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Korean J Gastroenterol. 2016 Jan;67(1):16-21. Korean.
Published online Jan 26, 2016.  https://doi.org/10.4166/kjg.2016.67.1.16
Copyright © 2016 The Korean Society of Gastroenterology
Can Glasgow-Blatchford Score and Pre-endoscopic Rockall Score Predict the Occurrence of Hypotension in Initially Normotensive Patients with Non-variceal Upper Gastrointestinal Bleeding?
June Sung Kim, Byuk Sung Ko, Chang Hwan Son, Shin Ahn, Dong Woo Seo, Yoon-Seon Lee, Jae Ho Lee, Bum Jin Oh, Kyoung Soo Lim and Won Young Kim
Department of Emergency Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

Correspondence to: Won Young Kim, Department of Emergency Medicine, Asan Medical Center, 88 Olympic-ro 43 gil, Songpa-gu, Seoul 05505, Korea. Tel: +82-2-3010-3350, Fax: +82-2-3010-3360, Email: wonpia73@naver.com
Received October 26, 2015; Revised November 16, 2015; Accepted November 26, 2015.

This is an open access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.


Abstract

Background/Aims

The aim of this study was to identify the ability of Glasgow-Blatchford score (GBS) and pre-endoscopic Rockall score (pre-E RS) to predict the occurrence of hypotension in patients with non-variceal upper gastrointestinal bleeding who are initially normotensive at emergency department.

Methods

Retrospective observational study was conducted at Asan Medical Center emergency department (ED) in patients who presented with non-variceal upper gastrointestinal bleeding from January 1, 2011 to December 31, 2013. Study population was divided according to the development of hypotension, and demographics, comorbidities, and laboratory findings were compared. GBS and pre-E RS were estimated to predict the occurrence of hypotension.

Results

A total of 747 patients with non-variceal upper gastrointestinal bleeding were included during the study period, and 120 (16.1%) patients developed hypotesion within 24 hours after ED admission. The median values GBS and pre-E RS were statistically different according to the occurrence of hypotension (8.0 vs. 10.0, 2.0 vs. 3.0, respectively; p<0.001). In the receiver operating characteristic curve analysis of hypotension development, the area under the curve of GBS and pre-E RS were 66% and 64%, respectively. The sensitivity and the specificity of GBS using optimal cut-off value were 81% and 46%, respectively, while those based on the pre-E RS were 74% and 46%, respectively.

Conclusions

GBS and pre-E RS were both not sufficient for predicting the occurrence of hypotension in non-variceal upper gastrointestinal bleeding. Development of other scoring systems are needed.

Keywords: Gastrointestinal bleeding; Emergency department; Score; Hypotension

Figures


 Fig. 1
Patient flow diagram.
ED, emergency department; UGIB, upper gastrointestinal bleeding; SBP, systolic blood pressure.
Click for larger image


Fig. 2
Receiver operating characteristic (ROC) curves for Glasgow-Blatchford score (GBS) and pre-endoscopy Rockall score in predicting the occurrence of hypotension.
Click for larger image

Tables


 Table 1
Clinical and Laboratory Variables Included in Glasgow-Blatchford Score (GBS) and Pre-endoscopic Rockall Score
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Table 2
Baseline Characteristics and Laboratory Findings of Acute Non-variceal Upper Gastrointestinal Bleeding in Patients with and without Hypotension Development
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Table 3
Comparison of GBS and Pre-E RS on Acute Non-variceal Upper Gastrointestinal Bleeding in Patients with and without Hypotension Development
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Table 4
Sensitivity, Specificity, PPV, and NPV of GBS and Pre-E RS for Predicting Hypotension
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Notes

Financial support:None.

Conflict of interest:None.

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