Introduction
Methods
Study design
Data collection
AIMS65 | Score | GBS | Score | ||
---|---|---|---|---|---|
Albumin < 3.0 mg/dl | 1 | Blood urea, mmol/L | |||
INR > 1.5 | 1 | 6.5–8 | 2 | ||
GCS < 14 | 1 | 8–10 | 3 | ||
SBP < 90 mmHg | 1 | 10–25 | 4 | ||
Age > 65 yrs | 1 | > 25 | 6 | ||
Maximum score | 5 | Hemoglobin, g/dl, men | |||
pRS | men | women | |||
Age | 12- < 13 | 1 | 0 | ||
< 60 yrs | 0 | 10- < 12 | 10- < 12 | 3 | 1 |
60–79 yrs | 1 | < 10 | < 10 | 6 | 6 |
> 80 yrs | 2 | SBP, mmHg | |||
Shock | 100–109 | 1 | |||
No shock | 0 | 90–99 | 2 | ||
Pluse > 100, SBP > 100 mmHg | 1 | < 90 | 3 | ||
SBP < 100 mmHg | 2 | Pluse (> = 100/bpm) | 1 | ||
Comorbidity | Melena | 1 | |||
No major | 0 | syncope | 2 | ||
CHF, IHD, or major comorbidity | 2 | Liver disease | 2 | ||
Renal failure, liver failure, metastatic cance | 3 | Heart failure | 2 | ||
Maximum score | 7 | Maximum score | 23 |
T-score | ABC | ||
---|---|---|---|
General conditions | Age | ||
Poor | 1 | 60-74yrs | 1 |
Intermediate | 2 | ≥ 75yrs | 2 |
Good | 3 | Blood tests | |
Pulse (beats /min) | Urea > 10 mmol/L | 1 | |
> 110 | 1 | Albumin < 30 g/L | 2 |
90–110 | 2 | Creatinine | |
< 90 | 3 | 100-150 μmol/L | 1 |
SBP, mmHg | > 150 μmol/L | 2 | |
< 90 | 1 | Comorbidity | |
90–110 | 2 | Altered mental status | 2 |
> 110 | 3 | Liver cirrhosis | 2 |
Hemoglobin, g/dl | Disseminated malignancy | 4 | |
< 9 | 1 | ASA score | |
9–10 | 2 | 3 | 1 |
> 10 | 3 | ≥ 4 | 3 |
Maximum score | 12 | Maximum score | 18 |
MAP | |||
M: altered mental status (Glasgow < 15) | 1 | A: albumin < 2.5 g/dL | 2 |
A: ASAscore > 2 | 1 | S: SBP < 90 mmHg | 2 |
P (pulse): HR > 100 | 1 | H: hemoglobin < 10 g/L | 2 |
Maximum score | 9 |
Data analysis
Results
Study population
Variables | Elderly patients | Younger patients | P-value (p < 0.05) |
---|---|---|---|
Age | 72.9 \(\pm\) 6.1 | 48.7 \(\pm\) 12.2 | – |
Sex (male/female) | 350:180 | 573:157 | < 0.01 |
Comorbidity | |||
Cirrhosis | 52 (9.8%) | 108(14.8%) | < 0.01 |
Renal failure | 56 (10.6%) | 10(1.4%) | < 0.01 |
Any malignancy | 46 (8.7%) | 118(16.2%) | < 0.01 |
PCI | 52 (9.8%) | 28(3.8%) | < 0.01 |
Heart failure | 16 (3.0%) | 2(0.3%) | < 0.01 |
Hypertension | 294 (55.5%) | 212(29%) | < 0.01 |
Diabetes | 102 (19.2%) | 90(12.3%) | < 0.01 |
Chronic lung disease | 18 (3.4%) | 2(0.3%) | < 0.01 |
Medications | |||
NSAIDs | 6 (1.1%) | 4(0.5%) | > 0.05 |
Aspirin | 130 (24.5%) | 62(8.5%) | < 0.01 |
Clopidogrel | 64 (12.1%) | 20(2.7%) | < 0.01 |
Oral anticoagulants | 22 (4.2%) | 4(0.5%) | < 0.01 |
Steroids | 8 (1.5%) | 6(0.8%) | > 0.05 |
Relevant variables and scores components (median (IQR)) | |||
Systolic blood pressure(mmHg) | 124(28) | 120(24) | – |
Pulse(beats/min) | 79(18) | 82(22.5) | – |
