Horibe GI bleeding prediction score: a simple score for triage decision-making in patients with suspected upper GI bleeding

Although upper GI bleeding (UGIB) is a significant cause of inpatient admissions, no scoring method has proven to be accurate and simple as a standard for triage purposes. Therefore, we compared a previously described 3-variable score (1 point each for absence of daily proton pump inhibitor use in t...

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Bibliographic Details
Published in:Gastrointestinal endoscopy 2020-09, Vol.92 (3), p.578-588.e4
Main Authors: Horibe, Masayasu, Iwasaki, Eisuke, Bazerbachi, Fateh, Kaneko, Tetsuji, Matsuzaki, Juntaro, Minami, Kazuhiro, Masaoka, Tatsuhiro, Hosoe, Naoki, Ogura, Yuki, Namiki, Shin, Hosoda, Yasuo, Ogata, Haruhiko, Chan, Andrew T., Kanai, Takanori
Format: Article
Language:English
Subjects:
Gastrointestinal Hemorrhage - diagnosis
Humans
Prognosis
Risk Assessment
ROC Curve
Severity of Illness Index
Triage
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Summary:Although upper GI bleeding (UGIB) is a significant cause of inpatient admissions, no scoring method has proven to be accurate and simple as a standard for triage purposes. Therefore, we compared a previously described 3-variable score (1 point each for absence of daily proton pump inhibitor use in the week before the index presentation, shock index [heart rate/systolic blood pressure] ≥1, and blood urea nitrogen/creatinine ≥30 [urea/creatinine≥140]), the Horibe gAstRointestinal BleedING scoRe (HARBINGER), with the 8-variable Glasgow-Blatchford Score (GBS) and 5-variable AIMS65 to evaluate and validate the accuracy in predicting high-risk features that warrant admission and urgent endoscopy. Consecutive patients presenting with suspected UGIB between 2012 and 2015 were prospectively enrolled in 3 acute care Japanese hospitals. On presentation to the emergency setting, an endoscopy was performed in a timely fashion. The primary outcome was the prediction of high-risk endoscopic stigmata. Of 1486 enrolled patients, 637 (43%) harbored high-risk endoscopic stigmata according to international consensus statements. The area under the receiver operating characteristic curve (AUC) for the HARBINGER was .76 (95% confidence interval [CI], .72-.79), which was significantly superior to both the GBS (AUC, .68; 95% CI, .64-.71; P < .001) and the AIMS65 (AUC, .54; 95% CI, .50-.58; P < .001). When the HARBINGER cutoff value was set at 1 to rule out patients who needed admission and urgent endoscopy, its sensitivity and specificity was 98.8% (95% CI, 97.9-99.6) and 15.5% (95% CI, 13.1-18.0), respectively. The HARBINGER, a simple 3-variable score, provides a more accurate method for triage of patients with suspected UGIB than both the GBS and AIMS65. [Display omitted]
ISSN:0016-5107
1097-6779
DOI:10.1016/j.gie.2020.03.3846