Search Results (18)

Background and Objectives: This study investigated the prognostic value of two simple blood urea nitrogen (BUN)-based ratios, BUN/hemoglobin (Hb) and BUN/Albumin, for predicting in-hospital mortality and prolonged hospitalization in patients with acute upper gastrointestinal bleeding (UGIB). Their performance was compared with established risk scores, including the Glasgow–Blatchford score (GBS), AIMS-65, ABC and Rockall scores. Materials and Methods: This retrospective cohort study included 486 patients evaluated for acute UGIB between March 2023 and February 2026. The diagnostic performance of BUN/Hb and BUN/Albumin ratios was assessed using receiver operating characteristic (ROC) analysis and compared with established risk scores. Associations with clinical outcomes were evaluated using logistic regression analyses. Results: The median age was 67 years, and 292 patients (60.1%) were male. In-hospital mortality occurred in 17 patients (3.5%), while prolonged hospitalization was observed in 207 patients (42.6%). AIMS-65 showed the highest Area Under the Curve (AUC) for mortality prediction (0.799; 95% CI 0.696–0.902), followed by the ABC score (0.731) and the BUN/Albumin ratio (0.711). For prolonged hospitalization, BUN/Hb showed the highest AUC (0.706; 95% CI 0.660–0.752), although differences from established scores were not statistically significant. In multivariable analysis, BUN/Albumin remained associated with mortality, whereas BUN/Hb did not reach statistical significance for prolonged hospitalization. However, mortality-related findings should be interpreted with caution because only 17 in-hospital deaths occurred in the study cohort. Conclusions: Simple BUN-based ratios may provide complementary prognostic information in acute UGIB. BUN/Albumin was associated with in-hospital mortality and showed modest discriminatory ability, but it did not demonstrate statistically significant superiority over established risk scores. BUN/Hb showed the numerically best discrimination for prolonged hospitalization, but without statistically significant superiority or persistent significance in multivariable analysis. Overall, these ratios may serve as supportive tools for early risk assessment rather than replacements for established risk scoring systems. Full article

Background/Objectives: Non-variceal upper gastrointestinal bleeding (NVUGIB) remains a major clinical emergency, particularly among patients receiving antiplatelet or anticoagulant therapy, whose use has increased substantially in recent years. This study aimed to evaluate the clinical characteristics, endoscopic findings, risk stratification, and outcomes of NVUGIB in patients receiving antithrombotic therapy, and to compare the predictive performance of commonly used prognostic scores. Methods: This prospective cohort study included 89 patients receiving antithrombotic therapy who presented with NVUGIB at Beni-Suef University Hospitals between March 2023 and March 2025. Clinical presentation, laboratory findings, and endoscopic characteristics were recorded. Risk stratification was assessed using Glasgow–Blatchford (GBS), Rockall, Baylor, AIMS65, ABC, and PNED scores. The optimal cut-off values for prediction of rebleeding and mortality were determined using receiver operating characteristic (ROC) analysis and the Youden index. Area under the curve (AUC) values were reported with 95% confidence intervals. Results: Endoscopy revealed that peptic ulcers were the most common lesion (41/89, 46%), followed by erosive disease (27/89, 30%), with the stomach being the most frequently involved site (76.5%). Rebleeding occurred in 16 patients (18.0%), while mortality was observed in 2 patients (2.2%). The Glasgow–Blatchford score demonstrated the most consistent performance for predicting rebleeding, with an optimal cutoff value of 5.5 (derived using the Youden index), yielding 92.9% sensitivity and 78.8% specificity. For mortality prediction, AIMS65, ABC, and PNED scores showed very high AUC values, although these findings should be interpreted cautiously due to the small number of mortality events (n = 2). No statistically significant difference in rebleeding or mortality was observed between single and dual antithrombotic therapy, although patients receiving dual therapy required longer hospitalization and more transfusion units. Conclusions: In patients with antithrombotic-related GI bleeding, ulcers and erosions predominate, with minimal differences between single and dual therapy outcomes. Concomitant NSAID use trends toward higher mortality. Glasgow–Blatchford score offers optimal performance for both rebleeding and mortality prediction, with a cutoff of 5.5 providing excellent sensitivity (92.9%) and specificity (78.8%) for rebleeding risk assessment. Full article