Creatinine(μmol/L) | 82(41) | 73(27) | – |
Hemoglobin(g/L) | 89(43) | 102.5(45) | – |
Albumin (g/L) | 33.7(8.45) | 37.25(9.08) | – |
Urea(mmol/L) | 9.7(10.1) | 7.9(6.35) | – |
ASA score | 3(1) | 2(2) | – |
Findings at endoscopy | |||
Duodenal/gastric ulcer | 246 (46.4%) | 424(58%) | < 0.01 |
Erosions | 44 (8.3%) | 56(7.7%) | > 0.05 |
Upper GI cancer | 70 (13.2%) | 28(3.8%) | < 0.01 |
Variceal bleeding | 44 (8.3%) | 88(12.1%) | < 0.05 |
Esophagitis | 16 (3.0%) | 10(1.4%) | < 0.05 |
Mallory-Weiss syndrome | 16 (3.0%) | 32(4.4%) | > 0.05 |
Normal | 94(16.9%) | 92(12.3%) | < 0.05 |
Outcomes | |||
Death (total) | 44 (8.3%) | 24(3.3%) | < 0.01 |
Intervention | 240 (45.3%) | 304 (41.6%) | > 0.05 |
Rebleeding | 112 (21.1%) | 60 (8.2%) | < 0.01 |
Comparison between the groups
Mortality
Scoring systems | AUC (95%CI) | Sensitivity %(95%CI) | Specificity %(95%CI) | P-value |
---|---|---|---|---|
Elderly group/younger group | ||||
ABC | 0.827(0.763–0.890)/ 0.958(0.929 -0.987) | 77.27(62.2–88.5)/ 100.00(73.5–100) | 82.72(79.1–86.0)/ 84.66(80.5–88.3) | < 0.01 |
AIMS65 | 0.762(0.680–0.843)/ 0.862(0.740—0.983) | 50.00(34.6–65.4)/ 83.33(51.6–97.9) | 94.26(91.8–96.2)/ 82.67(78.3–86.5) | 0.18 |
GBS | 0.787(0.726 -0.848)/ 0.737(0.614—0.860) | 86.36(72.6–94.8)/ 91.67(61.5–99.8) | 56.79(52.3–61.2)/ 36.08(31.1–41.3) | 0.67 |
MAP(ASH) | 0.795(0.725 -0.864)/ 0.859(0.748 -0.970) | 63.64(47.8–77.6)/ 66.67(34.9–90.1) | 83.54(79.9–86.7)/ 92.05(88.7–94.6) | 0.34 |
pRS | 0.710(0.634 -0.786)/ 0.913(0.864—0.963) | 72.73(57.2–85.0)/ 83.33(51.6–97.9) | 58.02(53.5–62.5)/ 88.5(84.5–91.5) | < 0.01 |
T-score | 0.670(0.596 -0.745)/ 0.749(0.615—0.883) | 72.73(57.2–85.0)/ 75.00(42.8–94.5) | 51.44(46.9–56.0)/ 54.26(48.9–59.6) | 0.32 |
Intervention
Scoring systems | AUC (95%CI) | Sensitivity %(95%CI) | Specificity %(95%CI) | P-value |
---|---|---|---|---|
Elderly group/ younger group | ||||
ABC | 0.713(0.670–0.757)/ 0.725(0.673–0.778) | 75.83(69.9–81.1)/ 54.61(46.3–62.7) | 57.93(52.0–63.7)/ 83.96(78.3–88.6) | 0.73 |
AIMS65 | 0.691(0.651–0.731)/ 0.657(0.615–0.700) | 53.33(46.8–59.8)/ 37.50(29.8–45.7) | 82.07(77.2–86.3)/ 93.40(89.2–96.3) | 0.25 |
GBS | 0.746(0.704–0.787)/ 0.802(0.758–0.846) | 82.50(77.1–87.1)/ 64.47(56.3–72.1) | 56.55(50.6–62.3)/ 78.77(72.6–84.1) | 0.07 |
MAP(ASH) | 0.769(0.731–0.806)/ 0.810(0.767–0.854) | 86.67(81.7–90.7)/ 79.61(72.3–85.7) | 57.24(51.3–63.0)/ 73.58(67.1–79.4) | 0.16 |
pRS | 0.623(0.578–0.669)/ 0.699(0.646–0.752) | 56.67(50.1–63.0)/ 44.74(36.7–53.0) | 65.52(59.7–71.0)/ 85.85(80.4–90.2) | < 0.05 |
T-score | 0.732(0.690–0.773)/ 0.786(0.740–0.833) | 71.67(65.5–77.3)/ 86.18(79.7–91.2) | 66.90(61.2–72.3)/ 57.08(50.1–63.8) | 0.09 |
Rebleeding
Scoring systems | AUC (95%CI) | Sensitivity %(95%CI) | Specificity %(95%CI) | P-value |
