Risk factors for Lower Gastrointestinal Bleeding

In this systematic review published JAMA Network Open, reports the risk scores for lower gastrointestinal bleeding, the Oakland score was the most discriminative for predicting safe discharge, major bleeding, and need for transfusion, whereas the Strate score was the best at predicting need for hemostasis.

Clinical prediction models, or risk scores, can be used to risk stratify patients with lower gastrointestinal bleeding, although the most discriminative score is unknown. Observational and interventional studies deriving or validating a lower gastrointestinal bleeding risk score for the prediction of a clinical outcome were included. Studies including patients younger than 16 years or limited to a specific patient population or a specific cause of bleeding were excluded. Two investigators independently screened the studies, and disagreements were resolved by consensus.

A total of 3268 citations were identified, the Oakland, Strate, NOBLADS [nonsteroidal anti-inflammatory drug use, no diarrhea, no abdominal tenderness, blood pressure ≤100 mm Hg, antiplatelet drug use (nonaspirin), albumin <3.0 g/dL, disease score ≥2, and BLEED were included in the meta-analysis.

For the prediction of safe discharge, the AUROC for the Oakland score was 0.86. For major bleeding, the AUROC was 0.93 for the Oakland score, 0.73 for the Strate score, 0.58 (95% CI, 0.53-0.62) for the NOBLADS score, and 0.65 for the BLEED score. For transfusion, the AUROC was 0.99 (95% CI, 0.98-1.00) for the Oakland score and 0.88 for the NOBLADS score. For hemostasis, the AUROC was 0.36 for the Oakland score, 0.82 for the Strate score, and 0.24 for the NOBLADS score.

The Oakland score was the most discriminative lower gastrointestinal bleeding risk score for predicting safe discharge, major bleeding, and need for transfusion, whereas the Strate score was best for predicting need for hemostasis. Study suggests that these scores can be used to predict outcomes from lower gastrointestinal bleeding and guide clinical care accordingly concluded the researchers.