A New Scoring System to Predict High-Risk Groups in Upper Gastrointestinal Bleeding (UGIS)

A New Scoring System to Predict High-Risk Groups in Upper Gastrointestinal Bleeding and Comparison of the Found Score With Scoring Systems in the Literature

Upper gastrointestinal bleeding (UGIB) remains a common and potentially life-threatening emergency condition requiring early risk stratification to guide clinical management. Although several validated scoring systems such as Rockall, Glasgow-Blatchford Score (GBS), AIMS65, H3B2, ABC, ABL, and Pre-endoscopic Rockall (Pre-RS) are widely used, their discriminative performance for identifying patients at high clinical risk varies across populations.

This retrospective, single-center observational study included 312 adult patients admitted to the emergency department between January 2024 and January 2026 with clinical manifestations of UGIB. Patients were categorized into high-risk and low-risk groups based on clinically significant outcomes, including transfusion requirement, endoscopic/radiological/surgical intervention, intensive care unit admission, rebleeding, or in-hospital mortality.

The primary objective was to develop a novel risk score (HOLD_B), derived from independent predictors identified through multivariable logistic regression analysis. Receiver Operating Characteristic (ROC) curve analysis was used to determine optimal cut-off values for continuous predictors and to evaluate discriminative performance. The newly developed score was compared with established scoring systems using area under the curve (AUC) analysis and DeLong's test for pairwise comparisons.

The study aims to provide a simplified and clinically applicable risk stratification tool for early identification of high-risk UGIB patients in the emergency department setting.

Study Overview

• Status: Completed
• Conditions: High Risk Bleeding; Upper Gastrointestinal Bleeding (UGIB)

• Study Type: Observational
• Enrollment (Actual): 312

Contacts and Locations

Study Locations

• Turkey (Türkiye)
  • Izmir, Turkey (Türkiye)
    • Izmir Katip Çelebi University Faculty of Medicine

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

• Sampling Method: Non-Probability Sample

Study Population

Demographic characteristics, presenting complaints, comorbid conditions, regularly used medications, mental status, vital signs, laboratory values, admission locations, blood transfusion requirements, endoscopic hemostasis procedures, radiological interventions, surgical procedures, length of stay (LOS), readmissions, and in-hospital mortality data were obtained from the electronic patient record system.

All data were recorded by a single physician using a pre-prepared data collection form.

Description

Inclusion Criteria

Age ≥18 years

Consecutive patients presenting to the emergency department between January 2024 and January 2026

Clinical presentation suggestive of upper gastrointestinal bleeding, including hematemesis, melena, or hematochezia suspected to originate from the upper gastrointestinal tract due to rapid intestinal transit

Patients who underwent upper gastrointestinal endoscopy during the index hospitalization

Presence of endoscopic findings confirming upper gastrointestinal pathology

Availability of complete clinical, laboratory, and outcome data in the hospital information management system

Patients evaluated and managed in the Emergency Department of İzmir Atatürk Training and Research Hospital

Exclusion Criteria

Age <18 years

Patients presenting with cardiac arrest at admission

Intubated patients at the time of emergency department presentation

Presence of concomitant active infectious diseases

Patients diagnosed with esophageal variceal bleeding

Use of medications known to increase serum lactate levels, including:

metformin

β2-agonists

methotrexate

zidovudine

linezolid

Patients with missing or incomplete clinical or laboratory data

Patients whose hospital outcomes could not be determined during follow-up

Study Plan

How is the study designed?

Number of groups / cohorts

3

Cohorts and Interventions

Group / Cohort
upper gastrointestinal bleeding; clinical manifestations of upper gastrointestinal bleeding (UGIB) and subsequently hospitalized during
High-Risk upper gastrointestinal bleeding group; Patients were classified as high risk if they met at least one of the following criteria during hospitalization: Requirement for blood transfusion Endoscopic hemostatic intervention Radiological intervention Surgical intervention Intensive Care Unit (ICU) admission Re-bleeding In-hospital mortality This composite definition was used to reflect clinically significant deterioration or the need for advanced care.
Low risk upper gastrointestinal bleeding group; Patients who did not meet any of the above high-risk criteria during hospitalization were classified as low risk.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
The primary outcome is the ability of the HOLD-B score to identify patients with high-risk upper gastrointestinal bleeding.	The HOLD-B score (Hemoglobin, Lactate, Diastolic Blood Pressure, Blood Urea Nitrogen) is a risk stratification score developed in this study. The score ranges from 0 to 6, where higher scores indicate a higher probability of high-risk clinical outcomes. Based on ROC analysis, the optimal cut-off value is 3.5. High-risk upper gastrointestinal bleeding was defined as the occurrence of at least one of the following events during hospitalization: blood transfusion endoscopic hemostatic intervention intensive care unit admission rebleeding in-hospital mortality Predictive performance will be evaluated using receiver operating characteristic (ROC) curve analysis and area under the curve (AUC).	1 year

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
compare the effectiveness of the newly developed risk score	The predictive performance of the HOLD-B score will be compared with commonly used upper gastrointestinal bleeding risk scores, including: Glasgow-Blatchford Score (GBS) Rockall Score Pre-endoscopic Rockall Score AIMS65 Score ABC Score (Age, blood tests, comorbidities) H3B2 Score (Hemodynamic Instability, Hemoglobin, Hematemesis, Blood Urea Nitrogen (BUN), Melena) ABL Score (systolic blood pressure, hemoglobin, BUN/Creatinine, INR/Albumin) Lactate/Hemoglobin Discriminative performance will be evaluated using ROC curve analysis, and AUC values will be compared using the DeLong test.	1 year

Collaborators and Investigators

• Sponsor: Izmir Katip Celebi University

Publications and helpful links

General Publications

• Guner NG, Catal F, Yurumez Y, Guneysu F, Bostanci F. 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. BMC Emerg Med. 2025 Jul 18;25(1):131. doi: 10.1186/s12873-025-01291-z.

Study record dates

Study Major Dates

• Study Start (Actual): January 1, 2024
• Primary Completion (Actual): January 1, 2026
• Study Completion (Actual): January 1, 2026

Study Registration Dates

• First Submitted: March 3, 2026
• First Submitted That Met QC Criteria: March 3, 2026
• First Posted (Actual): March 9, 2026

Study Record Updates

• Last Update Posted (Actual): March 13, 2026
• Last Update Submitted That Met QC Criteria: March 10, 2026
• Last Verified: March 1, 2026

More Information

Terms related to this study

• Keywords: Upper Gastrointestinal Bleeding; risk scores; high risk bleeding
• Additional Relevant MeSH Terms: Pathologic Processes; Digestive System Diseases; Gastrointestinal Diseases; Hemorrhage; Pathological Conditions, Signs and Symptoms; Gastrointestinal Hemorrhage
• Other Study ID Numbers: IZMIR-KCU-03

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No