P1526 - AIMS65 Score Predicts ICU Admission and Prolonged Length of Stay in Patients with Non-Variceal Upper Gastrointestinal Bleed on Dual Anti-Platelet Therapy

Rahul Karna, MD, Bandhul Hans, MD, Dhruv Chaudhary, MD, Manish Dhawan, MD
Allegheny Health Network, Pittsburgh, PA

Introduction: ICU admission and prolonged length-of-stay (PLOS) is associated with increased resources need, healthcare cost and poorer outcomes for the patients. There is a paucity of predictive parameters to assess ICU admission and PLOS in non-variceal upper gastrointestinal bleeding (NVUGIB) patients taking dual antiplatelet therapy (DAPT).

Methods: A retrospective chart review was done for all consecutive adult patients between 2015-2020 who presented with NVUGIB on DAPT (aspirin, clopidogrel; aspirin, ticagrelor; aspirin, prasugrel) to Allegheny Health Network and underwent endoscopy. Patients who had DAPT held as per ASGE guidelines were excluded from the study. An exploratory analysis was done to assess predictive ability of four GI bleeding risk scores [Glasgow Blatchford score (GBS), AIMS65, qSOFA and Rockall] to predict ICU admission and prolonged Length of Stay (PLOS). PLOS was defined as ≥5 days based on institutional experience in NVUGIB patients. Logistic regression was used to identify variables independently associated with ICU admission and PLOS and estimate their odds ratios and 95% CI. P value < 0.05 was considered as the level of significance.

Results: 75 patients (M: F 53:22), mean age±S.D. 70.1±11.2 years, meeting inclusion criteria were included for final analysis. 22/75 (29%) patients had ICU admission. AIMS65 and qSOFA predicted ICU admission (Table 1A). Sensitivity, specificity, PPV, NPV and accuracy of AIMS65 and qSOFA for ICU admission has been shown in Table 1B. Median LOS was 6; IQR=8 (range 2-43) days. 47/75 (63%) patients had PLOS. GBS and AIMS65 predicted PLOS (Table 1A). Sensitivity, specificity, PPV, NPV and accuracy of GBS and AIMS65 for PLOS has been shown in Table 1B.

Discussion: AIMS65 is a simple scoring system, originally developed to predict mortality in patients with UGIB. This study provides preliminary evidence for the use of AIMS65 to predict longer LOS and ICU admission in patients with NVUGIB taking DAPT which may help resource allocation and prognostication. However, the study needs to be validated in a larger study population before it can be used in clinical practice.

Table 1A	N	Odds Ratio	95% Confidence Interval	P-value	N	Odds Ratio	95% Confidence Interval	P-value
ICU Admission					Length of Stay ≥ 5 days
GBS	74	1.16	.986 – 1.371	0.073	74	1.22	1.046 – 1.423	0.011
AIMS65	74	2.09	1.138 – 3.847	0.018	74	2.06	1.091 – 3.903	0.026
qSOFA	75	2.79	1.413 – 5.520	0.003	75	1.65	.8457 – 3.227	0.142
Rockall	74	1.001	.765 – 1.322	0.967	75	1.14	.879 – 1.483	0.319
Table 1B	Sensitivity	Specificity	PPV	NPV	Accuracy
ICU Admission
AIMS65	22.7%	94.2%	62.5%	74.2%	73%
qSOFA	27.3%,	94.3%	66.7%	75.8%	74.7%
Length of Stay ≥ 5 days
GBS	84.8%	28.6%	66.1%	33.3%	63.5%
AIMS65	91.3%	21.4%	65.6%	60%	64.9%

Table: Table 1 (A) Gastrointestinal bleeding risk scores as predictor of ICU admission and length of stay ≥5 days. (B) Performance characteristics of bleeding risk scores as predictor of ICU admission and length of stay ≥5 days.
Abbreviations: ICU: intensive care unit, GBS: Glasgow-Blatchford score, qSOFA: quick sequential organ failure assessment, PPV: positive predictive value, NPV: negative predictive value


Disclosures:
Rahul Karna indicated no relevant financial relationships.
Bandhul Hans indicated no relevant financial relationships.
Dhruv Chaudhary indicated no relevant financial relationships.
Manish Dhawan indicated no relevant financial relationships.


Rahul Karna, MD, Bandhul Hans, MD, Dhruv Chaudhary, MD, Manish Dhawan, MD. P1526 - AIMS65 Score Predicts ICU Admission and Prolonged Length of Stay in Patients with Non-Variceal Upper Gastrointestinal Bleed on Dual Anti-Platelet Therapy, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.