The Horibe GI bleeding prediction score: a simple score for triage decision-making in patients with suspected upper GI bleeding.

BACKGROUND AND AIMS: Although upper gastrointestinal bleeding (UGIB) is a significant cause of inpatient admissions, no scoring method has proven to be accurate and simple as a standard for triage purposes. Therefore, we compared a previously described 3 variable score (1 point each for: absence of daily proton pump inhibitors use in the week before the index presentation, shock index (heart rate/systolic blood pressure >/=1, and blood urea nitrogen/creatinine >/=30), the Horibe gAstRointestinal BleedING prEdiction score(HARBINGER) with the 8 variable Glasgow Blatchford Score (GBS) and 5 variable AIMS65, to evaluate and validate the accuracy in predicting high-risk features that warrant admission and urgent endoscopy. METHODS: Consecutive patients presenting with suspected UGIB between 2012 and 2015 were prospectively enrolled in 3 acute care Japanese hospitals. Upon presentation to the emergency setting, an endoscopy was performed in a timely fashion. The primary outcome was the prediction of high-risk endoscopic stigmata. RESULTS: Of 1486 enrolled patients, 637 (43%) of patients harbored high-risk endoscopic stigmata according to international consensus statements. The area under the receiver-operating characteristic curve (AUC) for the HARBINGER was 0.76 (95% confidence interval [CI], 0.72-0.79), which was significantly superior both to the GBS (AUC, 0.68; 95% CI, 0.64-0.71; p<0.001) and to the AIMS65 (AUC, 0.54; 95% CI, 0.50-0.58; p<0.001). When the HARBINGER cut-off value was set at 1 to rule out patients who needed admission and urgent endoscopy, its sensitivity and specificity was 98.8% (95% CI, 97.9-99.6) and 15.5% (95% CI, 13.1-18.0), respectively. CONCLUSION: The HARBINGER, a simple 3-variable score, provides a more accurate method for triage of patients with suspected UGIB than both the GBS and the AIMS65.