Assessment of the Prognostic Performance of the Oakland Score in Lower Gastrointestinal Bleeding: A Retrospective Cohort Study.

Background/Objectives: Lower gastrointestinal bleeding (LGIB) is a common and potentially life-threatening emergency that disproportionately affects elderly, comorbid patients, yet evidence-based risk stratification tools remain underused. The Oakland Score was developed to identify patients who can be safely discharged. This study aimed to determine prognostic factors in patients presenting with LGIB and to evaluate the relationship between the Oakland Score and adverse clinical outcomes. Methods: In this single-centre, retrospective, descriptive study, patients aged 18 years and older who presented to the emergency department with LGIB between 2015 and 2024, and who were evaluated, treated and followed up by the Department of Gastroenterology at Dokuz Eylül University, and who underwent endoscopic evaluation were reviewed. A total of 890 patients who met the inclusion criteria and had complete medical records, defined as full availability of all Oakland Score variables and primary outcome data, were included in the final analysis. The Oakland Score was calculated for every patient, and its association with mortality, intensive care unit (ICU) admission, blood-product transfusion, early and late rebleeding, and the need for emergency surgery was analysed. Receiver operating characteristic (ROC) analysis was used to assess discriminative performance. Results: The mean age was 69.8 ± 15.6 years, and 50.4% of patients were female. The most frequent comorbidities were hypertension (56.2%), coronary artery disease (28.9%) and diabetes mellitus (25.1%). Diverticular bleeding was the most common aetiology (25.1%). Red blood cell transfusion was required in 52.8% of patients, and the in-hospital mortality rate was 6.1%. The Oakland Score was significantly associated with mortality, ICU admission, blood-product transfusion, early and late rebleeding, and emergency surgery (all p < 0.05). On ROC analysis the score performed best for ICU admission (AUC 0.754) and mortality (AUC 0.706), and was significantly associated with red blood cell, platelet and fresh frozen plasma transfusion requirements (p < 0.001). On multivariable logistic regression, the Oakland Score was an independent predictor of one-month rebleeding (OR 1.082; 95% CI 1.032-1.133; p = 0.001) but did not retain independent significance for mortality or ICU admission after adjustment for malignancy, serum albumin and BUN. Conclusions: The Oakland Score is significantly associated with major adverse outcomes in LGIB and is particularly sensitive for predicting mortality and ICU admission. It is a useful adjunct to clinical judgement for risk stratification, although it should be interpreted alongside the patient's overall clinical status.