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AIMS65 Score for Upper GI Bleeding Mortality

Calculators  Gastrointestinal
AIMS65 is a calculator used to predict a patient's mortality risk from an upper gastrointestinal bleeding.
Albumin Levels <3 g/dL (30 g/L)
No 0
Yes 1
INR >1.5
No 0
Yes 1
Variation in mental status
No 0
Yes 1
sBP rate ≤90 mm Hg
No 0
Yes 1
Age ≥65 years
No 0
Yes 1
Result:

Background

Measured Factor
In-hospital fatality rate
Measured Factor Disease
  • Mortality
Measured Factor Detail
The AIMS65 score determines a patient's risk of mortality after presenting with acute upper gastrointestinal bleeding, specially geriatric patients. This is a rapid test that requires no endoscopy or procedure to predict mortality and it can be easily calculated in the emergency department using lab values that are readily available. This test takes into consideration the patient's albumin levels, systolic blood pressure, international normalized ratio (INR), age and mental status. Patients are at high risk for mortality if they have albumin less than 3.0 g/dL, international normalized ratio greater than 1.5, altered mental status, systolic blood pressure 90 mm Hg or lower, and age older than 65 years.

An AIMS65 score of 0 indicates 0.3% in-hospital mortality rate. An AIMS65 score of 1 indicates 1.2% in-hospital mortality rate. An AIMS65 score of 2 indicates 5.3% in-hospital mortality rate. An AIMS65 score of 3 indicates 10.3% in-hospital mortality rate. An AIMS65 score of 4 indicates 16.5% in-hospital mortality rate. An AIMS65 score of 5 indicates 24.5% in-hospital mortality rate.
Speciality
Gastroenterologist
Body System
Gastrointestinal
Measured Factor Low Impact
  • An AIMS65 < 2 risk factors suggests a low mortality risk.
Measured Factor High Impact
  • An AIMS65 ≥ 2 risk factors suggests a high mortality risk.

Result Interpretation

Ranges Ranges
  • Normal: 0
  • Normal Adult Male: 0
  • Normal Adult Female: 0
  • Normal Pediatric: 0
  • Normal Geriatric Male: 1
  • Normal Geriatric Female: 1
Result High Conditions
  • An AIMS65 score of 2 and above indicates a high mortality risk (e.g. 5.3% or higher in-hospital mortality rate)
Test Limitations
The AIMS65 results has been established as a good predictor of mortality, however it has not been shown to be a good predictor for interventions such as transfusions, endoscopic treatment or surgery. Additionally, AIMS65 has shown lower sensitivity than the Glasgow-Blatchford Score (GBS) for low risk bleeding and should therefore not be used to recommend discharge.
References: 2, 3

