Risk stratification for upper gastrointestinal bleeding (UGIB) is recommended. However, scoring systems accuracy is suboptimal and score calculation can be complex. Our aim was to develop a new score, the MAP (ASH) score, with information available in the emergency room (ER), and to validate it.
The score was built from a prospective database of patients with UGIB, and validated in an international database of 3,012 patients from six hospitals. Outcomes were 30-day mortality, endoscopic intervention, any intervention (red blood transfusion, endoscopic treatment, interventional radiology, surgery or death) and rebleeding. Accuracy to predict outcomes was assessed by the area under the receiver operating characteristic (AUROC) curve.
547 patients were included in the development cohort. Impaired mental status, Albumin<2.5 g/dL, pulse>100, American Society of Anesthesiologists (ASA) score>2, Systolic blood pressure<90 mmHg, and Hemoglobin<10 g/dl were included in the score. The model had a good predictive accuracy for intervention (AUROC=0.83; 95% CI: 0.79-0.88) and fair for mortality (AUROC=0.74; 95%CI: 0.68-0.81). Regarding endoscopic intervention, AUROC was 0.61 (95%CI: 0.56-0.66) in the original cohort, and 0.69 (95% CI: 0,66 to 0,71) in the validation cohort, showing a poor performance, similar to other scores. For rebleeding, the MAP (ASH) (AUROC 0.73; 95%CI: 0,69 to 0,77) was similar to GBS (AUROC=0.72; 95%CI: 0,67 to 0,76), but superior to AIMS65 (AUROC=0.64; 95% CI: 0,59 to 0,68).
MAP (ASH) is a simple pre-endoscopy risk score to predict intervention after UGIB, with fair discrimination at predicting mortality. Because of its applicability, it could be an option in clinical practice.