MAP(ASH)

A new scoring system for the prediction of intervention and mortality in upper gastrointestinal bleeding

Eduardo Redondo-Cerezo*, Francisco Vadillo-Calles, Adrian J. Stanley, Stig Laursen, Loren Laine, Harry R. Dalton, Jing H. Ngu, Michael Schultz, Rita Jiménez-Rosales

*Kontaktforfatter for dette arbejde

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

Resumé

Background and Aim: Risk stratification for upper gastrointestinal bleeding (UGIB) is recommended. However, scoring system 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 and to validate it. Methods: The score was built from a prospective database of patients with UGIB and validated in an international database of 3012 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 curve (AUROC). Results: Five hundred forty-seven patients were included in the development cohort. Impaired mental status, albumin < 2.5 g/dL, pulse > 100, American Society of Anesthesiologists 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% confidence interval [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: 0.66–0.71) in the validation cohort, showing a poor performance, similar to other scores. For rebleeding, the MAP(ASH) (AUROC 0.73; 95% CI: 0.69–0.77) was similar to Glasgow Blatchford score (AUROC = 0.72; 95% CI: 0.67–0.76) but superior to AIMS65 (AUROC = 0.64; 95% CI: 0.59–0.68). Conclusion: 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.

OriginalsprogEngelsk
TidsskriftJournal of Gastroenterology and Hepatology (Australia)
ISSN0815-9319
DOI
StatusE-pub ahead of print - 29. jul. 2019

Fingeraftryk

ROC Curve
Confidence Intervals
Databases
Interventional Radiology
Hospital Emergency Service

Citer dette

Redondo-Cerezo, Eduardo ; Vadillo-Calles, Francisco ; Stanley, Adrian J. ; Laursen, Stig ; Laine, Loren ; Dalton, Harry R. ; Ngu, Jing H. ; Schultz, Michael ; Jiménez-Rosales, Rita. / MAP(ASH) : A new scoring system for the prediction of intervention and mortality in upper gastrointestinal bleeding. I: Journal of Gastroenterology and Hepatology (Australia). 2019.
@article{f8a2a616ecc643998c8a456af9c4cf88,
title = "MAP(ASH): A new scoring system for the prediction of intervention and mortality in upper gastrointestinal bleeding",
abstract = "Background and Aim: Risk stratification for upper gastrointestinal bleeding (UGIB) is recommended. However, scoring system 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 and to validate it. Methods: The score was built from a prospective database of patients with UGIB and validated in an international database of 3012 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 curve (AUROC). Results: Five hundred forty-seven patients were included in the development cohort. Impaired mental status, albumin < 2.5 g/dL, pulse > 100, American Society of Anesthesiologists 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{\%} confidence interval [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: 0.66–0.71) in the validation cohort, showing a poor performance, similar to other scores. For rebleeding, the MAP(ASH) (AUROC 0.73; 95{\%} CI: 0.69–0.77) was similar to Glasgow Blatchford score (AUROC = 0.72; 95{\%} CI: 0.67–0.76) but superior to AIMS65 (AUROC = 0.64; 95{\%} CI: 0.59–0.68). Conclusion: 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.",
keywords = "Admission Rockall score, AIMS65, Glasgow Blatchford score, MAP(ASH) score, Upper gastrointestinal bleeding",
author = "Eduardo Redondo-Cerezo and Francisco Vadillo-Calles and Stanley, {Adrian J.} and Stig Laursen and Loren Laine and Dalton, {Harry R.} and Ngu, {Jing H.} and Michael Schultz and Rita Jim{\'e}nez-Rosales",
year = "2019",
month = "7",
day = "29",
doi = "10.1111/jgh.14811",
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MAP(ASH) : A new scoring system for the prediction of intervention and mortality in upper gastrointestinal bleeding. / Redondo-Cerezo, Eduardo; Vadillo-Calles, Francisco; Stanley, Adrian J.; Laursen, Stig; Laine, Loren; Dalton, Harry R.; Ngu, Jing H.; Schultz, Michael; Jiménez-Rosales, Rita.

I: Journal of Gastroenterology and Hepatology (Australia), 29.07.2019.

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

TY - JOUR

T1 - MAP(ASH)

T2 - A new scoring system for the prediction of intervention and mortality in upper gastrointestinal bleeding

AU - Redondo-Cerezo, Eduardo

AU - Vadillo-Calles, Francisco

AU - Stanley, Adrian J.

AU - Laursen, Stig

AU - Laine, Loren

AU - Dalton, Harry R.

AU - Ngu, Jing H.

AU - Schultz, Michael

AU - Jiménez-Rosales, Rita

PY - 2019/7/29

Y1 - 2019/7/29

N2 - Background and Aim: Risk stratification for upper gastrointestinal bleeding (UGIB) is recommended. However, scoring system 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 and to validate it. Methods: The score was built from a prospective database of patients with UGIB and validated in an international database of 3012 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 curve (AUROC). Results: Five hundred forty-seven patients were included in the development cohort. Impaired mental status, albumin < 2.5 g/dL, pulse > 100, American Society of Anesthesiologists 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% confidence interval [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: 0.66–0.71) in the validation cohort, showing a poor performance, similar to other scores. For rebleeding, the MAP(ASH) (AUROC 0.73; 95% CI: 0.69–0.77) was similar to Glasgow Blatchford score (AUROC = 0.72; 95% CI: 0.67–0.76) but superior to AIMS65 (AUROC = 0.64; 95% CI: 0.59–0.68). Conclusion: 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.

AB - Background and Aim: Risk stratification for upper gastrointestinal bleeding (UGIB) is recommended. However, scoring system 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 and to validate it. Methods: The score was built from a prospective database of patients with UGIB and validated in an international database of 3012 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 curve (AUROC). Results: Five hundred forty-seven patients were included in the development cohort. Impaired mental status, albumin < 2.5 g/dL, pulse > 100, American Society of Anesthesiologists 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% confidence interval [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: 0.66–0.71) in the validation cohort, showing a poor performance, similar to other scores. For rebleeding, the MAP(ASH) (AUROC 0.73; 95% CI: 0.69–0.77) was similar to Glasgow Blatchford score (AUROC = 0.72; 95% CI: 0.67–0.76) but superior to AIMS65 (AUROC = 0.64; 95% CI: 0.59–0.68). Conclusion: 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.

KW - Admission Rockall score

KW - AIMS65

KW - Glasgow Blatchford score

KW - MAP(ASH) score

KW - Upper gastrointestinal bleeding

U2 - 10.1111/jgh.14811

DO - 10.1111/jgh.14811

M3 - Journal article

JO - Journal of Gastroenterology and Hepatology

JF - Journal of Gastroenterology and Hepatology

SN - 0815-9319

ER -