Studies

Study Validation 1
A study was conducted of 3012 patients from 6 different hospitals around the world to assess the predictive accuracy and clinical utility of the five risk scoring systems, Rockall, AIMS65, and Glasgow Blatchford, full Rockall, and PNED, in patients with upper gastrointestinal (GI) bleeding. The study included patients that presented to the hospital with evidence of upper GI bleed defined by haematemesis, coffee-ground vomiting or malaena. Data was collected over a 12 month period and consisted of patient characteristics and haemodynamic and laboratory values necessary to calculate the full AIMS65 and PNED scores. Each score's ability to predict the predetermined outcomes were compared using calculation of area under the recceiver operating characteristic curves (AUROCs) and 95% confidence intervals. Data analysis was perfomed using STATA 11.0. The Glasgow Blatchford score showed the greatest discriminative ability with an AUROC 0.86 at predicting the need for intervention or death, whereas the AIMS65's AUROC score was 0.68; P<0.001. AIMS65 was better at predicting mortality than the Glasgow Blatchford score (P<0.001) with the best thresholds at predicting 30 days mortality at a score of 2 or more. The Glasgow Blatchford score was better at predicting rebleeding when compared to the AIMS65 (P=0.04). Results of this study demonstrated that AIMS65 scores were best for predicting mortality, while Glasgow scores were best for predicting endoscopic treatment.
References: 4
Study Validation 2
A retrospective study published in 2015 evaluated the ability of the AIMS65 scores to predict mortality in 251 patients presenting with acute upper gastrointestinal bleeding (UGIB). Eligible patients included adults above the age of 14 years with acute UGIB who presented within 24 hours of hemorrhage onset and had an endoscopic evaluaiton within 12 hours of hospital admission.  A diagnosis of UGIB was based on clinical presentation of coffee ground vomiting, hematemesis, melena and the presence of blood in nasogastric aspirate. The AIMS65 score was calculated by alloting 1 point each for albumin level <30 g/L, INR >1.5, alteration in mental status, systolic blood pressure ≤90 mmHg, and age ≥65 years. Statistical date was performed using IBM SPSS version 22.0, normally distributed variables were compared using the Student t-test and skewed data was analyzed using the Mann-Whitney test. Results showed that blood transfusions (69.4% vs. 87.3%, p=0.008, ICU stay (16.8% vs. 38.2%, p=0.001), and mortality were significantly higher in patients with an AIMS65 score ≥2. Patients with AIMS65 scores of 0, 1, 2, 3, and 4 were 3%, 7.8%, 20%, 36% and 40% respectively. Mortality was significantly higher in patients with scores  ≥2 (30.9%) than with scores < 2 (4.5%, p < 0.001). The predictive accuracy for mortality with scores  ≥2 was also high with an AUROC of 0.74; 95% CI 0.63 to 0.85.
References: 5
Study Validation 3
A 5-year single-center, retrospective study published in 2015 evaluated the ability of the AIMS65 score in predicting mortality in patients with nonvariceal upper gastrointestinal bleeding (UGIB) and the effectiveness of urgent endoscopic procedures in patients who had a high AIMS65 score. The inclusion criteria included patients 18 years of age or older who had visited the emergency department for any upper GI bleeding symptoms who had a complete medical chart. Urgent endoscopic procedures were defined as those happening in less than 8 hours, a low-risk AIMS65 score was defined as 0 or 1, and a high-risk  AIMS65 score was defined as ≥2. The scores for mortality were assessed by calculating the area under the receiver-operating characteristic curve or AUROC. Data was compared using the chi-square test and the t-test, with a p<0.05 considered significant. Results included mortality scores of 0.9%, 1.5%, 9.5% and 50.0% for AIMS65 scores of 2,3,4, and 5, respectively. The AUROC for AIMS65 score predicting mortality was 0.943 (95% CI, 0.876 to 0.99). When compared to the Rockall score (0.856, 95% CI 0.743 to 0.969) the AIMS65 was superior.
References: 6
Study Additional 1
Retrospective study assessed the correlation between the AIMS65 score and Endoscopic Rockall score in patients with and without chirrosis admitted with overt upper gastrointestinal bleed (UGIB) and undergoing esophagogastroduodenoscopy (EGD). Patients were excluded if they had minimal, self limited UGIB not requiring a diagnostic or interventional endoscopic procedure. All scores were calculated at the time of admission with a score of 2 or less deemed as low risk of further bleeding or mortality. Rockall scores was computed using a variety of variables with different weight given to each one, while the AIMS65 score was computed with each variable being allotted 1 point. Scores were compared using an unpaired t-test and a p-value < 0.05 was considered statistically significant. A total of 1255 patients were evaluated, 152 had cirrhosis and 1103 did not have chirrosis. Results showed a significant correlation between the length of hospitalization and AIMS65 scores in cirrhotic patients with variceal bleed (p < 0.0002) but not in cirrhotic patients with nonvariceal bleed (p = 0.4069). AIMS65 scores were significantly higher (2 ± 0.75) in noncirrhotic patients who died from UGIB than in patients who did not die (0.80 ± 0.85) (p = 0.0003). Additionally, cirrhotic patients who died from UGIB had a significantly higher AIMS65 score (2.14 ± 0.37) than patients who did not die (1.08 + 0.82) (p = 0.0011). There correlation between AIMS65 and Total Rockall scores was significant in patients with and without chirrosis.
References: 7
Study Additional 2
A retrospective cohort study compared the efficacy of the AIMS65 score versus the Glasgow-Blatchford risk score (GBRS) across different patient populations. All adult patients with a primary diagnosis of upper gastroinstestinal bleeding (UGIB) who presented to the emergency department at Brigham and Women's Hospital were included in the study as long as they had all the data required for calculating the scores. The study's primary outcome measured was inpatient mortality and the data was analyzed using the area under the receiver-operating characteristic curve (AUROC). All P values were two sided and a value of 0.05 was considered statistically significant. AIMS65 scores of 2 and above were considered high-risk and the was also the cutoff that maximized the sum of the sensitivity and specificity. The study cohort consisted of 278 patients with a median age of 63 years (Range 50 - 77 years). Overall mortality was 6.5% with increased inpatient mortality with increasing AIMS65 score. AIMS65 score of 0 had no deaths, but scores of 1, 2, 3, 4 and 5 had 0.9%, 7.4%, 42.9%, 75% and 100.0% mortality, respectively. The AUROC for AIMS65 score predicting mortality was 0.93 and it was superior to GBRS  (0.93 vs. 0.68; p <0.001).  The mortality for patients with low-risk AIMS65 was 0.5% and 21% for high-risk (p<0.01); while mortality for low risk GBRS was 2% and 10% for high-risk (p=0.01). The AIMS65 score is superior to the GBRS in predicting inpatient mortality in patients presenting with UGIB. However, the GBRS was superior in predicting the need for blood transfusions (AUROC, 0.85 vs 0.65; P < .01)
References: 8
Study Additional 3
A retrospective, single-center study assessed the AIMS65 score as a predictor of inpatient mortality in patients presenting with an upper gastrointestinal bleed (UGIB) and also compared it with other pre- and post endoscopy risk scores. A total of 481 patients were identified using the ICD-10 (International Classification of Diseases, Tenth Revision) diagnosis codes for UGIB, 424 patients had a primary diagnosis of acute UGIB and were included in the study. Overall in-hospital mortality rate was 4.2% with an increase in AIMS65 correlating with increased mortality. There were no deaths in patients with an AIMS65 score of 0. Additionally, the AIMS65 score was shown to be superior in predicting in-patient mortality when compared to the GBS and pre-endoscopy Rockall scores with an AUROC of 0.80 vs. 0.76 (p<0.027) and 0.74 (p=0.001) respectively. An AIMS65 score of 3 was the threshold for maximizing sensitivity (0.72) and specificity (0.77), and defining high risk versus low risk groups. Patients with high-risk AIMS65 score had a mortality rate of 12.1% compared to a mortality rate of 1.6% in patients in the low-risk score group (p<0.001). This study validates the AIMS65 score in a larger patient population and shows its superiority to other pre-endoscopy risk scores in comparing in-hospital mortality.
References: 9

