Comparison of 3 scoring systems to predict mortality from unstable upper gastrointestinal bleeding in cirrhotic patients

Objective

We aimed to compare the performance of Glasgow-Blatchford, preendoscopic Rockall, and model for end-stage liver disease (MELD) scores in cirrhotic patients with unstable upper gastrointestinal bleeding (UGIB) in the emergency department (ED).

Methods

This was a retrospective cohort study conducted at a university-affiliated teaching hospital. Adult cirrhotic patients who presented with acute UGIB and unstable vital signs (heart rate > 100 beats/min or systolic blood pressure < 100 mm Hg) between January 2009 and February 2011 were included. Patients who were transferred from another hospital, received no emergency endoscopy study, or had incomplete medical records were excluded. Data were retrieved from the admission list of the ED critical zone using international classification of disease code via computer registration.

Results

Among enrolled visits, the initial median hemoglobin level was 8.6 (interquartile range, 7.2-10.1) mg/dL in the ED. The median heart rate and systolic blood pressure were 111.0 beats/min and 94.0 mm Hg, respectively. The endoscopic diagnosis of variceal bleeding accounted for 86.6% of the events. The mortality rate was 16.0% (19/119). Model for end-stage liver disease score performed better with an area under the curve (AUC) of 0.736 (95% confidence interval [CI], 0.629-0.842; P = .001) compared with other scoring systems (Glasgow-Blatchford score: AUC, 0.527; 95% CI, 0.393-0.661; P = .709; preendoscopic Rockall score: AUC, 0.591; 95% CI, 0.465-0.717; P = .208).

Conclusion

Model for end-stage liver disease score performed better in terms of predicting mortality of unstable UGIB in cirrhotic patients compared with Glasgow-Blatchford and preendoscopic Rockall scores in the ED.