Background and Aims
Although upper GI bleeding (UGIB) is a significant cause of inpatient admissions,
no scoring method has proven to be accurate and simple as a standard for triage purposes.
Therefore, we compared a previously described 3-variable score (1 point each for absence
of daily proton pump inhibitor use in the week before the index presentation, shock
index [heart rate/systolic blood pressure] ≥1, and blood urea nitrogen/creatinine
≥30 [urea/creatinine≥140]), the Horibe gAstRointestinal BleedING scoRe (HARBINGER),
with the 8-variable Glasgow-Blatchford Score (GBS) and 5-variable AIMS65 to evaluate
and validate the accuracy in predicting high-risk features that warrant admission
and urgent endoscopy.
Methods
Consecutive patients presenting with suspected UGIB between 2012 and 2015 were prospectively
enrolled in 3 acute care Japanese hospitals. On presentation to the emergency setting,
an endoscopy was performed in a timely fashion. The primary outcome was the prediction
of high-risk endoscopic stigmata.
Results
Of 1486 enrolled patients, 637 (43%) harbored high-risk endoscopic stigmata according
to international consensus statements. The area under the receiver operating characteristic
curve (AUC) for the HARBINGER was .76 (95% confidence interval [CI], .72-.79), which
was significantly superior to both the GBS (AUC, .68; 95% CI, .64-.71; P < .001) and the AIMS65 (AUC, .54; 95% CI, .50-.58; P < .001). When the HARBINGER cutoff value was set at 1 to rule out patients who needed
admission and urgent endoscopy, its sensitivity and specificity was 98.8% (95% CI,
97.9-99.6) and 15.5% (95% CI, 13.1-18.0), respectively.
Conclusions
The HARBINGER, a simple 3-variable score, provides a more accurate method for triage
of patients with suspected UGIB than both the GBS and AIMS65.
Graphical abstract
Graphical Abstract
Abbreviations:
AUC (area under the receiver operating characteristic curve), CI (confidence interval), GBS (Glasgow-Blatchford Score), HARBINGER (Horibe gAstRointestinal BleedING prEdiction scoRe), IDI (integrated discrimination improvement), NRI (net reclassification improvement), UGIB (upper GI bleeding)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: March 30, 2020
Accepted:
March 19,
2020
Received:
November 5,
2019
Footnotes
DISCLOSURE: All authors disclosed no financial relationships. Dr Horibe received research support for this study from the Japanese Society for Abdominal Emergency Medicine.
See CME section; p. 754.
Identification
Copyright
© 2020 by the American Society for Gastrointestinal Endoscopy
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