Digestive Diseases and Sciences

, Volume 61, Issue 7, pp 2002–2010 | Cite as

The Novel Scoring System for 30-Day Mortality in Patients with Non-variceal Upper Gastrointestinal Bleeding

  • Sejin Hwang
  • Seong Woo Jeon
  • Joong Goo Kwon
  • Dong Wook Lee
  • Chang Yoon Ha
  • Kwang Bum Cho
  • ByungIk Jang
  • Jung Bae Park
  • Youn Sun Park
  • Daegu-Gyengbuk Gastrointestinal Study Group (DGSG)
Original Article



Although the mortality rates for non-variceal upper gastrointestinal bleeding (NVUGIB) have recently decreased, it remains a significant medical problem.


The main aim of this prospective multicenter database study was to construct a clinically useful predictive scoring system by using our predictors and compare its prognostic accuracy with that of the Rockall scoring system.


Data were collected from consecutive patients with NVUGIB. Logistic regression analysis was performed to identify the independent predictors of 30-day mortality. Each independent predictor was assigned an integral point proportional to the odds ratio (OR) and we used the area under the curve to compare the discrimination ability between the new predictive model and the Rockall score.


The independent predictors of mortality included age >65 years [OR 2.627; 95 % confidence interval (CI) 1.298–5.318], hemodynamic instability (OR 2.217; 95 % CI 1.069–4.597), serum blood urea nitrogen level >40 mg/dL (OR 1.895; 95 % CI 1.029–3.490), active bleeding at endoscopy (OR 2.434; 95 % CI 1.283–4.616), transfusions (OR 3.811; 95 % CI 1.640–8.857), comorbidities (OR 3.481; 95 % CI 1.405–8.624), and rebleeding (OR 10.581; 95 % CI 5.590–20.030). The new predictive model showed a high discrimination capability and was significantly superior to the Rockall score in predicting the risk of death (OR 0.837;95 % CI 0.818–0.855 vs. 0.761; 0.739–0.782; P = 0.0123).


The new predictive score was significantly more accurate than the Rockall score in predicting death in NVUGIB patients. We need to prospectively validate the accuracy of this score for predicting mortality in NVUGIB patients.


Prediction Mortality Gastrointestinal hemorrhage Risk assessment 



The DGSG initiative was a collaborative effort supported by the Daegu-Gyeongbuk Gastrointestinal Study Group. We acknowledge the great deal of work performed by the medical and nursing staff in each of the participating units.

Author contributions

Guarantor of the article Seong Woo Jeon, M.D., Ph.D., Specific author contributions Sejin Hwang was involved in the analysis and interpretation of data, drafting of the manuscript, statistical analysis. Seong Woo Jeon was involved in the study design, analysis and interpretation of data, critical revision of the manuscript, administrative, technical and material support. Joong Goo Kwon, Dong Wook Lee, Chang Yoon Ha, Kwang Bum Cho, Byung Ik Jang, Jung Bae Park, Youn Sun Park were involved in the acquisition of data, critical revision of the manuscript, study supervision. All authors read and approved the final manuscript.

