The clinical significance of upper gastrointestinal bleeding etiology score in determining variceal bleeding

BACKGROUND: Upper gastrointestinal bleeding (UGIB) is a common, and potentially life threatening condition, which can be divided into variceal and non-variceal sources of bleeding. OBJECTIVE: To examine the validity of the upper gastrointestinal bleeding etiology score compared to the current gold standard, the emergency Esophagogastroduodenoscopy (EGD), for determining the etiology of UGIB. METHODOLOGY: 101 patients presenting with upper gastrointestinal bleeding presented in the emergency department of Capital Hospital, Islamabad between February 2010 and March 2012 were included in this cross-sectional study. The upper gastrointestinal bleeding score was computed for each case by accounting for the clinical parameters of previous diagnosis of cirrhosis or signs of chronic liver disease × 3.1, presence of red vomitus × 1.5, and red N/G aspirate × 1.2. Each parameter was given a score of 1 if present, and 0 if absent, with a total score ≥3.1 favoring variceal bleed, and a score of <3.1 indicating non-variceal bleeding as a cause of UGIB. Esophagogastroduodenoscopy was performed within 72 hours of presentation. RESULTS: The mean ± SD age of the patients was 50.2 ± 14.1 years ranging from 18 to 80 years. Out of 101 patients, 56% were males while the remaining 44% were females. The sensitivity of the UGIB score was 78.2% and the specificity was 84.3%. The positive predictive value (PPV) was 91.5% and negative predictive value (NPV) was 64.2%. The overall diagnostic accuracy of UGIB score in determining variceal bleeding was found to be 80.2%. CONCLUSION: Variceal bleeding is a common cause of UGIB in Pakistan. UGIB etiology score is a highly sensitive and specific clinical tool in determining the etiology of UGIB as either variceal or non-variceal bleeding.