Retrospective analysis of 2 scoring systems in patients admitted with non-varicose vein upper gastrointestinal system bleeding

Upper gastrointestinal bleeding (UGIB) refers to bleeding into the lumen between the proximal duodenum up to the ligament of Treitz and the upper esophageal sphincter. Its severity covers a wide spectrum ranging from subclinical occult bleeding to subcutaneous bleeding, from chronic anemia to acute hypovolemic shock (1). The incidence is 103/100.000 per year. It is the cause of 300,000 hospitalizations per year in the USA and constitutes approximately 1% of all hospitalizations. Despite all the advances in pharmacologic and interventional treatment methods, mortality is between 2-10% (2). Mortality rate is closely related to age. In fact, while mortality is 8% below the age of 60 years, this rate increases to 13% above the age of 60 years (2). Other factors associated with mortality include recurrent bleeding, presence of comorbidities (cardiac disease, chronic liver disease, respiratory or central nervous system disease, renal failure), history of peptic ulcer or previous surgical intervention, presentation with hematemesis, development of hypotension and esophageal variceal bleeding (3). Peptic ulcer is the cause of approximately 50% of UICs. Non-steroidal anti-inflammatory drug (NSAID) use is present in 30-50% of patients. Especially in elderly patients, the risk of NSAID-related UICs is high (4). Mostly bleeding stops spontaneously. In cases where bleeding continues, hemostasis can be achieved with endoscopic treatment. Risky cases in whom hemodynamic stability and bleeding control cannot be achieved or who have recurrent bleeding are candidates for surgery. Although many scoring systems have been developed in recent years to classify patients according to risk groups, the two most commonly used scoring systems are the Rockall score (RS) system, which includes pre-endoscopic and endoscopic components and is used to predict mortality, and the Glasgow-Blatchford scoring (GBS) system, which is used to predict low-risk patients who do not require intervention based only on clinical and laboratory findings. (5, 6) In this study, the effect of Rockal and GlasgowBlachford scores on mortality in patients with Upper GI bleeding together with parameters such as duration of endoscopy, helicobacter pylori positivity, forrest classification and need for surgery will be evaluated. Thus, what is the effect of helicobacter pylori positivity on mortality, what is the effect of duration of endoscopy on mortality? What is the effect of Rockal and Glasgow-Blachford scores on mortality? Materials and Methods: This study was planned as a study with materials obtained during routine examination and treatment procedures. A total of 200 volunteers, 45 female and 155 male patients, were included in the study. In the study, patients between the ages of 18-99 with upper gastrointestinal bleeding who were examined for helicobacterium pylori status, forrest level, Rockal and Glasgow-Blachford scores were analyzed. The study was planned to statistically evaluate Rockal and Glasgow-Blachford scores in patients with upper gastric bleeding in Van YYÜ Dursun Odabaş Medical Center, Internal Medicine service, Gastroenterology service, Internal Medicine Intensive Care service, General Surgery service, General Surgery Intensive Care service and Anesthesia and Reamination Intensive Care service after January 2013. In calculating the sample size of the study, the Standard Effect Size was determined as 0.61 by taking the Power (Power of the Test) at least 80% and Type-1 error 5% for each variable. It is sufficient to include n=42 cases in each group. In the study, 3 cases were reserves for each group. All data were tried to be accessed. All the information obtained was computerized. Descriptive statistics were used to analyze the data. Mean, standard deviation, median, minimum, maximum, frequencies and ratios were used in the descriptive statistics of the data. The distribution of variables was measured using the Kolmogorov-Simirnov test. Independent samples t-test, Mann-Whitney u-test were used to analyse independent quantitative data. Paired sample t-test and Wilcoxon test were used to analyse dependent quantitative data. The chi-square test was used in the analysis of independent IV qualitative data, and the fischer test was used when the conditions for the chi-square test were not met. SPSS 28.0 was used for analyses. A value of p < 0.05 was considered significant. Results: A total of 200 patients (155 males and 45 females) were included in the study, and the mortality rate was found to be 38.5%. Normality tests revealed that only the age variable showed a parametric distribution, while all scoring systems and inflammatory markers followed non-parametric distributions. According to the Mann-Whitney U test, the Glasgow-Blatchford score, Rockall score, CRP/Alb ratio, NLR, PLR, and SII values were significantly higher in deceased patients compared to survivors (p<0.05). The Chi-square test for gender and survival showed that male patients had a significantly higher survival rate than females (p=0.010). In ROC analysis, the Glasgow-Blatchford Score (AUC: 0.801) demonstrated the highest discriminatory power, followed by NLR (0.761), PLR (0.732), Rockall Score (0.742), and CRP/Alb ratio (0.726). Furthermore, the Forrest classification showed that patients in the Ia–Ib group had the highest mortality rate at 27.6%, while Helicobacter pylori-negative patients had a mortality rate of 21.5%. Mortality was significantly higher in patients who underwent endoscopy after more than 12 hours. Conclusion: In this retrospective analysis, the Rockall and Glasgow-Blatchford scoring systems were found to be effective tools in predicting mortality among patients with upper gastrointestinal bleeding. The Glasgow-Blatchford Score, in particular, was supported for clinical use due to its high AUC value. Additionally, inflammatory markers such as CRP/Alb ratio, NLR, SII, and PLR demonstrated significant predictive power for both mortality and rebleeding. The higher mortality rate observed in female patients suggests that gender-based risk profiles may exist. The increased mortality in advanced stages of Forrest classification underscores the importance of endoscopic classification in predicting clinical outcomes. Interestingly, lower mortality rates among Helicobacter pylori-positive patients may indicate that the systemic effects of this infection differ from expected patterns. Therefore, early risk stratification using scoring systems, monitoring of inflammatory parameters, and the use of endoscopic classification may enhance treatment effectiveness and reduce mortality and complications in UGIB patients.