Clinical Application of AIMS65 Scores to Predict Outcomes in Patients with Upper Gastrointestinal Hemorrhage

Ragesh Babu Thandassery, Manik Sharma, Anil K John, Khalid Mohsin Al-Ejji, Hamidulla Wani, Khaleel Sultan, Muneera Al-Mohannadi, Rafie Yakoob, Moutaz Derbala, Nazeeh Al-Dweik, Muhammed Tariq Butt, Saad Rashid Al-Kaabi, Ragesh Babu Thandassery, Manik Sharma, Anil K John, Khalid Mohsin Al-Ejji, Hamidulla Wani, Khaleel Sultan, Muneera Al-Mohannadi, Rafie Yakoob, Moutaz Derbala, Nazeeh Al-Dweik, Muhammed Tariq Butt, Saad Rashid Al-Kaabi

Abstract

Background/aims: To evaluate the ability of the recently proposed albumin, international normalized ratio (INR), mental status, systolic blood pressure, age >65 years (AIMS65) score to predict mortality in patients with acute upper gastrointestinal bleeding (UGIB).

Methods: AIMS65 scores were calculated in 251 consecutive patients presenting with acute UGIB by allotting 1 point each for albumin level <30 g/L, INR >1.5, alteration in mental status, systolic blood pressure ≤90 mm Hg, and age ≥65 years. Risk stratification was done during the initial 12 hours of hospital admission.

Results: Intensive care unit (ICU) admission, endoscopic therapy, or surgery were required in 51 patients (20.3%), 64 (25.5%), and 12 (4.8%), respectively. The predictive accuracy of AIMS65 scores ≥2 was high for blood transfusion (area under the receiver operator characteristic curve [AUROC], 0.59), ICU admission (AUROC, 0.61), and mortality (AUROC, 0.74). The overall mortality was 10.3% (n=26), and was 3%, 7.8%, 20%, 36%, and 40% for AIMS65 scores of 0, 1, 2, 3, and 4, respectively; these values were significantly higher in those with scores ≥2 (30.9%) than in those with scores <2 (4.5%, p<0.001).

Conclusions: AIMS65 is a simple, accurate, non-endoscopic risk score that can be applied early (within 12 hours of hospital admission) in patients with acute UGIB. AIMS65 scores ≥2 predict high in-hospital mortality.

Keywords: AIMS65 score; Endoscopy; Mortality; Upper gastrointestinal bleed.

Conflict of interest statement

Conflicts of Interest: The authors have no financial conflicts of interest.

References

    1. Loperfido S, Baldo V, Piovesana E, et al. Changing trends in acute upper-GI bleeding: a population-based study. Gastrointest Endosc. 2009;70:212–224.
    1. Stanley AJ, Ashley D, Dalton HR, et al. Outpatient management of patients with low-risk upper-gastrointestinal haemorrhage: multicentre validation and prospective evaluation. Lancet. 2009;373:42–47.
    1. Rockall TA, Logan RF, Devlin HB, Northfield TC. Risk assessment after acute upper gastrointestinal haemorrhage. Gut. 1996;38:316–321.
    1. Vreeburg EM, Terwee CB, Snel P, et al. Validation of the Rockall risk scoring system in upper gastrointestinal bleeding. Gut. 1999;44:331–335.
    1. 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.
    1. 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.
    1. Adams BD, McHugh KJ, Bryson SA, Dabulewicz J. The law of unintended consequences: the Joint Commission regulations and the digital rectal examination. Ann Emerg Med. 2008;51:197–201. 201 e191.
    1. Le Jeune IR, Gordon AL, Farrugia D, Manwani R, Guha IN, James MW. Safe discharge of patients with low-risk upper gastrointestinal bleeding (UGIB): can the use of Glasgow-Blatchford Bleeding Score be extended? Acute Med. 2011;10:176–181.
    1. Stephens JR, Hare NC, Warshow U, et al. Management of minor upper gastrointestinal haemorrhage in the community using the Glasgow Blatchford Score. Eur J Gastroenterol Hepatol. 2009;21:1340–1346.
    1. Dicu D, Pop F, Ionescu D, Dicu T. Comparison of risk scoring systems in predicting clinical outcome at upper gastrointestinal bleeding patients in an emergency unit. Am J Emerg Med. 2013;31:94–99.
    1. Wang CH, Chen YW, Young YR, Yang CJ, Chen IC. A prospective comparison of 3 scoring systems in upper gastrointestinal bleeding. Am J Emerg Med. 2013;31:775–778.
    1. Bryant RV, Kuo P, Williamson K, et al. Performance of the Glasgow-Blatchford score in predicting clinical outcomes and intervention in hospitalized patients with upper GI bleeding. Gastrointest Endosc. 2013;78:576–583.
    1. Chen IC, Hung MS, Chiu TF, Chen JC, Hsiao CT. Risk scoring systems to predict need for clinical intervention for patients with nonvariceal upper gastrointestinal tract bleeding. Am J Emerg Med. 2007;25:774–779.
    1. Jung SH, Oh JH, Lee HY, et al. Is the AIMS65 score useful in predicting outcomes in peptic ulcer bleeding? World J Gastroenterol. 2014;20:1846–1851.
    1. Chandra S. AIMS65 score predicts short-term mortality but not the need for intervention in acute upper GI bleeding. Gastrointest Endosc. 2013;78:381–382.
    1. Nakamura S, Matsumoto T, Sugimori H, Esaki M, Kitazono T, Hashizume M. Emergency endoscopy for acute gastrointestinal bleeding: prognostic value of endoscopic hemostasis and the AIMS65 score in Japanese patients. Dig Endosc. 2014;26:369–376.
    1. Masaoka T, Suzuki H. Does the AIMS65, a new risk score for upper gastrointestinal bleeding, work in Japan? Dig Endosc. 2014;26:331–332.

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