As risk assessment in patients with peptic ulcer bleeding can be used to predict rebleeding and mortality rate, it is recommended to use scoring tools as an indicator to decide admission, treatment in the intensive care unit, and timing of endoscopy [16, 17]. The ability to select patients who will benefit the most from intensive treatment is an important step in the rational use of resources . There are many scoring tools to indicate patients at high risk of adverse outcomes and identify those in need of urgent endoscopic evaluation . GBS, AIMS65, and MAP(ASH) are scoring tools used to predict outcomes in patients with bleeding. However, these scores have been developed based on Western populations; hence, they might be influenced by ethnic differences. For example, the AIMS65 was reported to be insufficient in predicting the outcomes of peptic ulcer bleeding in a study conducted in Korea .
In this study, we validated the ABC score in Korean populations with peptic ulcer bleeding. The ABC score was developed to predict the outcomes of patients with acute GI bleeding, regardless of the source . In the original article, it was reported to have a high accuracy in predicting 30-day mortality in both upper and lower GI bleeding. Some parameters of the ABC score such as albumin level and liver cirrhosis are associated with variceal bleeding. Hence, its utility in cases of non-variceal upper GI bleeding, such as peptic ulcer, should be investigated.
Our retrospective single-center study in patients with peptic ulcer bleeding found that the ABC score is superior to other well-known scores such as GBS, AIMS65, and MAP(ASH) in predicting 30-day mortality. However, the scores were similar in their ability to predict the secondary outcomes of rebleeding and the need for radiologic or surgical intervention to stop bleeding.
Area under the ROC curve is a popular measure of diagnostic test accuracy. The closer the ROC curve area is to 1.0, the better the diagnostic test . In general, a test is considered excellent if its AUROC is between 0.9 and 1, good if it is between 0.8 and 0.9, fair is the AUROC is between 0.7 and 0.8, and poor if the AUROC is between 0.5 and 0.7 . We found that the ABC score was an excellent predictor of 30-day mortality, with an AUROC of 0.927 (95% CI 0.899–0.956). This result was higher than those of AIMS65, GBS, and MAP(ASH).
In the current study, five out of the eight variables of the ABC score showed a statistically significant association with 30-day mortality. However, three components (namely, serum urea, liver cirrhosis, and disseminated malignancy) were not associated with 30-day mortality. In the original article describing the ABC score, liver cirrhosis and disseminated malignancy were identified as significant predictors of 30-day mortality. In contrast, serum urea was not a significant predictor of mortality. Nevertheless, it improved the identification of patients with a low mortality risk  In our study, all of these three factors were not significant predictors of 30-day mortality. This may be attributable to the different characteristics of patients as well as the small population size of the mortality group. Patients with upper GI bleeding and liver cirrhosis usually present with variceal bleeding; however, they were not included in this study. Patients with disseminated malignancy accounted for 4.4% in the survival group and 15% in the mortality group, although these rates were not statistically significant. This might have been due to the small population size of the mortality group (20 patients). Hence, more studies with a larger number of patients are necessary.
Interestingly, lower serum albumin levels were associated with 30-day mortality (p < 0.001). Hypoalbuminemia is associated with several debilitating clinical conditions, such as malnutrition and diabetes, and is a widely accepted risk factor for mortality in some diseases .
Our study has certain limitations. First, the present study was a single-center study conducted at a local tertiary hospital; thus, the patient group may not be representative of the general population. The results may be different from those of studies involving more patients from multiple centers and other areas. Second, the small sample size of the mortality group might have influenced the results. Third, only patients who underwent endoscopy were included, and those who did not undergo endoscopy because of any reason were excluded, which might have created a selection bias. Fourth, this study was limited to patients with peptic ulcer bleeding; therefore, the results can be different in other clinical settings. Finally, ethnic differences should be considered, as this study only included Korean patients.