Evaluation of the effectiveness of Glasgow blatchford score in predicting prognosis in upper gastrointestinal system bleeding

Aim: Acute upper gastrointestinal bleeding is one of the common causes of emergency admissions that can have serious consequences. Therefore, it is important to evaluate patients in the early period, predict morbidity, bleeding recurrence, mortality. Glasgow Blatchford score is a scoring system developed to predict the need for medikal intervention (blood transfusion, endoscopy, surgery). The aim of the study was to investigate the relationship of Glasgow Blatchford score with prognostic markers in patients with upper gastrointestinal bleeding. Materials and Methods: Patients admitted to Hitit Üniversity Erol Olçok Training and Research Hospital with upper gastrointestinal tract bleeding between December 2022 and May 2023 were included in the study. Demographic data of the patients, complaints at the time of admission, chronic disease, medications used, intensive care/ward admission status, vital signs, presence of melena, syncope status, whether there is a need for blood transfussion, time of endoscopic intervention, whether there are signs of active bleeding endoscopy, intervention method, need for surgery, rebleeding status, outcome of hospitalization and length of stay were recorded. Glasgow Blatchford score of the patients were calculated and their relationship with prognostic markers and mortality were investigated. Result: A total of 140 patients were included included in the study. The average age of the patients was 69.7±18 years. 41.4% (n=58) of the patients were female and 58.6% (n=82) were male. The average Glasgow Blatchford score was 9.5±4. While the average length of stay of the patient was 5.1±6.3 days, 15.7% (n=21) died. There was a moderate positive correlation between Glasgow Blatchford Score and age (r=0.470, p<0,001), Charlson comorbity index (r=0.518, p<0.001) and length of stay (r=0.272, p=0.001). In the logistic regression analysis performed to predict mortality, the Charlson Comorbidity index (OR: 1.023, CI= 1.008-1.437, p=0.046) was significant, while the Glasgow Blatchford score was not a predictor of mortality (p=0.582). Glasgow Blatchford score; in determining the need for blood transfusion (OR: 1.493, 95% CI:1.297-1.719, p<0.001), in the need for endoscopic intervention (OR:1.248, 95% CI:1.089-1.430, p=0.001) and in ward/intensive care vii preference (OR:0.869, %95 CI:0.790-0.953, p=0.003) was a significant predıctor. In ROC analysis, with a cut off value of 9.5 for Glasgow Blatchford Scorefor mortality, AUC was 0.64 (%95 CI:0.513-0.775, p=0.032), sensivity was 68.2% and specifity was 52.5%. With a Glasgow Blatchford Score 8.5, cut off value for blood transfusion requirement, AUC was 0.853 (95% CI:0.782-0.924, p<0.001), sensivity was 84.9% and specificity was 75.9%. With a Glasgow Blatchford Score 9.5 cut off value for the need for endoscopıc intervention, AUC was 0.752(95% CI:0.653-0.812, p<0.001), sensitivity was 90% and specificity was 50.8%. With a Glasgow Blatchford Score cut off value of 9.5 for the need for intensive care unit admission, AUC was 0.72 (95%CI:0.646-0.812, p<0.001), sensitivity was 70.1% and specificity was 58.9%. Conclusion: Glasgow Blatchford score was not predictive for mortality, but Charlson Comorbidity index was predictive for mortality. Glasgow Blatchford score was predictive in determining the need for blood transfussion, the need for endoscopic intervention and the need for intensive care. Key Words: Glasgow Blatchford scale, prognosis, upper gastrointestinal bleeding.