A risk score to predict need for treatment for upper-gastrointestinal haemorrhage

Background Current risk-stratification systems for patients with acute uppe r-gastrointestinal bleeding discriminate between patients at high or low ri sks of dying or rebleeding. We therefore developed and prospectively valida ted a risk score to identify a patient's need for treatment. Methods Our first study used data from 1748 patients admitted for upper-gas trointestinal haemorrhage. By logistic regression, we derived a risk score that predicts patients' risks of needing blood transfusion or intervention to control bleeding, rebleeding, or dying. From this score, we developed a simplified fast-track screen for use at initial presentation. In a second s tudy, we prospectively Validated this score using receiver operating charac teristic (ROC) curves-a measure of the validity of a scoring system-and chi (2) goodness-of-fit testing with data from 197 patients. We also validated the quicker screening tool. Findings We calculated risk scores from patients' admission haemoglobin, bl ood urea, purse, and systolic brood pressure, as well as presentation with syncope or melaena, and evidence of hepatic disease or cardiac failure. The score discriminated well with a ROC curve area of 0.92 (95% CI 0.88-0.95). The score was well calibrated for patients needing treatment (p-=0.84). Interpretation Our score identified patients at low or high risk of needing treatment to manage their bleeding. This score should assist the clinical management of patients presenting with upper-gastrointestinal haemorrhage, but requires external validation.