The following is a summary of “Development and Validation of a Novel 1-year Mortality Risk Score That Includes the Use of Antithrombotic in Patients With Overt Gastrointestinal Bleeding,” published in the August 2023 issue of the Clinical Gastroenterology by Nammour et al.
The researcher’s objective was to create an innovative scoring system for predicting mortality risk within one year, specifically focusing on utilizing antithrombotic (AT) medications. Researchers then validated this scoring system by comparing it to other existing methods in patients experiencing acute gastrointestinal bleeding (GIB). A risk-scoring plan was formulated using prospectively gathered data on patients admitted with gastrointestinal bleeding (GIB) from January 2013 to August 2020, with a minimum follow-up period of one year. The study aimed to identify independent factors that predict mortality within one year while considering potential confounding variables. These variables included the age-adjusted Charlson Comorbidity Index (CCI), which was categorized into four groups: CCI-0 (score of 0), CCI-1 (scores ranging from 1 to 3), CCI-2 (scores ranging from 4 to 6), and CCI-3 (scores of 7 or higher).
Other factors considered were the requirement for blood transfusion, the severity of gastrointestinal bleeding (GIB), the need for endoscopic therapy, and the type of antithrombotic therapy (AT) used. The risk score was derived from independent predictors. Five hundred seventy-six patients were enrolled, and one hundred twenty-three individuals (21%) experienced mortality within the 1-year follow-up period. The researcher’s risk score was determined using the following medical factors: CCI-2 (2 points), CCI-3 (4 points), the requirement for blood transfusion (1 point), and absence of aspirin usage (1 issue), as aspirin usage was found to have a protective effect (maximum score = 6). Patients with elevated risk scores exhibited increased mortality rates.
The model exhibited superior predictive accuracy [AUC=0.82, 95% CI (0.78-0.86), P<0.0001] compared to the Rockall score for upper gastrointestinal bleeding (Area Under the Curve (AUC)=0.68, P<0.0001), the Oakland score for lower gastrointestinal bleeding (AUC=0.69, P=0.004), or the Shock Index for all cases (AUC=0.54, P<0.0001). A straightforward and innovative scoring system incorporating antithrombotic therapy upon admission reliably forecasts the likelihood of mortality within one year for patients with gastrointestinal bleeding. This scoring system may guide follow-up decisions and provide prognosis information for patients with gastrointestinal bleeding.