---|---|---|---|---|
Elderly group/ younger group | ||||
ABC | 0.703(0.647–0.758)/ 0.864(0.799–0.928) | 46.63(37.0–56.1)/ 86.67(69.3–96.2) | 84.21(80.4–87.6)/ 72.75(67.6–77.5) | < 0.01 |
AIMS65 | 0.713(0.661–0.764)/ 0.758(0.663–0.853) | 64.29(54.7–73.1)/ 63.33(43.9–80.1) | 74.16(69.7–78.3)/ 84.43(80.1–88.1) | 0.41 |
GBS | 0.664(0.607–0.722)/ 0.768(0.679–0.858) | 57.14(47.4–66.5)/ 73.33(54.1–87.7) | 67.46(62.7–71.9)/ 73.05(68.0–77.7) | 0.06 |
MAP(ASH) | 0.731(0.680–0.782)/ 0.808(0.735–0.882) | 48.21(38.7–57.9)/ 73.33(54.1–87.7) | 87.08(83.5–90.1)/ 74.25(69.2–78.9) | 0.09 |
pRS | 0.586(0.530–0.642)/ 0.800(0.725–0.875) | 55.36(45.7–64.8)/ 53.33(34.3–71.7) | 58.37(53.5–63.1)/ 89.52(85.7–92.6) | < 0.01 |
T-score | 0.635(0.581–0.688)/ 0.723(0.630–0.815) | 69.64(60.2–78.0)/ 76.67(57.7–90.1) | 54.55(49.6–59.4)/ 55.99(50.5–61.4) | 0.1 |
ICU admission
Scoring systems | AUC (95%CI) | Sensitivity %(95%CI) | Specificity %(95%CI) | P-value |
---|---|---|---|---|
Elderly group/younger group | ||||
ABC | 0.730(0.669–0.791)/ 0.786(0.696–0.876) | 94.74(82.3–99.4)/ 84.62(54.6–98.1) | 45.53(41.1–50.0)/ 69.80(64.7–74.6) | 0.31 |
AIMS65 | 0.737(0.654–0.821)/ 0.854(0.744–0.964) | 68.42(51.3–82.5)/ 84.62(54.6–98.1) | 68.70(64.4–72.8)/ 82.91(78.6–86.7) | 0.09 |
GBS | 0.806(0.750–0.862)/ 0.819(0.731–0.908) | 100(90.7–100.0)/ 92.31(64.0–99.8) | 49.59(45.1–54.1)/ 62.68(57.4–67.8) | 0.4 |
MAP(ASH) | 0.791(0.718–0.865)/ 0.891(0.831–0.950) | 57.89(40.8–73.7)/ 92.31(64.0–99.8) | 82.52(78.9–85.8)/ 72.65(67.7–77.2) | < 0.05 |
pRS | 0.610(0.514–0.706)/ 0.782(0.699–0.865) | 31.58(17.5–48.7)/ 61.54(31.6–86.1) | 86.59(83.3–89.5)/ 74.36(69.5–78.8) | < 0.01 |
T-score | 0.714(0.641–0.788)/ 0.807(0.697–0.916) | 78.95(62.7–90.4)/ 53.85(25.1–80.8) | 51.63(47.1–56.1)/ 91.74(88.3–94.4) | 0.16 |
Elderly group | AUC | P-value of pairwise the AUC curves | |||||
---|---|---|---|---|---|---|---|
ABC | AIMS65 | GBS | MAP(ASH) | pRS | T-score | ||
Mortality | |||||||
ABC | 0.827 | * | 0.218 | 0.205 | 0.506 | < 0.05 | < 0.01 |
AIMS65 | 0.762 | 0.218 | * | 0.910 | 0.546 | 0.360 | 0.101 |
GBS | 0.787 | 0.205 | 0.910 | * | 0.579 | 0.256 | 0.052 |
MAP(ASH) | 0.795 | 0.506 | 0.546 | 0.579 | * | 0.106 | < 0.05 |
pRS | 0.710 | < 0.05 | 0.360 | 0.256 | 0.106 | * | 0.461 |
T-score | 0.670 | < 0.01 | 0.101 | 0.052 | < 0.05 | 0.461 | * |
Intervetion | ABC | AIMS65 | GBS | MAP(ASH) | pRS | T-score | |
ABC | 0.713 | * | 0.465 | 0.282 | 0.055 | < 0.01 | 0.535 |
AIMS65 | 0.691 | 0.465 | * | 0.061 | < 0.01 | < 0.05 | 0,161 |
GBS | 0.746 | 0.282 | 0.061 | * | 0.419 | < 0.01 | 0.640 |
MAP(ASH) | 0.769 | 0.055 | < 0.01 | 0.419 | * | < 0.01 | 0.193 |
pRS | 0.623 | < 0.01 | < 0.05 | < 0.01 | < 0.01 | * | < 0.01 |
