Analysis of the diagnostic utility of Glasgow-Blatcford Score, Rockall Score, AIMS65 Score, BUN-to-albumin ratio and BUN-to-creatinine ratio for predicting the need for transfusion in upper gastrointestinal bleeding Predicting the need for transfusion in upper gastrointestinal bleeding

Main Article Content

Tahir Talat Yurttaş
Sarper Yılmaz
Başar Cander


Objective: This study aimed to compare the predictive accuracy of commonly used risk scores in predicting the need for transfusion among patients with upper gastrointestinal bleeding (UGIB).

Material and Methods: This retrospective diagnostic utility study was conducted at a tertiary care academic hospital. The primary outcome was the diagnostic accuracy of the Glasgow-Blatchford Score (GBS), the Rockall Score, the AIMS65 Score, the BUN-to-albumin ratio (BAR), and the BUN-to-creatinine ratio (BCR) in the prediction of transfusion in UGIB.

Results: Results from the study showed that 75% of the 104 patients included in the study received blood transfusions, with a median of 3 (IQR 2 - 4) units. Admission hemoglobin and hematocrit values were higher in the non-transfusion group (p<0.001 for both comparisons). The GBS (AUC 0.790 [95% CI 0.699 - 0.864]; p<0.001), AIMS65 (AUC 0.672 [95% CI 0.573 - 0.761]; p=0.001), and BAR (AUC 0.625 [95% CI 0.525 - 0.718, p=0.04) were found to be useful diagnostic indices in predicting transfusion administration, with ideal cut-offs of >0, >10.75, and >0, respectively. But Rockall and BCR were not found to be useful diagnostically. The study suggests that these indices can be used as decision tools for transfusion administration in patients with acute upper gastrointestinal bleeding.

Conclusion: The GBS demonstrated superior accuracy compared to AIMS65 and BAR, while Rockall score and BCR were found to be ineffective. The GBS may therefore be useful to clinicians when assessing the potential need for blood transfusions in patients with UGIB.


Download data is not yet available.

Article Details

How to Cite
Yurttaş, T. T. ., Yılmaz, S., & Cander, B. . (2023). Analysis of the diagnostic utility of Glasgow-Blatcford Score, Rockall Score, AIMS65 Score, BUN-to-albumin ratio and BUN-to-creatinine ratio for predicting the need for transfusion in upper gastrointestinal bleeding: Predicting the need for transfusion in upper gastrointestinal bleeding. Medical Science and Discovery, 10(5), 325–331.
Research Article
Received 2023-05-09
Accepted 2023-05-21
Published 2023-05-22


Barkun AN, Almadi M, Kuipers EJ, Laine L, Sung J, Tse F, et al. Management of Nonvariceal Upper Gastrointestinal Bleeding: Guideline Recommendations From the International Consensus Group. Ann Intern Med. 2019 Dec 3;171(11):805–22.

Ak R, Hökenek NM. Comparison of AIMS65 and Glasgow Blatchford scores in predicting mortality in patients with upper gastrointestinal bleeding. Rev Assoc Med Bras (1992). 2021;67(5):766-770.

Kılıç M, Ak R, Dalkılınç Hökenek U, Alışkan H. Use of the AIMS65 and pre-endoscopy Rockall scores in the prediction of mortality in patients with the upper gastrointestinal bleeding. Ulus Travma Acil Cerrahi Derg. 2022;29(1):100-104.

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 Dec;74(6):1215–24.

Tatlıparmak AC, Dikme Ö, Dikme Ö, Topaçoğlu H. Cancer, platelet distribution width, and total protein levels as predictors of rebleeding in upper gastrointestinal bleeding. PeerJ. 2022;10:e14061.

Taha AS, McCloskey C, Craigen T, Angerson WJ, Shah AA, Morran CG. Mortality following blood transfusion for non-variceal upper gastrointestinal bleeding. Frontline Gastroenterol. 2011 Oct;2(4):218–25.

Odutayo A, Desborough MJR, Trivella M, Stanley AJ, Dorée C, Collins GS, et al. Restrictive versus liberal blood transfusion for gastrointestinal bleeding: a systematic review and meta-analysis of randomised controlled trials. Lancet Gastroenterol Hepatol. 2017 May;2(5):354–60.

Gutierrez G, Reines HD, Wulf-Gutierrez ME. Clinical review: hemorrhagic shock. Crit Care. 2004 Oct;8(5):373–81.

Zhang M, Zhang G, Yang J, Chen ACN. The impact of a regular blood donation on the hematology and EEG of healthy young male blood donors. Brain Topogr. 2012 Jan;25(1):116–23.

Martínez-Cara JG, Jiménez-Rosales R, Úbeda-Muñoz M, de Hierro ML, de Teresa J, Redondo-Cerezo E. Comparison of AIMS65, Glasgow-Blatchford score, and Rockall score in a European series of patients with upper gastrointestinal bleeding: performance when predicting in-hospital and delayed mortality. United European Gastroenterol J. 2016 Jun;4(3):371–9.

Nakamura S, Matsumoto T, Sugimori H, Esaki M, Kitazono T, Hashizume M. Emergency endoscopy for acute gastrointestinal bleeding: prognostic value of endoscopic hemostasis and the AIMS65 score in Japanese patients. Dig Endosc. 2014 May;26(3):369–76.