Authors

John Robinson Saltzman
MD, Brigham and Women's Hospital
Harvard Medical School, Director of Endoscopy
Research Interests: Professor
Gastroenterology, Hepatology and Endoscopy

References

  1. Saltzman JR, Tabak YP, Hyett BH, Sun X, Travis AC, Johannes RS. A simple risk score accurately predicts in-hospital mortality, length of stay, and cost in acute upper GI bleeding. Gastrointest Endosc. 2011 Dec;74(6):1215-24.
  2. Yaka E, Yılmaz S, Doğan NÖ, Pekdemir M. Comparison of the Glasgow-Blatchford and AIMS65 scoring systems for risk stratification in upper gastrointestinal bleeding in the emergency department. Acad Emerg Med. 2015 Jan;22(1):22-30.
  3. Stanley AJ, Laine L, Dalton HR, Ngu JH, Schultz M, Abazi R, et al.; International Gastrointestinal Bleeding Consortium. Comparison of risk scoring systems for patients presenting with upper gastrointestinal bleeding: international multicentre prospective study. BMJ. 2017 Jan 4;356:i6432.
  4. Stanley AJ, Laine L, Dalton HR, Ngu JH, Schultz M, Abazi R, et al.; International Gastrointestinal Bleeding Consortium. Comparison of risk scoring systems for patients presenting with upper gastrointestinal bleeding: international multicentre prospective study. BMJ. 2017 Jan 4;356:i6432.
  5. Thandassery RB, Sharma M, John AK, Al-Ejji KM, Wani H, Sultan K, et al. Clinical Application of AIMS65 Scores to Predict Outcomes in Patients with Upper Gastrointestinal Hemorrhage. Clin Endosc. 2015 Sep;48(5):380-4.
  6. Park SW, Song YW, Tak DH, Ahn BM, Kang SH, Moon HS, et al.The AIMS65 Score Is a Useful Predictor of Mortality in Patients with Nonvariceal Upper Gastrointestinal Bleeding: Urgent Endoscopy in Patients with High AIMS65 Scores. Clin Endosc. 2015 Nov;48(6):522-7.
  7. Gaduputi V, Abdulsamad M, Tariq H, Rafeeq A, Abbas N, Kumbum K, et al. Prognostic Value of AIMS65 Score in Cirrhotic Patients with Upper Gastrointestinal Bleeding. Gastroenterol Res Pract. 2014;2014:787256.
  8. Hyett BH, Abougergi MS, Charpentier JP, Kumar NL, Brozovic S, Claggett BL, et al. The AIMS65 score compared with the Glasgow-Blatchford score in predicting outcomes in upper GI bleeding. Gastrointest Endosc. 2013 Apr;77(4):551-7.
  9. Robertson M, Majumdar A, Boyapati R, Chung W, Worland T, Terbah R, et al. Risk stratification in acute upper GI bleeding: comparison of the AIMS65 score with the Glasgow-Blatchford and Rockall scoring systems. Gastrointest Endosc. 2016 Jun;83(6):1151-60.