha B, Park JS, et al. Efficacy of a novel hemostatic adhesive powder in patients with upper gastrointestinal tumor bleeding. BMC Gastroenterol 2021;21:40. 
  22. Stanley AJ, Laine L, Dalton HR, et al. Comparison of risk scoring systems for patients presenting with upper gastrointestinal bleeding: international multicentre prospective study. BMJ 2017;356:i6432. 
  23. Abougergi MS, Charpentier JP, Bethea E, et al. A prospective, multicenter study of the AIMS65 score compared with the Glasgow-Blatchford score in predicting upper gastrointestinal hemorrhage outcomes. J Clin Gastroenterol 2016;50:464-469. 
  24. van Leerdam ME. Epidemiology of acute upper gastrointestinal bleeding. Best Pract Res Clin Gastroenterol 2008;22:209-224. 
  25. Maluf-Filho F. Predicting clinical outcomes in patients with bleeding from gastric cancer: novel tools are needed to nail it! Endoscopy 2020;52:332-333.