Yue W, Liu Y, Jiang W, Huang J, Liu J. Prealbumin and D-dimer as Prognostic Indicators for Rebleeding in Patients with Nonvariceal Upper Gastrointestinal Bleeding. Dig Dis Sci. 2021 Jun;66(6):1949–56.

Levi R, Carli F, Arévalo AR, Altinel Y, Stein DJ, Naldini MM, et al. Artificial intelligence-based prediction of transfusion in the intensive care unit in patients with gastrointestinal bleeding. BMJ Health Care Inform. 2021 Jan 17;28(1):e100245.

Shung D, Huang J, Castro E, Tay JK, Simonov M, Laine L, et al. Neural network predicts need for red blood cell transfusion for patients with acute gastrointestinal bleeding admitted to the intensive care unit. Sci Rep. 2021 Apr 23;11(1):8827.

Bitar SM, Moussa M. The risk factors for the recurrent upper gastrointestinal hemorrhage among acute peptic ulcer disease patients in Syria: A prospective cohort study. Ann Med Surg (Lond). 2022 Feb;74:103252.

Restellini S, Kherad O, Jairath V, Martel M, Barkun AN. Red blood cell transfusion is associated with increased rebleeding in patients with nonvariceal upper gastrointestinal bleeding. Aliment Pharmacol Ther. 2013 Feb;37(3):316–22.

Subramaniam K, Spilsbury K, Ayonrinde OT, Latchmiah F, Mukhtar SA, Semmens JB, et al. Red blood cell transfusion is associated with further bleeding and fresh-frozen plasma with mortality in nonvariceal upper gastrointestinal bleeding. Transfusion. 2016 Apr;56(4):816–26.

Kaya E, Karaca MA, Aldemir D, Ozmen MM. Predictors of poor outcome in gastrointestinal bleeding in emergency department. World J Gastroenterol. 2016 Apr 28;22(16):4219–25.

Wilhoit CB, Holman ND, Rockey DC. Blood transfusion practices in upper gastrointestinal bleeding: response to a landmark study. J Investig Med. 2020 Apr;68(4):882–7.

Maher PJ, Khan S, Karim R, Richardson LD. Determinants of empiric transfusion in gastrointestinal bleeding in the emergency department. Am J Emerg Med. 2020 May;38(5):962–5.

Wilcox CM, Clark WS. Association of nonsteroidal antiinflammatory drugs with outcome in upper and lower gastrointestinal bleeding. Dig Dis Sci. 1997 May;42(5):985–9.

Abougergi MS. Epidemiology of Upper Gastrointestinal Hemorrhage in the USA: Is the Bleeding Slowing Down? Dig Dis Sci. 2018 May;63(5):1091–3.

Lau JYW, Yu Y, Tang RSY, Chan HCH, Yip HC, Chan SM, et al. Timing of Endoscopy for Acute Upper Gastrointestinal Bleeding. N Engl J Med. 2020 Apr 2;382(14):1299–308.

Forrest JA, Finlayson ND, Shearman DJ. Endoscopy in gastrointestinal bleeding. Lancet. 1974 Aug 17;2(7877):394–7.

Giese A, Grunwald C, Zieren J, Büchner NJ, Henning BF. Use of the Complete Rockall Score and the Forrest Classification to Assess Outcome in Patients with Non-variceal Upper Gastrointestinal Bleeding Subject to After-hours Endoscopy: A Retrospective Cohort Study. West Indian Med J. 2014 Jan;63(1):29–33.

Kim DS, Jung Y, Rhee HS, Lee SJ, Jo YG, Kim JH, et al. Usefulness of the Forrest Classification to Predict Artificial Ulcer Rebleeding during Second-Look Endoscopy after Endoscopic Submucosal Dissection. Clin Endosc. 2016 May;49(3):273–81.

Al-Naamani K, Alzadjali N, Barkun AN, Fallone CA. Does blood urea nitrogen level predict severity and high-risk endoscopic lesions in patients with nonvariceal upper gastrointestinal bleeding? Can J Gastroenterol. 2008 Apr;22(4):399–403.

Tomizawa M, Shinozaki F, Hasegawa R, Shirai Y, Motoyoshi Y, Sugiyama T, et al. Patient characteristics with high or low blood urea nitrogen in upper gastrointestinal bleeding. World J Gastroenterol. 2015 Jun 28;21(24):7500–5.

Richards RJ, Donica MB, Grayer D. Can the Blood Urea Nitrogen/Creatinine Ratio Distinguish Upper From Lower Gastrointestinal Bleeding? Journal of Clinical Gastroenterology. 1990 Oct;12(5):500.

González-González JA, Vázquez-Elizondo G, Monreal-Robles R, García-Compean D, Borjas-Almaguer OD, Hernández-Velázquez B, et al. Hypoalbuminemia in the outcome of patients with non-variceal upper gastrointestinal bleeding. Rev Gastroenterol Mex. 2016;81(4):183–9.

Bae SJ, Kim K, Yun SJ, Lee SH. Predictive performance of blood urea nitrogen to serum albumin ratio in elderly patients with gastrointestinal bleeding. Am J Emerg Med. 2021 Mar;41:152–7.

Neideen T, Lam M, Brasel KJ. Preinjury beta blockers are associated with increased mortality in geriatric trauma patients. J Trauma. 2008 Nov;65(5):1016–20.

Tatliparmak AC, Yilmaz S. Impact of rigid cervical collars on the vital signs and cervical vasculature: Should we be on the alert for anything? Am J Emerg Med. 2023 Apr;66:31–5.