Compliance with ethical standards

Conflict of interest



  1. 1.
    Loperfido S, Baldo V, Piovesana E, et al. Changing trends in acute upper-GI bleeding: a population-based study. Gastrointest Endosc. 2009;70:212–224.CrossRefPubMedGoogle Scholar
  2. 2.
    Kohn A, Ancona C, Belleudi V, et al. The impact of endoscopy and specialist care on 30-day mortality among patients with acute non-variceal upper gastrointestinal hemorrhage: an Italian population-based study. Dig Liver Dis. 2010;42:629–634.CrossRefPubMedGoogle Scholar
  3. 3.
    Barkun AN, Bardou M, Kuipers EJ, et al. International consensus recommendations on the management of patients with nonvariceal upper gastrointestinal bleeding. Ann Intern Med. 2010;152:101–113.CrossRefPubMedGoogle Scholar
  4. 4.
    Gralnek IM, Barkun AN, Bardou M. Management of acute bleeding from a peptic ulcer. N Engl J Med. 2008;359:928–937.CrossRefPubMedGoogle Scholar
  5. 5.
    Kuipers EJ. Improved risk assessment in upper GI bleeding. Gastrointest Endosc. 2011;74:1225–1229.CrossRefPubMedGoogle Scholar
  6. 6.
    Thomopoulos KC, Vagenas KA, Vagianos CE, et al. Changes in aetiology and clinical outcome of acute upper gastrointestinal bleeding during the last 15 years. Eur J Gastroenterol Hepatol. 2004;16:177–182.CrossRefPubMedGoogle Scholar
  7. 7.
    Rockall TA, Logan RF, Devlin HB, Northfield TC. Risk assessment after acute upper gastrointestinal haemorrhage. Gut. 1996;38:316–321.CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Hearnshaw SA, Logan RF, Lowe D, Travis SP, Murphy MF, Palmer KR. Acute upper gastrointestinal bleeding in the UK: patient characteristics, diagnoses and outcomes in the 2007 UK audit. Gut. 2011;60:1327–1335.CrossRefPubMedGoogle Scholar
  9. 9.
    Cai S, Garcia Rodriguez LA, Masso-Gonzalez EL, Hernandez-Diaz S. Uncomplicated peptic ulcer in the UK: trends from 1997 to 2005. Aliment Pharmacol Ther. 2009;30:1039–1048.CrossRefPubMedGoogle Scholar
  10. 10.
    Rotondano G, Cipolletta L, Koch M, et al. Predictors of favourable outcome in non-variceal upper gastrointestinal bleeding: Implications for early discharge? Dig Liver Dis. 2014;46:231–236.CrossRefPubMedGoogle Scholar
  11. 11.
    Jairath V, Kahan BC, Stanworth SJ, et al. Prevalence, management, and outcomes of patients with coagulopathy after acute nonvariceal upper gastrointestinal bleeding in the United Kingdom. Transfusion. 2013;53:1069–1076.CrossRefPubMedGoogle Scholar
  12. 12.
    Jairath V, Martel M, Logan RF, Barkun AN. Why do mortality rates for nonvariceal upper gastrointestinal bleeding differ around the world? A systematic review of cohort studies. Can J Gastroenterol. 2012;26:537–543.CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Lanas A, Garcia-Rodriguez LA, Polo-Tomas M, et al. Time trends and impact of upper and lower gastrointestinal bleeding and perforation in clinical practice. Am J Gastroenterol. 2009;104:1633–1641.CrossRefPubMedGoogle Scholar
  14. 14.
    Soncini M, Triossi O, Leo P, et al. Management of patients with nonvariceal upper gastrointestinal hemorrhage before and after the adoption of the Rockall score, in the Italian Gastroenterology Units. Eur J Gastroenterol Hepatol. 2007;19:543–547.CrossRefPubMedGoogle Scholar
  15. 15.
    Marmo R, Koch M, Cipolletta L, et al. Predictive factors of mortality from nonvariceal upper gastrointestinal hemorrhage: a multicenter study. Am J Gastroenterol. 2008;103:1639–1647. (quiz 1648).CrossRefPubMedGoogle Scholar
  16. 16.
    Barkun A, Sabbah S, Enns R, et al. The Canadian Registry on Nonvariceal Upper Gastrointestinal Bleeding and Endoscopy (RUGBE): endoscopic hemostasis and proton pump inhibition are associated with improved outcomes in a real-life setting. Am J Gastroenterol. 2004;99:1238–1246.CrossRefPubMedGoogle Scholar
