Validation of the AIMS65 score in predicting outcomes in UGIB patients in Pahang population

Abstract

Upper gastrointestinal bleeding (UGIB) is a gastrointestinal emergency that can result in significant mortality, morbidity, and use of health care resources. International consensus and American guidelines recommend early risk stratification for acute UGIB to identify patients at higher risk for mortality and morbidity. The currently available scores are complicated, and the usage in local settings is low. The newly proposed AIMS65 score is easy and accurate in predicting outcomes in UGIB. The objective of this study aims to validate the AIMS65 score as a predictor of mortality in patients with acute UGIB in the Pahang population. This was a retrospective study of emergency endoscopies performed in IIUM Hospital, Kuantan, and Sultan Haji Ahmad Shah Hospital, Temerloh from 1st January 2017 to 31st December 2019 for upper gastrointestinal bleeding (UGIB). AIMS65 scores were calculated in 150 patients involved in the study. Patients were monitored throughout their hospitalization. The outcomes measured were in-patient mortality, rebleeding, and the clinical intervention required in UGIB patients. The study included 150 patients with UGIB. There is a male predominance with 72.7%. The median age of patients in our analysis was 63 years old. Forty-three patients (28.7%) had rebleeding. Endoscopic therapy was performed in 40(26.7%), radiological intervention in 3 (2%), and surgery required in 7 (4.7%) among patients who had rebleeding. The predictive accuracy of AIMS65 scores more than 2 was high for inpatient mortality (AUROC 0.89), rebleeding (AUROC 0.867), and endoscopy therapy (AUROC 0.881). The overall mortality was 11.3% (n=17) and was 6%, 36%, 60% and 100% for AIMS65 score of 2,3,4 and 5 respectively. However, AIMS65 scores were not statistically significant to predict radiological intervention and surgery for UGIB patients. As a conclusion, the AIMS65 score is a simple, accurate, and valid risk score that can be applied to patients with acute UGIB.