Background: Early risk assessment in non-variceal upper gastrointestinal bleeding (NVUGIB) is essential for guiding clinical management. The neutrophil percentage-to-albumin ratio (NPAR) has recently been proposed as a marker reflecting both inflammatory response and physiological reserve. This study aimed to evaluate the prognostic value of NPAR for in-hospital mortality and its relationship with established risk scores in patients with NVUGIB. Methods: This retrospective observational study included 94 patients hospitalized with NVUGIB. NPAR was calculated using laboratory parameters obtained at admission. Patients were stratified according to AIMS65 (<2 vs. ≥2) and Rockall (<5 vs. ≥5) scores. In addition, inflammation-based indices, including neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and systemic immune-inflammation index (SII), were calculated. Predictive performance was evaluated using receiver operating characteristic (ROC) curve analysis, and associations with clinical outcomes were assessed. Results: The in-hospital mortality rate was 12.8%. NPAR values were significantly higher in patients with AIMS65 ≥ 2 and Rockall ≥ 5 (p < 0.001 for both). NPAR demonstrated good discriminative ability for AIMS65 ≥ 2 (AUC: 0.843) and moderate performance for Rockall ≥ 5 (AUC: 0.714). For mortality prediction, NPAR showed excellent performance (AUC: 0.900). A cut-off value of 27.4 yielded a sensitivity of 91.7% and a specificity of 75.6%. Higher NPAR values were associated with increased mortality risk (OR 31.9, 95% CI: 3.88–102.59, p < 0.001), while the negative predictive value was high (98.4%). In contrast, NLR, PLR, and SII showed limited predictive value for in-hospital mortality. Conclusions: NPAR shows promise as a potential prognostic biomarker for assessing disease severity and in-hospital mortality in NVUGIB. Its high negative predictive value and association with established risk scores suggest that it may complement current risk stratification approaches. However, these findings should be considered preliminary, given the retrospective design and limited sample size, and require validation in larger prospective studies. Full article

Background and Objectives: Acute variceal bleeding (AVB) in cirrhotic patients remains associated with considerable early rebleeding and mortality despite guideline-based therapy. Endoscopic band ligation (EBL) is recommended as first-line therapy for esophageal variceal bleeding, while alternative endoscopic hemostasis strategies may be required when EBL is technically difficult or judged unsafe. Materials and Methods: We conducted a single, tertiary referral center retrospective cohort study of adults with cirrhosis and AVB undergoing emergency endoscopy. Hemostasis modality at index endoscopy was EBL or argon plasma coagulation (APC), used selectively at the endoscopist’s discretion when bleeding was sourced to gastric varices or when EBL was technically difficult or unsafe. The primary endpoint was 5-day rebleeding, with key secondary endpoints set as 6-week mortality and in-hospital mortality. ICU admission and time to endoscopy were evaluated as process and outcome metrics. Multivariable models were used, adjusted for liver severity (MELD-Na, ALBI, PALBI) and bleeding and mortality scores (AIMS65, Rockall, Glasgow Blatchford). Results: Among 181 eligible AVB cases (APC n = 29, EBL n = 152), 5-day rebleeding was higher with APC (31%) than EBL (13.8%). In-hospital mortality (APC 20.7% vs. EBL 23.0%) and 6-week mortality (APC 31.0% vs. EBL 35.5%) were similar. In adjusted models (age, MELD-Na, time to endoscopy), APC was associated with increased odds of 5-day rebleeding (aOR 2.73, 95% CI 1.06–7.03), but not with in-hospital (aOR 0.51) or 6-week mortality (aOR 0.45). Time to endoscopy was not independently associated with mortality in adjusted models. Discrimination for in-hospital mortality was highest for MELD-Na (AUC 0.898) and ALBI (AUC 0.859). Conclusions: In this observational AVB cohort, APC, used as a rescue or alternative strategy, showed similar short-term mortality compared with EBL after adjustment for liver severity and was associated with higher 5-day rebleeding. APC may be a pragmatic option when EBL is not feasible or is judged unsafe. However, prospective evaluation and careful selection are warranted. Full article

