Scandinavian Journal of Gastroenterology

ISSN: 0036-5521 (Print) 1502-7708 (Online) Journal homepage: http://www.tandfonline.com/loi/igas20

AIMS65 score: a new prognostic tool to predict

mortality in variceal bleeding

T. Cúrdia Gonçalves, M. Barbosa, S. Xavier, P. Boal Carvalho, J. Magalhães, C.

Marinho & J. Cotter

To cite this article: T. Cúrdia Gonçalves, M. Barbosa, S. Xavier, P. Boal Carvalho, J. Magalhães, C.
Marinho & J. Cotter (2016): AIMS65 score: a new prognostic tool to predict mortality in variceal
bleeding, Scandinavian Journal of Gastroenterology, DOI: 10.1080/00365521.2016.1260155

To link to this article: http://dx.doi.org/10.1080/00365521.2016.1260155

Published online: 25 Nov 2016.

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Download by: [University of Otago] Date: 27 November 2016, At: 10:01

SCANDINAVIAN JOURNAL OF GASTROENTEROLOGY, 2016
http://dx.doi.org/10.1080/00365521.2016.1260155
LETTER TO THE EDITOR
AIMS65 score: a new prognostic tool to predict mortality in variceal bleeding
Sir,
Since upper gastrointestinal bleeding (UGIB) remains a com-
mon condition worldwide, efforts are being continuously
made to optimize its management and to improve patients’
outcomes. Latest guidelines on this subject, both European,
American, and Asian, state that risk stratification should
become a part of the initial assessment of the patients.[1–3]
Although several risk scores exist, none of them can satis-
factorily predict all the clinical relevant outcomes, such as 30-
day mortality, 30-day rebleeding, or need for hospitalization,
endoscopic intervention, blood transfusion or surgery. In an
attempt to fill this gap, the recent AIMS65 score have been
suggested as an alternative to the most well-known scores,
namely, Rockall score or Glasgow–Blatchford score.[4] AIMS65
score is an easily calculated bedside score, composed of five
parameters (albumin lower than 3.0 g/dL, international nor-
malized ratio greater than 1.5, altered mental status, systolic
blood pressure less than 90 mmHg and age >65 years) which
has been shown to predict mortality and length of hospital
stay in an unselected population of UGIB patients.[4]
As most of the studies with these risk assessment tools
include patients with all types of UGIB and little is known
about the performance of these scores specifically in variceal
bleeding patients, it was with great interest that we read the
paper from Budumir et al. entitled ‘Glasgow Blatchford, pre-
endoscopic Rockall and AIMS65 scores show no difference in
predicting rebleeding rate and mortality in variceal
bleeding’.[5] In this retrospective study of 225 patients, the
authors concluded that AIMS65 was not useful in predicting
neither mortality, nor rebleeding or need for blood
transfusion.
We recently performed a single-center, retrospective study
(presented in the Gastro Update Europe 2016 meeting in
Prague, Czech Republic) to assess the accuracy of AIMS65
score in predicting clinically relevant outcomes in patients
with variceal bleeding. In our study, 75 variceal UGIB epi-
sodes were included. Accuracy of AIMS65 score to predict
clinical outcomes, specifically 30-day mortality, 30-day
rebleeding, and blood transfusion, was evaluated using area
under the receiver operating characteristic curve (AUROC).
Bleeding esophageal varices were found in 65 patients
(86.7%), while bleeding gastric varices were found in the
remaining 10 patients (13.3%). Globally, 12 patients scored 0
points, 14 scored 1, 29 scored 2, 16 scored 3, 4 scored 4, but
any patient scored 5 points. Mean AIMS65 score was 1.81,
and no differences in the mean AIMS65 score were found
between esophageal and gastric varices bleeding (1.82 vs.
1.80; p ¼ .968). In our cohort of patients, blood transfusion
was needed in 61 (81.3%) patients, while rebleeding and
death during the following 30 days after the bleeding event
were present in 10 (13.3%) and 12 (16.0%) patients, respect-
ively. When applied to patients with variceal bleeding and a
cutoff of 2 points was used, AIMS65 could fairly predict
30-day mortality (AUROC ¼ 0.723), but not 30-day rebleeding
(AUROC ¼ 0.529) or need for blood transfusion
(AUROC ¼ 0.612). As all patients in this group received endo-
scopic therapy, AIMS65 score could not be assessed for this
outcome.
Similarly to the results from Budumir et al., we found that
AIMS65 is not useful in predicting rebleeding or need for
blood transfusion in the particular case of variceal bleeding
patients. However, our study suggests that AIMS65 might
have a role in predicting mortality in patients with variceal
bleeding. In fact, these results might be somehow explained
by the fact that three out of the five parameters included in
the AIMS65 score (specifically albumin lower than 3.0 g/dL,
international normalized ratio greater than 1.5 and altered
mental status) are directly related to liver function.
In conclusion, although not reliable in predicting 30-day
rebleeding or blood transfusion, the AIMS65 score seems to
be useful in predicting 30-day mortality in patients with vari-
ceal bleeding. Therefore, we suggest that assessment of
AIMS65 score should be performed early in the management
of all the patients with suspected variceal bleeding.
Disclosure statement
The authors report no conflicts of interest. The authors alone are respon-
sible for the content and writing of this article.
References
[1] Gralnek IM, Dumonceau JM, Kuipers EJ, et al. Diagnosis and man-
agement of nonvariceal upper gastrointestinal hemorrhage:
European Society of Gastrointestinal Endoscopy (ESGE) Guideline.
Endoscopy. 2015;47:a1–46.
[2] Laine L, Jensen DM. Management of patients with ulcer bleeding.
Am J Gastroenterol. 2012;107:345–360.
[3] Sung JJ, Chan FK, Chen M, et al. Asia-Pacific Working Group con-
sensus on non-variceal upper gastrointestinal bleeding. Gut.
2011;60:1170–1177.
[4] Saltzman JR, Tabak YP, Hyett BH, et al. A simple risk score
accurately predicts in-hospital mortality, length of stay, and cost
in acute upper GI bleeding. Gastrointest Endosc. 2011;74:
1215–1224.
2

T. CURDIA GONÇALVES ET AL.

[5] Budimir I, Gradiser M, Nikolic M, et al. Glasgow Blatchford, pre- J. Cotter

endoscopic Rockall and AIMS65 scores show no difference in pre- Gastroenterology Department, Hospital da Senhora da Oliveira,
dicting rebleeding rate and mortality in variceal bleeding. Scand J
Guimara~es, Portugal
Gastroenterol. 2016;51:1375–1379.
Life and Health Sciences Research Institute, University of Minho,
Braga/Guimara ~es, Portugal
ICVS/3B’s, PT Government Associate Laboratory, Braga/

rdia Gonçalves, M. Barbosa, S. Xavier, P. Boal Carvalho,
T. Cu ~es, Portugal
Guimara
J. Magalh~aes, and C. Marinho
Gastroenterology Department, Hospital da Senhora da Oliveira, Received 8 November 2016; accepted 9 November 2016
Guimara ~es, Portugal
tiagogoncalves@chaa.min-saude.pt ß 2016 Informa UK Limited, trading as Taylor & Francis Group