T-score | 0.723 | 0.535 | 0,161 | 0.640 | 0.193 | < 0.01 | * |
Rebleeding | ABC | AIMS65 | GBS | MAP(ASH) | pRS | T-score | |
ABC | 0.703 | * | 0.795 | 0.339 | 0.467 | < 0.01 | 0.083 |
AIMS65 | 0.713 | 0.795 | * | 0.213 | 0.626 | < 0.01 | < 0.05 |
GBS | 0.664 | 0.339 | 0.213 | * | 0.088 | 0.058 | 0.469 |
MAP(ASH) | 0.731 | 0.467 | 0.626 | 0.088 | * | < 0.01 | < 0.05 |
pRS | 0.586 | < 0.01 | < 0.01 | 0.058 | < 0.01 | * | 0.216 |
T-score | 0.635 | 0.083 | < 0.05 | 0.469 | < 0.05 | 0.216 | * |
ICU | ABC | AIMS65 | GBS | MAP(ASH) | pRS | T-score | |
ABC | 0.730 | * | 0.894 | 0.071 | 0.210 | < 0.05 | 0.741 |
AIMS65 | 0.737 | 0.894 | * | 0.178 | 0.342 | < 0.05 | 0.685 |
GBS | 0.806 | 0.071 | 0.178 | * | 0.751 | < 0.01 | 0.051 |
MAP(ASH) | 0.791 | 0.210 | 0.342 | 0.751 | * | < 0.01 | 0.147 |
pRS | 0.610 | < 0.05 | < 0.05 | < 0.01 | < 0.01 | * | 0.091 |
T-score | 0.714 | 0.741 | 0.685 | 0.051 | 0.147 | 0.091 | * |
Younger group | AUC | P-value of pairwise the AUC curves | |||||
---|---|---|---|---|---|---|---|
ABC | AIMS65 | GBS | MAP(ASH) | pRS | T-score | ||
Mortality | |||||||
ABC | 0.958 | * | 0.133 | < 0.01 | 0.091 | 0.123 | < 0.01 |
AIMS65 | 0.862 | 0.133 | * | 0.157 | 0.972 | 0.447 | 0.221 |
GBS | 0.737 | < 0.01 | 0.157 | * | 0.149 | < 0.01 | 0.897 |
MAP(ASH) | 0.859 | 0.091 | 0.972 | 0.149 | * | 0.384 | 0.215 |
pRS | 0.913 | 0.123 | 0.447 | < 0.01 | 0.384 | * | < 0.05 |
T-score | 0.749 | < 0.01 | 0.221 | 0.897 | 0.215 | < 0.05 | * |
Intervetion | ABC | AIMS65 | GBS | MAP(ASH) | pRS | T-score | |
ABC | 0.725 | * | < 0.05 | < 0.05 | < 0.05 | 0.495 | 0.088 |
AIMS65 | 0.657 | < 0.05 | * | < 0.01 | < 0.01 | 0.225 | < 0.01 |
GBS | 0.802 | < 0.05 | < 0.01 | * | 0.801 | < 0.01 | 0.625 |
MAP(ASH) | 0.810 | < 0.05 | < 0.01 | 0.801 | * | < 0.01 | 0.461 |
pRS | 0.699 | 0.495 | 0.225 | < 0.01 | < 0.01 | * | < 0.01 |
T-score | 0.786 | 0.088 | < 0.01 | 0.625 | 0.461 | < 0.01 | * |
Rebleeding | ABC | AIMS65 | GBS | MAP(ASH) | pRS | T-score | |
ABC | 0.864 | * | 0.071 | 0.088 | 0.264 | 0.204 | < 0.05 |
AIMS65 | 0.758 | 0.071 | * | 0.881 | 0.416 | 0.496 | 0.606 |
GBS | 0.768 | 0.088 | 0.881 | * | 0.499 | 0.590 | 0.493 |
MAP(ASH) | 0.808 | 0.264 | 0.416 | 0.499 | * | 0.881 | 0.159 |
pRS | 0.800 | 0.204 | 0.496 | 0.590 | 0.881 | * | 0.204 |
T-score | 0.723 | < 0.05 | 0.606 | 0.493 | 0.159 | 0.204 | * |
ICU | ABC | AIMS65 | GBS | MAP(ASH) | pRS | T-score | |
ABC | 0.786 | * | 0.348 | 0.609 | 0.057 | 0.949 | 0.772 |
AIMS65 | 0.854 | 0.348 | * | 0.627 | 0.561 | 0.305 | 0.552 |
GBS | 0.819 | 0.609 | 0.627 | * | 0.187 | 0.551 | 0.867 |
MAP(ASH) | 0.891 | 0.057 | 0.561 | 0.187 | * | < 0.05 | 0.186 |
pRS | 0.782 | 0.949 | 0.305 | 0.551 | < 0.05 | * | 0.721 |
T-score | 0.807 | 0.772 | 0.552 | 0.867 | 0.186 | 0.721 | * |