الفهرس 
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Abstract
Upper gastrointestinal bleeding (UGIB) is the most common cause of emergency admission in gastrointestinal disease. Despite the development of endoscopic therapies and pharmacological management, UGIB is still associated with considerable rates of mortality and morbidity, and high medical expenses. Different scoring systems have been suggested for diagnosing these patients.
In this study we aimed to compare the predictive value of three scoring systems Rockall, Glasgow Blatchfors scale (GBS) and AIMS65 in patients with UGIB.
This study was conducted on 120 adult Egyptian patients presented by UGIB at Emergency department of Ain Shams University Hospital in Cairo, Egypt at a period from October 2020 to June 2021. Patients underwent upper endoscopy within first day from an attack of UGIB. AIMS65, GBS, and PRS scores were calculated for each patient. The ability of these scores to predict clinical outcomes was determined. Area under the receiver-operating-characteristics (ROC) curve, sensitivity, specificity, positive and negative predictive values were calculated for rebleeding and mortality.
Statistical analysis of clinical, laboratory and endoscopic data of enrolled patients were as following:
• Mean age was years (48 years) and about three quarters of cases were males (77.5%) with male to female 3.44: 1.
• Regard to comorbidities among the studied cases; about half of cases (61) had chronic liver disease, 38 (31.7%) of them had renal or liver failure or malignancy and 20 (16.7%) had IHD.
• The most frequent clinical presentation was melena (52.5%) followed by syncope (25.8%) and shock (21.7%).
• Endoscopic findings among the studied cases: Stigmata (Blood in UGIT, adherent clot, visible/ spurting vessel) were in more than half of cases (71; 59.2%), while Mallory-Weiss or no lesion and no stigmata was in one third of cases (41; 34.2%), Peptic ulcer disease or erosive esophagitis or other non-malignancy (67; 55.8%) and malignancy was seen in 12 (10%) of enrolled patients.
• Scores among the studied cases: Mean of pre-endoscopic and post-endoscopic Baylor was 4.6±2.8 and 1.9±1.4 respectively, mean incomplete and complete Rockall was 1.9±1.4 and 3.7±2.1 respectively, mean Blatchford was 9.7±3.0 and mean AIMS65 was 1.4±1.1.
• Outcomes among the studied cases: 52 (43.3%) was in need for interventional endoscopy, 48 (40%) was in need for blood transfusion, 44 (36.7%) was in need for ICU admission in hospital, 41 (34.2%) Rebleeding in hospital and mortality rate was 11 (9.2%) among studied cases.
• Cases with need for interventional endoscopy had significant higher hepatic disease, severe comorbidities, melena, syncope, shock and worser laboratories& endoscopic findings. They had significant higher Post-Endoscopic Baylor, Blatchford and AIMS65.
• Cases with blood transfusion had significant higher age, female sex, hepatic disease, severe comorbidities, melena and worser laboratories& endoscopic findings. They had significant higher scores of Pre-Endoscopic Baylor, Incomplete Rockall, Blatchford and AIMS65 and no higher but non-significance to post-endoscopic Baylor and complete Rockall scores.
• Cases with ICU admission had significant higher age, hepatic disease, severe comorbidities, and worser laboratories, clinical & endoscopic findings. They had significant higher all studied scores compared to those not in needs.
• Cases rebleeded in hospital had significant higher age, hepatic disease, severe comorbidities and worser clinical, laboratories& endoscopic findings. They had significant higher scores.
• Cases with death in hospital had significant higher age, hepatic disease, severe comorbidities and worser clinical, laboratories& endoscopic findings. They had significant higher all studied scores compared to those lived.
• GBS was superior to AIMS65, Rockall and Baylor scores in identifying the patients who are likely to need interventional endoscopy ”cutoff ≥8.5, sensitivity 80.8%, specificity 54.4%”, need blood transfusion ”cutoff ≥11.5, sensitivity 54.2%, specificity 90.3%. While AIMS65 score was superior to GBS and other scores in prediction of unfavorable outcomes, namely risk of need for ICU admission ”Cutoff ≥1.5, sensitivity 86.4% specificity 96.1%”, need for rebleeding in hospital ”cutoff ≥1.5, sensitivity 92.7%, specificity 96.2%” and death in hospital ”cutoff ≥2.5, sensitivity 90.9%, specificity 98.2%.