Background/Objectives: Systemic inflammatory markers have recently gained attention as prognostic indicators in various acute conditions. However, their predictive value in non-variceal upper gastrointestinal bleeding (UGIB) remains uncertain. This study aimed to evaluate the prognostic performance of the Systemic Inflammation Response Index (SIRI) and the Aggregate Index of Systemic Inflammation (AISI) for in-hospital mortality among patients with non-variceal UGIB and to compare them with established clinical scoring systems. Methods: This retrospective cohort study included 531 adult patients admitted with non-variceal UGIB between April 2023 and February 2025. Demographic, clinical, and laboratory data were collected at presentation. Inflammatory indices (SIRI, AISI, AISI/Hb) and established risk scores (Glasgow-Blatchford, Rockall, AIMS-65, and ABC) were calculated. The primary outcome was all-cause in-hospital mortality. Discriminatory ability was assessed using receiver operating characteristic (ROC) curve analysis, and independent predictors were identified by multivariable logistic regression. Results: The overall in-hospital mortality rate was 4.7% (25/531). Non-survivors were older and had lower systolic blood pressure, higher serum urea, and elevated inflammatory indices. Among biomarkers, SIRI (AUC = 0.773, 95% CI: 0.737–0.809) and AISI (AUC = 0.709, 95% CI: 0.670–0.747) showed good discriminatory ability, comparable to AIMS-65 (AUC = 0.765) and ABC (AUC = 0.786). In multivariable models, SIRI (OR = 1.10, p = 0.011) and AISI (OR = 1.04 per 100 units, p = 0.003) remained independent predictors of mortality after adjustment for age, systolic blood pressure, hemoglobin, serum urea, and albumin. Conclusions: SIRI and AISI are independent predictors of in-hospital mortality in patients with non-variceal UGIB, demonstrating comparable prognostic performance to conventional risk scores. These readily available inflammatory indices may serve as simple and cost-effective adjuncts for early risk stratification in clinical practice. Full article

Background/Objectives: Non-variceal upper gastrointestinal bleeding (NVUGIB) is associated with considerable morbidity and mortality, particularly in emergency department (ED) settings. While traditional clinical scores such as the Glasgow-Blatchford Score (GBS), AIMS65, and Pre-Endoscopic Rockall are widely used for risk stratification, their accuracy in mortality prediction is limited. This study aimed to evaluate the performance of multiple supervised machine learning (ML) models in predicting 30-day all-cause mortality in NVUGIB and to compare these models with established risk scores. Methods: A retrospective cohort study was conducted on 1233 adult patients with NVUGIB who presented to the ED of a tertiary center between January 2022 and January 2025. Clinical and laboratory data were extracted from electronic records. Seven supervised ML algorithms—logistic regression, ridge regression, support vector machine, random forest, extreme gradient boosting (XGBoost), naïve Bayes, and artificial neural networks—were trained using six feature selection techniques generating 42 distinct models. Performance was assessed using AUROC, F1-score, sensitivity, specificity, and calibration metrics. Traditional scores (GBS, AIMS65, Rockall) were evaluated in parallel. Results: Among the cohort, 96 patients (7.8%) died within 30 days. The best-performing ML model (XGBoost with univariate feature selection) achieved an AUROC > 0.80 and F1-score of 0.909, significantly outperforming all traditional scores (highest AUROC: Rockall, 0.743; p < 0.001). ML models demonstrated higher sensitivity and specificity, with improved calibration. Key predictors consistently included age, comorbidities, hemodynamic parameters, and laboratory markers. The best-performing ML models demonstrated very high apparent AUROC values (up to 0.999 in internal analysis), substantially exceeding conventional scores. These results should be interpreted as apparent performance estimates, likely optimistic in the absence of external validation. Conclusions: While machine-learning models showed markedly higher apparent discrimination than conventional scores, these findings are based on a single-center retrospective dataset and require external multicenter validation before clinical implementation. Full article

Background/Objectives: This study aimed to determine the in-hospital mortality rate after upper gastrointestinal (GI) bleeding in geriatric patients with comorbidities. Additionally, it sought to identify effective cut-off values for predicting high-risk patients using AIMS65 and Rockall scores and to assess the impact of oral anticoagulant and NSAID use on mortality. Methods: A retrospective cohort study was conducted on 64 patients aged 60 and above with at least one comorbidity who were admitted for upper GI bleeding between January 2023 and June 2024. AIMS65 and Rockall scores were calculated for each patient. The relationship between these scores, medication use, and mortality was analyzed using statistical methods, including ROC analysis and Kaplan–Meier survival curves. Results: The mean age was 77.6 years, and all patients had at least one chronic disease; 57.8% used medications increasing bleeding risk. In-hospital mortality was 18.7%, with no significant association for oral anticoagulants (p = 0.275) or NSAIDs (p = 0.324). Sepsis, heart failure, chronic renal failure, and malignancy were strongly linked to mortality in univariate analysis; multivariate analysis confirmed sepsis and malignancy as independent predictors, with a trend for heart failure. AIMS65 ≥ 2 (sensitivity 90.1%, AUC = 0.920) and Rockall ≥ 6 (sensitivity 91.7%, AUC = 0.822) were both effective in predicting mortality, with risk rising cumulatively with higher scores (p < 0.001). Conclusions: In-hospital mortality after upper GI bleeding is high in elderly patients with multiple comorbidities, mainly from sepsis, malignancy, and heart failure. AIMS65 and Rockall scores effectively predict mortality and may support earlier intervention. The small, high-risk cohort limits generalizability, underscoring the need for multicenter validation. Full article

