AIMS65 score predicts short-term mortality but not the need for intervention in acute upper GI bleeding
2013; Elsevier BV; Volume: 78; Issue: 2 Linguagem: Inglês
10.1016/j.gie.2013.02.034
ISSN1097-6779
Autores Tópico(s)Gastrointestinal disorders and treatments
ResumoI read the article by Hyett et al1Hyett B.H. Abougergi M.S. Charpentier J.P. et al.The AIMS65 score compared with the Glasgow-Blatchford score in predicting outcomes in upper GI bleeding.Gastrointest Endosc. 2013; 77: 551-557Abstract Full Text Full Text PDF PubMed Scopus (89) Google Scholar with great interest. The investigators have validated the predictive performance of the AIMS65 score for inpatient mortality and compared its predictive accuracy with the Glasgow-Blatchford score for need for blood transfusion in acute upper GI bleeding. However, the AIMS65 score was not predictive for the need for blood transfusion.In the current status of health care, more and more patients are transferred to hospice care. This could lead to underestimation of inpatient mortality. Henceforth, we validated AIMS65 scores to predict short-term mortality and need for blood transfusion. In brief, we included a consecutive cohort of adult patients admitted to a community hospital for upper GI bleeding from October 2005 to September 2011. Objective components of the score were extracted by medical informatics support, and alteration in mental status was determined by internal medicine residents based on a Glasgow Coma Scale score of <14 or mention of disoriented, lethargy, stupor, or coma in physician admission notes. Main outcomes measured were all-cause 30-day and 90-day mortality and need for intervention. Need for intervention was identified by using ICD-9 CM procedure codes 44.43 (endoscopic control of gastric or duodenal bleeding), 44.44 (transcatheter embolization for gastric or duodenal bleeding), 44.49 (other control of hemorrhage of stomach or duodenum), or 99.04 (packed cell transfusion). A total of 802 admissions were identified, with a mean (± standard deviation) age of 69.5 (± 18.2) years, and 48.9% were male. A total of 54 patients (6.7%) died within 30 days, and 80 (10%) died within 90 days from admission. A total of 40 patients (5.0%) required endoscopic or surgical intervention to stop bleeding, and 274 (34.2%) required blood transfusion. The area under the receiver operating characteristic curve was 0.78 (0.72-0.85) for in-hospital mortality, 0.77 (0.71-0.83) for 30-day mortality, 0.79 (95% confidence interval [CI], 0.74-0.84) for 90-day mortality, and 0.53 (95% CI, 0.48-0.57) for need for intervention (Fig. 1). Henceforth, it is reasonable to conclude that the AIMS65 score can reliably predict short-term mortality but not the need for intervention. I read the article by Hyett et al1Hyett B.H. Abougergi M.S. Charpentier J.P. et al.The AIMS65 score compared with the Glasgow-Blatchford score in predicting outcomes in upper GI bleeding.Gastrointest Endosc. 2013; 77: 551-557Abstract Full Text Full Text PDF PubMed Scopus (89) Google Scholar with great interest. The investigators have validated the predictive performance of the AIMS65 score for inpatient mortality and compared its predictive accuracy with the Glasgow-Blatchford score for need for blood transfusion in acute upper GI bleeding. However, the AIMS65 score was not predictive for the need for blood transfusion. In the current status of health care, more and more patients are transferred to hospice care. This could lead to underestimation of inpatient mortality. Henceforth, we validated AIMS65 scores to predict short-term mortality and need for blood transfusion. In brief, we included a consecutive cohort of adult patients admitted to a community hospital for upper GI bleeding from October 2005 to September 2011. Objective components of the score were extracted by medical informatics support, and alteration in mental status was determined by internal medicine residents based on a Glasgow Coma Scale score of <14 or mention of disoriented, lethargy, stupor, or coma in physician admission notes. Main outcomes measured were all-cause 30-day and 90-day mortality and need for intervention. Need for intervention was identified by using ICD-9 CM procedure codes 44.43 (endoscopic control of gastric or duodenal bleeding), 44.44 (transcatheter embolization for gastric or duodenal bleeding), 44.49 (other control of hemorrhage of stomach or duodenum), or 99.04 (packed cell transfusion). A total of 802 admissions were identified, with a mean (± standard deviation) age of 69.5 (± 18.2) years, and 48.9% were male. A total of 54 patients (6.7%) died within 30 days, and 80 (10%) died within 90 days from admission. A total of 40 patients (5.0%) required endoscopic or surgical intervention to stop bleeding, and 274 (34.2%) required blood transfusion. The area under the receiver operating characteristic curve was 0.78 (0.72-0.85) for in-hospital mortality, 0.77 (0.71-0.83) for 30-day mortality, 0.79 (95% confidence interval [CI], 0.74-0.84) for 90-day mortality, and 0.53 (95% CI, 0.48-0.57) for need for intervention (Fig. 1). Henceforth, it is reasonable to conclude that the AIMS65 score can reliably predict short-term mortality but not the need for intervention. The AIMS65 score compared with the Glasgow-Blatchford score in predicting outcomes in upper GI bleedingGastrointestinal EndoscopyVol. 77Issue 4PreviewWe previously derived and validated the AIMS65 score, a mortality prognostic scale for upper GI bleeding (UGIB). Full-Text PDF ResponseGastrointestinal EndoscopyVol. 78Issue 2PreviewWe thank Dr Chandra for the letter and interest in the AIMS65 score. Dr Chandra reports that the AIMS65 score accurately predicted 30- and 90-day all-cause mortality among patients with upper GI hemorrhage (UGIH). Mortality at 30 and 90 days is an important metric, because it captures patients who die shortly after hospitalization. The AIMS65 score has now been shown to reliably predict in-hospital 30- and 90-day mortality among patients with UGIH.1,2 Full-Text PDF
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