Are Scoring Systems Useful in Predicting Mortality from Upper GI Bleeding in Geriatric Patients?

Background/

Objectives

This study aimed to determine the in-hospital mortality rate after upper gastrointestinal (GI) bleeding in geriatric patients with comorbidities. Additionally, it sought to identify effective cut-off values for predicting high-risk patients using AIMS65 and Rockall scores and to assess the impact of oral anticoagulant and NSAID use on mortality.

Methods

A retrospective cohort study was conducted on 64 patients aged 60 and above with at least one comorbidity who were admitted for upper GI bleeding between January 2023 and June 2024. AIMS65 and Rockall scores were calculated for each patient. The relationship between these scores, medication use, and mortality was analyzed using statistical methods, including ROC analysis and Kaplan-Meier survival curves.

Results

The mean age was 77.6 years, and all patients had at least one chronic disease; 57.8% used medications increasing bleeding risk. In-hospital mortality was 18.7%, with no significant association for oral anticoagulants (p = 0.275) or NSAIDs (p = 0.324). Sepsis, heart failure, chronic renal failure, and malignancy were strongly linked to mortality in univariate analysis; multivariate analysis confirmed sepsis and malignancy as independent predictors, with a trend for heart failure. AIMS65 ≥ 2 (sensitivity 90.1%, AUC = 0.920) and Rockall ≥ 6 (sensitivity 91.7%, AUC = 0.822) were both effective in predicting mortality, with risk rising cumulatively with higher scores (p < 0.001).

Conclusions

In-hospital mortality after upper GI bleeding is high in elderly patients with multiple comorbidities, mainly from sepsis, malignancy, and heart failure. AIMS65 and Rockall scores effectively predict mortality and may support earlier intervention. The small, high-risk cohort limits generalizability, underscoring the need for multicenter validation.