# Comparison of the Quick Sequential Organ Failure Assessment (qSOFA) Score With the Glasgow-Blatchford Score (GBS) and Rockall Score (RS) in Predicting the Need for Intensive Care Among Acute Upper Gastrointestinal Bleeding Patients

## TL;DR

This study compares three scoring systems to predict the need for intensive care in patients with upper gastrointestinal bleeding, finding that the Glasgow-Blatchford score performs best overall.

## Contribution

The study evaluates the performance of qSOFA, GBS, and RS in predicting ICU admission for upper gastrointestinal bleeding patients in a South Indian hospital.

## Key findings

- GBS showed the best overall prediction accuracy for ICU admission.
- qSOFA had 100% sensitivity but very low specificity for ICU admission.
- RS had intermediate predictive values for ICU admission.

## Abstract

Objective: The present study aims to compare the quick sequential organ failure assessment (qSOFA) score, Glasgow-Blatchford score (GBS), and Rockall score (RS) in predicting intensive care needs among patients with upper gastrointestinal bleeding at a tertiary care medical college hospital in South India, thus helping to determine the most useful scores in predicting in-hospital adverse events among the three.

Methodology: This single-center, cross-sectional study was conducted from March 1, 2023, to February 29, 2024, after obtaining institutional review board approval from Pushpagiri Institute of Medical Sciences and Research Centre, Tiruvalla, Kerala, India. The investigator assessed the patients' characteristics (age, sex, presenting complaints, comorbidities), hemodynamic status, and laboratory variables at presentation in order to calculate the RS, GBS, and qSOFA for each patient. The patient's course in the hospital, including pre- and post-endoscopy characteristics and events such as recurrent bleeding, hematemesis, melena, mortality, intensive care, blood product transfusions, prolonged hospitalization, and the presence of hemodynamic instability, was documented.

Results: Out of the total 95 patients, 67.4% were aged over 60 years, with 66% being male. Chronic liver disease, hypertension, and diabetes mellitus were present in more than half of the patients. Hematemesis was the predominant presentation (51.6%), while tachycardia, tachypnea, and elevated blood urea nitrogen levels were noted more frequently. The patients were classified into low-risk and high-risk groups based on the three scores and were compared for intensive care unit (ICU) admissions, rebleeding, and death. A significant difference was noted between the GBS and the incidence of rebleeding (p-value: 0.043). The scores were compared for ICU admission using different parameters, and it was found that qSOFA had 100% sensitivity but very low specificity (10.59%), GBS had 92.11% sensitivity, with the lowest negative predictive value (NPV) at 33.33% and the highest positive predictive value (PPV) at 81.4%, and RS had a sensitivity of 96.08%, with intermediate NPV and PPV.

Conclusion: GBS provided the best overall prediction accuracy for the need for ICU admission in acute upper gastrointestinal bleeding patients, while qSOFA demonstrated extremely high sensitivity as a screening tool.