Post written by Riccardo Marmo, MD, from the Gastroenterology and Endoscopy Unit, “L. Curto” Hospital, Salerno, Italy, and Cristina Bucci, MD, PhD, from the Endoscopy Unit, AORN Santobono-Pausillipon Napoli, Naples, Italy.
Despite the advances in managing acute upper GI bleeding, it remains a common emergency in clinical practice with a high mortality rate. Different clinical conditions, ranging from esophageal cancer to peptic ulcers to dieulafoy lesions, may lead to bleeding.
Commonly used risk stratification scores are strictly endoscopy-based and not meant to characterize underlining comorbidities of bleeding patients or the evolving clinical scenario in the days after endoscopy, so they can be inadequate outside the endoscopy unit.
We thought to create an “after admission” risk score that can be more accurate at predicting mortality in upper GI bleeding patients once the bleeding source has been endoscopically diagnosed. Our score also sheds light on those comorbidities that may worsen the patient’s clinical condition, helping the clinician correctly evaluate the mortality risk and optimize the patient’s management.
If we want to further improve the outcomes of our bleeding patients, we also must consider the comorbidity treatment and prevent the clinical deterioration. We suggest using the Re.Co.De (rebleeding-comorbidities-deteriorating) score during hospitalization to correctly assess the death risk and understand the patient’s evolution in terms of improvement and deterioration with the aim to create multidisciplinary bleeding teams within each third-level hospital that could optimize medical treatment of bleeding patients.
Area under the receiver-operating characteristic (ROC) curves of the Re.Co.De score compared with pre-endoscopy scores in predicting death risk. ABC, Age, blood tests, comorbidities; GB, Glasgow-Blatchford score; Re.Co.De, rebleeding-comorbidities-deteriorating.
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