  17. 17.
    Leontiadis GI, Sharma VK, Howden CW. Systematic review and meta-analysis: enhanced efficacy of proton-pump inhibitor therapy for peptic ulcer bleeding in Asia—a post hoc analysis from the Cochrane Collaboration. Aliment Pharmacol Ther. 2005;21:1055–1061.CrossRefPubMedGoogle Scholar
  18. 18.
    Romagnuolo J, Barkun AN, Enns R, Armstrong D, Gregor J. Simple clinical predictors may obviate urgent endoscopy in selected patients with nonvariceal upper gastrointestinal tract bleeding. Arch Intern Med. 2007;167:265–270.CrossRefPubMedGoogle Scholar
  19. 19.
    Saltzman JR, Tabak YP, Hyett BH, Sun X, Travis AC, Johannes RS. A simple risk score accurately predicts in-hospital mortality, length of stay, and cost in acute upper GI bleeding. Gastrointest Endosc. 2011;74:1215–1224.CrossRefPubMedGoogle Scholar
  20. 20.
    Jung SH, Oh JH, Lee HY, et al. Is the AIMS65 score useful in predicting outcomes in peptic ulcer bleeding? World J Gastroenterol. 2014;20:1846–1851.CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Marmo R, Koch M, Cipolletta L, et al. Predicting mortality in non-variceal upper gastrointestinal bleeders: validation of the Italian PNED Score and Prospective Comparison with the Rockall Score. Am J Gastroenterol. 2010;105:1284–1291.CrossRefPubMedGoogle Scholar
  22. 22.
    Stanley AJ, Dalton HR, Blatchford O, et al. Multicentre comparison of the Glasgow Blatchford and Rockall Scores in the prediction of clinical end-points after upper gastrointestinal haemorrhage. Aliment Pharmacol Ther. 2011;34:470–475.CrossRefPubMedGoogle Scholar
  23. 23.
    Laine L, Jensen DM. Management of patients with ulcer bleeding. Am J Gastroenterol. 2012;107:345–360. (quiz 361).CrossRefPubMedGoogle Scholar
  24. 24.
    Barkun AN, Martel M, Toubouti Y, Rahme E, Bardou M. Endoscopic hemostasis in peptic ulcer bleeding for patients with high-risk lesions: a series of meta-analyses. Gastrointest Endosc. 2009;69:786–799.CrossRefPubMedGoogle Scholar
  25. 25.
    Chiu PW, Ng EK, Cheung FK, et al. Predicting mortality in patients with bleeding peptic ulcers after therapeutic endoscopy. Clin Gastroenterol Hepatol. 2009;7:311–316. (quiz 253).CrossRefPubMedGoogle Scholar
  26. 26.
    Sung JJ, Chan FK, Chen M, et al. Asia-Pacific Working Group consensus on non-variceal upper gastrointestinal bleeding. Gut. 2011;60:1170–1177.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  • Sejin Hwang
    • 1
  • Seong Woo Jeon
    • 1
  • Joong Goo Kwon
    • 2
  • Dong Wook Lee
    • 2
  • Chang Yoon Ha
    • 3
  • Kwang Bum Cho
    • 4
  • ByungIk Jang
    • 5
  • Jung Bae Park
    • 6
  • Youn Sun Park
    • 7
  • Daegu-Gyengbuk Gastrointestinal Study Group (DGSG)
  1. 1.Division of Gastroenterology and Hepatology, Department of Internal MedicineKyungpook National University Medical CenterDaeguSouth Korea
  2. 2.Division of Gastroenterology and Hepatology, Department of Internal MedicineCatholic University of Daegu School of MedicineDaeguSouth Korea
  3. 3.Division of Gastroenterology and Hepatology, Department of Internal MedicineGyeongsang National University HospitalJinjuSouth Korea
  4. 4.Division of Gastroenterology and Hepatology, Department of Internal MedicineKeimyung University Dongsan Medical CenterDaeguSouth Korea
  5. 5.Division of Gastroenterology and Hepatology, Department of Internal MedicineYeungnam University College of MedicineDaeguSouth Korea
  6. 6.Division of Gastroenterology and Hepatology, Department of Internal MedicineDongguk University College of MedicineGyeongjuSouth Korea
  7. 7.Division of Gastroenterology and Hepatology, Department of Internal MedicineSoonchunhyang University HospitalGumiSouth Korea

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