Comparison of Pre-Endoscopic C-WATCH Score with Established Risk Assessment Tools in Patients with Upper Gastrointestinal Bleeding

Gabriel Allo; Martin Bürger; Johannes Gillessen; Philipp Kasper; Jeremy Franklin; Vera Mück; Dirk Nierhoff; Hans-Michael Steffen; Tobias Goeser; Christoph Schramm

doi:10.1159/000522121

Comparison of Pre-Endoscopic C-WATCH Score with Established Risk Assessment Tools in Patients with Upper Gastrointestinal Bleeding

Dig Dis. 2022;40(6):826-834. doi: 10.1159/000522121. Epub 2022 Jan 24.

Affiliations

¹ Department of Gastroenterology and Hepatology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.
² Institute of Medical Statistics and Computational Biology, University of Cologne, Cologne, Germany.
³ Clinic for Gastroenterology, Hepatology and Transplant Medicine, Essen University Hospital, Essen, Germany.

Abstract

Introduction: Use of risk scores for early assessment of patients with upper gastrointestinal bleeding (UGIB) is recommended by various guidelines. We compared Cologne-WATCH (C-WATCH) score with Glasgow-Blatchford score (GBS), Rockall score (RS), and pre-endoscopic RS (p-RS).

Methods: Patients with UGIB between January and December 2017 were retrospectively analyzed for 30-day mortality and composite endpoints risk of complications and need for intervention using areas under the receiver-operating characteristics curve (AUROC). Subgroup analysis was conducted for patients with UGIB on admission and in-hospital UGIB.

Results: A total of 252 patients were identified (67.5% men, mean age 63.8 ± 14.9 years). In-hospital UGIB occurred in 49.6%. AUROCs for 30-day mortality, risk of complications, and need for intervention (not applicable to RS) were 0.684 (95% confidence interval [CI]: 0.606-0.763), 0.665 (95% CI: 0.594-0.735), and 0.694 (95% CI: 0.612-0.775) for C-WATCH score, 0.724 (95% CI: 0.653-0.796) and 0.751 (95% CI: 0.687-0.815) for RS, 0.652 (95% CI: 0.57-0.735), 0.653 (95% CI: 0.579-0.727), and 0.673 (95% CI: 0.602-0.745) for p-RS and 0.652 (95% CI: 0.572-0.732), 0.663 (95% CI: 0.592-0.734), and 0.752 (95% CI: 0.683-0.821) for GBS. RS outperformed pre-endoscopic scores in predicting risk of complications, while there were no significant differences between pre-endoscopic scores except GBS outperforming p-RS in predicting need for intervention. The subgroup analysis obtained similar results. Positive predictive values for patients with estimated low risk for all three endpoints (C-WATCH score ≤1, RS ≤2, p-RS <1, and GBS ≤1) were 89%, 69%, 78%, and 92%.

Conclusion: C-WATCH score performed similar to the established pre-endoscopic risk scores in patients with UGIB regarding relevant patient-related endpoints with no significant differences between both the subgroups.

Keywords: C-WATCH score; Gastrointestinal bleeding; Glasgow-Blatchford score; Mortality; Rockall score.

MeSH terms

Aged
Area Under Curve
Female
Gastrointestinal Hemorrhage* / diagnosis
Gastrointestinal Hemorrhage* / etiology
Humans
Male
Middle Aged
Prognosis
ROC Curve
Retrospective Studies
Risk Assessment / methods
Severity of Illness Index

Grants and funding

No funding has been received to conduct this study.