Performance of the New ABC and MAP(ASH) Scores in the Prediction of Relevant Outcomes in Upper Gastrointestinal Bleeding
Abstract
1. Introduction
2. Methods
2.1. Study Design and Population
2.2. Definitions
2.3. Management
2.4. Data Collection
2.5. Data Analysis
3. Results
3.1. Patients’ Characteristics
3.2. Predicting Ability of Pre-Endoscopy Risk Scores
3.3. Low-Risk Patients
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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MAP(ASH) Score | |
Risk Factor | Value |
M: Altered mental status (Glasgow < 15) | 1 |
A: ASA score > 2 | 1 |
P (pulse): HR > 100 | 1 |
A: Albumin < 2.5 mg/dL | 2 |
S: SBP < 90 mmHg | 2 |
H: Hemoglobin < 10 g/dL | 2 |
ABC score | |
Risk factor | Value |
Age | |
60–74 years | 1 |
≥75 years | 2 |
Blood tests | |
Urea > 10 mmol/L | 1 |
Albumin < 3 g/dL | 2 |
Creatinine | |
100–150 μmol/L | 1 |
>150 μmol/L | 2 |
Comorbidity | |
Altered mental status | 2 |
Liver cirrhosis | 2 |
Disseminated malignancy | 4 |
ASA score | |
3 | 1 |
≥4 | 3 |
n | % | |
---|---|---|
Male | 534 | 67.2 |
Medical History | ||
Cirrhosis | 161 | 20.3 |
Chronic lung diseases | 89 | 11.2 |
Chronic renal disease | 124 | 15.6 |
Heart failure | 81 | 10.2 |
Myocardial infarction | 94 | 11.8 |
Atrial fibrilation | 149 | 18.7 |
Previous stroke | 61 | 7.7 |
Previous GI bleeding events | 191 | 24.1 |
Hypertension | 391 | 49.2 |
Diabetes | 221 | 27.8 |
Peripheral vascular disease | 33 | 4.2 |
Neoplasm | 111 | 14 |
Smoking habit | 168 | 22.6 |
Alcoholic habit | 154 | 21.2 |
Medications | ||
NSAIDS | 159 | 20.4 |
Aspirin | 169 | 21.3 |
Clopidogrel | 27 | 3.4 |
Oral anticoagulants | 176 | 22.1 |
Steroids | 20 | 2.5 |
Immunosuppressants | 15 | 2 |
Relevant variables and scores components | ||
Age (years) | 64.18 | Range: 14–94 |
Albumin (g/dL) | 3.2 | 1.1–5.3 |
International normalized ratio | 1.52 | 0.9–10.0 |
Systolic blood pressure | 112 | 55–195 |
Pulse | 89.5 | 37–144 |
Hemoglobin | 9.5 | 3.2–18.1 |
Urea | 84.1 | 9–135 |
Mental status change | 63 | 8% |
Findings at endoscopy | ||
Duodenal/Gastric Ulcer | 368 | 46.4 |
Erosions | 74 | 9.3 |
Esophagitis | 78 | 9.8 |
Neoplasms | 50 | 6.3 |
Esophageal varices | 99 | 12.5 |
Active bleeding | 212 | 26.7 |
Endoscopic intervention | 371 | 46.8 |
Outcomes | ||
In-hospital mortality | 79 | 9.9 |
Rebleeding | 91 | 11.5 |
Surgery | 39 | 3.8 |
Interventional radiology | 14 | 1.8 |
Transfusion | 320 | 55.4 |
Length of stay | 9 ± 14.59 | |
Delayed cardiovascular events | 46 | 6.1 |
Delayed hemorrhagic events | 101 | 13.1 |
Delayed deaths | 44 | 5.9 |
Scores (mean ± SD) | ||
AIMS65 | 1.28 ± 1.31 | |
Glasgow Blatchford | 11.29 ± 4.44 | |
ABC | 4.5 ± 2.83 | |
MAP(ASH) | 3.27 ± 2.09 | |
ASA | 2.63 ± 0.77 |
MAP(ASH) | ABC | GBS | AIMS65 | ||
In-hospital mortality | Sensitivity | 48.1% (95% CI 43.4–52.7%) | 44.8% (95% CI 40–49.5%) | 3.7% (95% CI 2.5–5.4%) | 63.9% (95% CI 59–67%) |
Specificity | 93.8% (95% CI 79.9–98.3%) | 96.8% (95% CI 83.8–99.4%) | 98.7% (95% CI 93.1–99.8%) | 68.2% (95% CI 56–78%) | |
PPV | 99.1% (95% CI 96.7–99.7%) | 99.5% (95% CI 97.2–99.9%) | 96% (95% CI 80.5–99.3%) | 94.3% (95% CI 91.5–96.2%) | |
NPV | 11.6% (95% CI 8.1–16.1%) | 10.9% (95% CI 7.8–15%) | 11% (95% CI 8.9–13.5%) | 18.6% (95% CI 14.2–24%) | |
Intervention | Sensitivity | 74.6% (95% CI 67–81%) | 62.2% (95% CI 54–70%) | 6.5% (95% CI 3.7–10.9%) | 81% (95% CI 74–86%) |
Specificity | 69.5% (95% CI 65.2–73.5%) | 67.7% (95% CI 63.4–72%) | 97.8% (95% CI 96.3–98.7%) | 45.5% (95% CI 41–50%) | |
PPV | 42.4% (95% CI 36.4–48.6%) | 36.8% (95% CI 31–43%) | 48% (95% CI 30–66.5%) | 31% (95% CI 26.4–35.4%) | |
NPV | 90.1% (95% CI: 86.6–92.8%) | 85.6% (95% CI 82–89%) | 77% (95% CI 74–80%) | 88.8% (95% CI 84–92%) |
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Jimenez-Rosales, R.; Lopez-Tobaruela, J.M.; Lopez-Vico, M.; Ortega-Suazo, E.J.; Martinez-Cara, J.G.; Redondo-Cerezo, E. Performance of the New ABC and MAP(ASH) Scores in the Prediction of Relevant Outcomes in Upper Gastrointestinal Bleeding. J. Clin. Med. 2023, 12, 1085. https://doi.org/10.3390/jcm12031085
Jimenez-Rosales R, Lopez-Tobaruela JM, Lopez-Vico M, Ortega-Suazo EJ, Martinez-Cara JG, Redondo-Cerezo E. Performance of the New ABC and MAP(ASH) Scores in the Prediction of Relevant Outcomes in Upper Gastrointestinal Bleeding. Journal of Clinical Medicine. 2023; 12(3):1085. https://doi.org/10.3390/jcm12031085
Chicago/Turabian StyleJimenez-Rosales, Rita, Jose Maria Lopez-Tobaruela, Manuel Lopez-Vico, Eva Julissa Ortega-Suazo, Juan Gabriel Martinez-Cara, and Eduardo Redondo-Cerezo. 2023. "Performance of the New ABC and MAP(ASH) Scores in the Prediction of Relevant Outcomes in Upper Gastrointestinal Bleeding" Journal of Clinical Medicine 12, no. 3: 1085. https://doi.org/10.3390/jcm12031085
APA StyleJimenez-Rosales, R., Lopez-Tobaruela, J. M., Lopez-Vico, M., Ortega-Suazo, E. J., Martinez-Cara, J. G., & Redondo-Cerezo, E. (2023). Performance of the New ABC and MAP(ASH) Scores in the Prediction of Relevant Outcomes in Upper Gastrointestinal Bleeding. Journal of Clinical Medicine, 12(3), 1085. https://doi.org/10.3390/jcm12031085