(1) Background: Acute variceal bleeding (AVB) represents an important cause of upper gastrointestinal bleeding (UGIB). Several prognostic scores may be useful for assessing mortality and rebleeding risk, with the Glasgow-Blatchford score (GBS) and Rockall score being the most commonly used for non-variceal bleeding. Scores assessing liver failure (MELD and Child) do not reflect bleeding severity. The neutrophil-to-lymphocyte ratio (NLR) increases in UGIB and can predict survival and rebleeding. (2) Methods: We analyzed the predictive role of NLR, GBS, Rockall, AIMS65, Child, and MELD for mortality (48 h, 5-day, in-hospital, and 6-week) and rebleeding in AVB patients admitted to our hospital from 2017 to 2021. ROC analysis was performed, and a multivariate analysis with logistic regression was used to construct a simplified model. (3) Results: A total of 415 patients were admitted. NLR exhibited fair accuracy for 48-h mortality (AUC 0.718, 95% CI 0.597–0.839, p < 0.0001), with limited predictive value for medium-term mortality. The NLR accuracy was better than that of the GBS and Rockall score, similar to that of the AIMS65 and Child scores, but inferior to that of MELD. The value for all scores in predicting rebleeding was poor, with the highest AUC for the NLR. (4) Conclusions: The NLR exhibited reasonable accuracy in predicting short-term mortality in AVB. Our model (including NLR, age, creatinine, bilirubin, albumin, INR, platelet count, HCC, and etiology) demonstrated 80.72% accuracy in predicting 6-week mortality. Full article

Lower gastrointestinal bleeding (LGIB) is a frequent and potentially life-threatening clinical condition. Over the past two decades, several prognostic scoring systems have been developed to stratify risk and guide the management of patients with LGIB. This comprehensive review aims to summarize and compare the current evidence on the utility, accuracy, and limitations of key LGIB scoring systems, including the Glasgow-Blatchford Score (GBS), AIMS65, ABC score, Oakland score, SALGIB, CHAMPS, and Rockall score. We conducted a structured literature review of studies evaluating these scores in adult patients with LGIB. For each scoring system, we analyzed its origin, components, intended use, and predictive performance regarding clinical outcomes such as severe bleeding, transfusion requirement, in-hospital mortality, rebleeding, and safe discharge. Comparative analyses of diagnostic accuracy were extracted where available. Our findings indicate that while no single score offers comprehensive predictive accuracy across all outcomes, certain tools are particularly effective for specific endpoints. The Oakland and GBS scores are useful for identifying patients at low risk who may be managed safely as outpatients. The ABC and CHAMPS scores demonstrate superior performance in predicting mortality, especially in elderly or comorbid populations. SALGIB, a newer score developed in Vietnam, shows promising performance for early triage but requires further validation. The Rockall score, although historically valuable in upper GI bleeding, offers limited applicability in LGIB due to its reliance on post-endoscopic findings. In conclusion, multiple prognostic tools are now available to support early decision-making in LGIB. Their optimal use requires understanding their strengths, limitations, and appropriate clinical contexts. Integrating these scores into routine practice, along with clinical judgment, can enhance patient outcomes and resource allocation. Full article

