Upper gastrointestinal bleeding risk scores: Who, when and why?

Table 1 Rockall score

Score	0	1	2	3
Variable
Age	< 60 yr	60-79 yr	≥ 80 yr
Shock	No shock, systolic BP ≥ 100, pulse < 100	Tachycardia, systolic BP ≥ 100, pulse ≥ 100	Hypotension, systolic BP < 100
Comorbidity	No major comorbidity		Cardiac failure, ischaemic heart disease, any major comorbidity	Renal failure, liver failure, disseminated malignancy
Diagnosis	Mallory-Weiss tear, no lesion identified and no SRH	All other diagnoses	Malignancy of UGI tract
Major SRH	None or dark spot only		Blood in UGI tract, adherent clot, visible or spurting vessel

Admission score: Sum of age, shock and comorbidity; full score: Sum of age, shock, comorbidity, diagnosis and major SRH; BP: Blood pressure (measured in mmHg); UGI: Upper gastrointestinal; SRH: Stigmata of recent haemorrhage.

Table 2 Baylor bleeding score

Pre-endoscopy score	1	2	3	4	5
Age (yr)	30-49	50-59	60-69		≥ 70
No. of illnesses	1-2			3-4	> 5
Severity of illnesses				Chronic1	Acute2
Endoscopy Score
Site of bleeding				Posterior wall bulb
Stigmata of bleeding	Clot		Visible vessel		Active bleeding

Pre-endoscopy score: Sum of the scores for age and the number and severity of concurrent illnesses; Endoscopy score: Sum of the scores for site and stigmata of haemorrhage; Post-endoscopy score: Sum of the pre-endoscopy and endoscopy score;

¹Chronic: Presence of a concurrent chronic life-threatening illness;

²Acute: Presence of a concurrent acute life-threatening illness.

Table 3 Cedars-sinai medical centre predictive index

Score	EGD findings1	Time2	Haemodynamics	Comorbidities
0	Ulcer without SHR, non-bleeding MW tear	> 48 h	Stable	≤ 1
	Erosive disease, normal EGD
1	Ulcer with flat spot or clot, erosive disease with SHR, angiodysplasia	< 48 h	Intermediate	2
2	Ulcer with non- bleeding visible vessel or SHR	In hospital	Unstable	3
3				≥ 4
4	Persistent haemorrhage, varices
	UGI cancer

¹Score for endoscopic findings was reduced by 1 point if effective endoscopic therapy was applied (not applicable to varices or cancer);

²Time from onset of symptoms to hospitalization; SHR: Stigmata of recent haemorrhage; MW: Mallory-Weiss tear; EGD: Esophagogastroduodenoscopy; UGI: Upper gastrointestinal.

Table 4 Progetto nazionale emorragia digestiva score

Score	1	2	3	4
Variables	ASA 3	Hb level ≤ 7 g/dL	Rebleeding	Failure of endoscopic
	Time to	Age ≥ 80	ASA 4	treatment
	admission < 8 h	Renal failure	Neoplasia
			Liver cirrhosis

ASA: American Society of Anaesthesiology; GI: Gastrointestinal.

Table 5 Glasgow blatchford score

Variable	Score
Blood urea (mmol/L)
6.5-8	2
8-10	3
10-25	4
> 25	6
Hb (g/L) for men
120-130	1
100-120	3
< 100	6
Hb (g/L) for women
100-120	1
< 100	6
Systolic blood pressure (mmHg)
100-109	1
90-99	2
< 90	3
Pulse ≥ 100/min	1
History and comorbidities
Melaena	1
Syncope	2
Hepatic disease1	2
Cardiac failure2	2

¹Known history or clinical and laboratory evidence, of chronic or acute liver disease;

²Known history or clinical and echocardiographic evidence, of cardiac failure.

Table 6 AIMS65 Score

Variable	Score
Albumin < 3 g/dL	1
International normalized ratio > 1.5	1
Systolic blood pressure < 90 mmHg	1
Altered mental status	1
Age > 65 yr	1

Table 7 T-score

Score	1	2	3
Variable
General conditions	Poor	Intermediate	Good
Pulse (beats/min)	> 110	90-110	< 90
Systolic blood pressure (mmHg)	< 90	90-110	> 110
Haemoglobin levels (g/dL)	≤ 8	9-10	> 10

Table 8 Outcomes

Scores	Primary outcome	Original studies
Endoscopy based score
Forrest classification	Rebleeding	[12]
BBS	Rebleeding	[19]
CSMCPI	Mean length of stay	[20]
Rockall	Mortality	[15]
PNED	Mortality	[21]
Clinical scores
Clinical rockall	Mortality	[15]
GBS	Need intervention	[41]
AIMS65	Mean length of stay/mortality	[23]
T-score	Time to endoscopy	[24,65]

BBS: Baylor bleeding score; CSMCPI: Cedars-sinai medical centre predictive index; PNED: Progetto nazionale emorragia digestiva; GBS: Glasgow blatchford score.