A Risk Scoring System to Predict Outcome of Non-Variceal Upper Gastrointestinal Bleeding in Thai Patients
DUANGPORN THONG-NGAM, M.D.*,
SATCHAPAN ISARASENA, M.D.***,
PINIT KULLAVANUAYA,MBChB. FRCP.***
PISIT TANGKUVANICH,M.D.**,
NUS ON KLADCHAREON, MBChB. MRCP***,
Affiliation : * Gastroenterology Unit, Department of Physiology,
** Department of Biochemistry,
*** Department of Internal Medicine, Faculty of Medicine, Chulalongkom University, Bangkok 10330, Thailand.
AbstractThe purpose of this study was to determine the predictors for poor outcome in patients
with upper gastrointestinal bleeding (UGIB) by constructing a risk-scoring system based on
retrospective data analysis and validating the scoring system prospectively. In the first phase
of the study, 264 patients with acute non-variceal UGIB were retrospectively reviewed, and
likely predictors of poor outcome, including major re-bleeding, need for emergency surgery to
control bleeding and hospital death, were ranked into a risk scoring system. In the second phase,
this scoring system was prospectively validated in 107 patients. The characteristics of the retro-
spective and the prospective groups were not significantly different. Four predictors of
outcome were found to be significant, namely concurrent illnesses, the presence of at least one
disease (score 1), heart rate above 110 beat/min (score 1), blood transfusion over 6 units (score 2)
and the presence of visible vessels on endoscopic examination (score I). Patients with a total
score of less than 2 had good outcome whereas scores of 2 or more were associated with a
poor outcome. The accuracy of the test was 82.5 per cent. The positive and negative predictive
values were 46.3 per cent and 92.7 per cent respectively. The likelihood ratio was 4.5. It is
concluded that the risk scoring system constructed in this study represents a good predictor of
poor clinical outcome in patients presenting with non-variceal UGIB.
Keywords : Risk Scoring System, Predictors, Gastrointestinal Bleeding
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