Introduction: Upper gastrointestinal bleeding (UGIB) is among the most common causes of morbidity and mortality worldwide, accounting for major resource allocation and increasing incidence. This study aimed to evaluate the severity of non-variceal bleeding in patients at risk of bleeding through the use of NSAIDs, oral anticoagulants, and antiplatelet therapy. Material and Method: The study included 296 patients admitted in the Gastroenterology Department of the Municipal County Emergency University Hospital, Timisoara, between 01.01.2018 and 01.04.2020, and diagnosed via gastroscopy with non-variceal gastrointestinal bleeding. The patients were divided among four groups based on their use of different drugs known to induce UGIB, i.e., aspirin and clopidogrel, NOACs, NSAIDs, and anti-vitamin K drugs, respectively. Statistical analyses were performed based on ANOVA one-way tests for continuous variables and Chi-square tests for categorical variables with pairwise comparisons based on Bonferroni adjusted significance tests. Results: The results showed several parameters having statistical significance among the different groups of patients. Patients on NOACs had statistically significant lower hemoglobin levels, lower hematocrit values, lower erythrocytes, lower RDW and higher fibrinogen levels compared to patients on VKA. Discussion: Surprisingly, the results from our study suggest that the use of NOACs was associated with a higher risk of bleeding when compared to VKA, which differs from the existing literature. Conclusions: One of the important factors causing upper non-variceal bleeding can be iatrogenic, either due to antiplatelet drugs or anticoagulants, to which NSAID treatment is additionally associated for various reasons. In our study, the use of NOACs seemed to have a more severe bleeding spectrum with higher morbidity compared to VKA. Full article

Background: Several risk scores have attempted to risk stratify patients with acute upper gastrointestinal bleeding (UGIB) who are at a lower risk of requiring hospital-based interventions or negative outcomes including death. This systematic review and meta-analysis aimed to compare predictive abilities of pre-endoscopic scores in prognosticating the absence of adverse events in patients with UGIB. Methods: We searched MEDLINE, EMBASE, Central, and ISI Web of knowledge from inception to February 2023. All fully published studies assessing a pre-endoscopic score in patients with UGIB were included. The primary outcome was a composite score for the need of a hospital-based intervention (endoscopic therapy, surgery, angiography, or blood transfusion). Secondary outcomes included: mortality, rebleeding, or the individual endpoints of the composite outcome. Both proportional and comparative analyses were performed. Results: Thirty-eight studies were included from 2153 citations, (n = 36,215 patients). Few patients with a low Glasgow-Blatchford score (GBS) cutoff (0, ≤1 and ≤2) required hospital-based interventions (0.02 (0.01, 0.05), 0.04 (0.02, 0.09) and 0.03 (0.02, 0.07), respectively). The proportions of patients with clinical Rockall (CRS = 0) and ABC (≤3) scores requiring hospital-based intervention were 0.19 (0.15, 0.24) and 0.69 (0.62, 0.75), respectively. GBS (cutoffs 0, ≤1 and ≤2), CRS (cutoffs 0, ≤1 and ≤2), AIMS65 (cutoffs 0 and ≤1) and ABC (cutoffs ≤1 and ≤3) scores all were associated with few patients (0.01–0.04) dying. The proportion of patients suffering other secondary outcomes varied between scoring systems but, in general, was lowest for the GBS. GBS (using cutoffs 0, ≤1 and ≤2) showed excellent discriminative ability in predicting the need for hospital-based interventions (OR 0.02, (0.00, 0.16), 0.00 (0.00, 0.02) and 0.01 (0.00, 0.01), respectively). A CRS cutoff of 0 was less discriminative. For the other secondary outcomes, discriminative abilities varied between scores but, in general, the GBS (using cutoffs up to 2) was clinically useful for most outcomes. Conclusions: A GBS cut-off of one or less prognosticated low-risk patients the best. Expanding the GBS cut-off to 2 maintains prognostic accuracy while allowing more patients to be managed safely as outpatients. The evidence is limited by the number, homogeneity, quality, and generalizability of available data and subjectivity of deciding on clinical impact. Additional, comparative and, ideally, interventional studies are needed. Full article

Early risk stratification is mandatory in acute upper gastrointestinal bleeding (AUGIB) to guide optimal treatment. Numerous risk scores were introduced, but lack of practicability led to limited use in daily clinical practice. Lactate clearance is an established risk assessment tool in a variety of diseases, such as trauma and sepsis. Therefore, this study compares the predictive ability of pre-endoscopic lactate clearance and established risk scores in patients with AUGIB at the University Hospital of Cologne. Active bleeding was detected in 27 (25.2%) patients, and hemostatic intervention was performed in 35 (32.7%). In total, 16 patients (15%) experienced rebleeding and 12 (11.2%) died. Initially, lactate levels were elevated in 64 cases (59.8%), and the median lactate clearance was 18.7% (2.7–48.2%). Regarding the need for endoscopic intervention, the predictive ability of Glasgow Blatchford Score, pre-endoscopic Rockall score, initial lactate and lactate clearance did not differ significantly, and their area under the receiver operating characteristic curves were 0.658 (0.560–0.747), 0.572 (0.473–0.667), 0.572 (0.473–0.667) and 0.583 (0.483–0.677), respectively. Similar results were observed in relation to rebleeding and mortality. In conclusion, lactate clearance had comparable predictive ability compared to established risk scores. Further prospective research is necessary to clarify the potential role of lactate clearance as a reliable risk assessment tool in AUGIB. Full article

(1) Background: The assessment of mortality and rebleeding rate in upper gastrointestinal bleeding (UGIB) is essential, and several prognostic scores have been proposed. Some patients with UGIB did not undergo endoscopy, either because they refused the procedure, suffered from alcohol withdrawal symptoms or altered general status, or because the bleeding was severe enough to cause death before the endoscopy. The mortality risk in the subgroup of patients without endoscopy is poorly evaluated in the literature. (2) Methods: The purpose of the study was to identify the most useful scores for the assessment of in-hospital mortality in patients with UGIB with no endoscopy performed and no known etiology. A total of 198 patients with UGIB and no endoscopy performed were admitted between January 2017 and December 2021 and the accuracy of 12 prognostic scores and the Charlson comorbidity index for in-hospital mortality prediction were analyzed, as well as Child–Pugh Turcotte (CPT) and Meld scores in patients with cirrhosis. (3) Results: The mortality rate was 37.9%, higher than in variceal (21.9%, p < 0.0001) and non-variceal bleeding (7.4%, p < 0.0001). The most accurate scores by AUC were the International Bleeding score (INBS, 0.844), Glasgow Blatchford (0.783), MAP score (0.78), Iino (0.766), AIM65 and modified N-score (0.745 each), modified Glasgow-Blatchford (0.73), H3B2 and N-score (0.701); Rockall, Baylor, and T-score had an AUC below 0.7. MELD score was superior to CPT in patients with cirrhosis (AUC 0.811 versus 0.670). (4) Conclusions: The mortality rate in UGIB with no endoscopy was higher than in both variceal and non-variceal bleeding and was higher in the pandemic period but with no statistical significance (45.3% versus 32.14%, p = 0.0586), mainly because of positive cases. Only one case of rebleeding was noted; the hospitalization period was significantly shorter. The most accurate score was International Bleeding Score; the MELD score had a higher but moderate accuracy compared with CPT in patients with cirrhosis. Full article

Background and Objectives: The aim of this study is to compare the performance of six clinical physiological-based scores, including the pre-endoscopy Rockall score, shock index (SI), age shock index (age SI), Rapid Acute Physiology Score (RAPS), Rapid Emergency Medicine Score (REMS), and Modified Early Warning Score (MEWS), in predicting in-hospital mortality in elderly and very elderly patients in the emergency department (ED) with acute upper gastrointestinal bleeding (AUGIB). Materials and Methods: Patients older than 65 years who visited the ED with a clinical diagnosis of AUGIB were enrolled prospectively from July 2016 to July 2021. The six scores were calculated and compared with in-hospital mortality. Results: A total of 336 patients were recruited, of whom 40 died. There is a significant difference between the patients in the mortality group and survival group in terms of the six scoring systems. MEWS had the highest area under the curve (AUC) value (0.82). A subgroup analysis was performed for a total of 180 very elderly patients (i.e., older than 75 years), of whom 27 died. MEWS also had the best predictive performance in this subgroup (AUC, 0.82). Conclusions: This simple, rapid, and obtainable-by-the-bed parameter could assist emergency physicians in risk stratification and decision making for this vulnerable group. Full article

SARS-COV 2 recently caused a global pandemic, with the first case being reported in Romania in February 2020. Important restrictive measures were imposed, so that the addressability of patients to medical services decreased. Upper gastrointestinal bleeding had more severe forms of evolution at the time of presentation, which required additional methods of diagnosis and treatment. This is a retrospective study performed on 268 patients, which aims to evaluate the type and effectiveness of different treatment methods for upper gastrointestinal bleeding during the COVID 19 pandemic. Severity assessment was performed by measuring the Rockall score and additional methods of diagnosis. The association of COVID-19 with upper gastrointestinal bleeding can lead to much more severe outcomes for the patient, so treatment must be sustained and fast established. If the initial therapeutic methods fail, the other available therapeutic measures should be introduced progressively and without delay to achieve the best possible outcomes. Full article