A novel scoring system in emergency non-variceal upper gastrointestinal bleeding patients: LActate-Based Bleeder Score (LABBS)

Background: Upper gastrointestinal bleeding is a common medical emergency that requires careful evaluation for appropriate treatment planning. Plasma lactate has been shown to be a useful marker for predicting hypovolemic shock, even in patients with stable physiological parameters. This study aims to develop a simple scoring system – LActate-Based Bleeder Score (LABBS) – for risk assessment in cases of non-variceal upper gastrointestinal bleeding (NVUGIB), incorporating lactate as a key parameter. LABBS was compared with the Glasgow–Blatchford score (GBS) in predicting gastroscopy findings, specifically Forrest-classified ulcers requiring intervention, as well as the risks of rebleeding and the need for re-intervention. Methods: Patients with a first presentation of NVUGIB, as confirmed by endoscopic findings, were evaluated using the newly developed LABBS and the GBS. The accuracy of both scoring systems was assessed using receiver operating characteristic (ROC) curves with 95% confidence intervals. This retrospective study was conducted at a tertiary care center. Results: A total of 592 patients with unstable physiological parameters and documented Forrest ulcers on gastroscopy were included in the study. The LABBS demonstrated comparable accuracy to the GBS in predicting high-risk Forrest ulcers requiring intervention. For the prediction of high-risk ulcers, a LABBS ≥3 and GBS ≥12 yielded specificities of 76.1% and 68.2%, and sensitivities of 38.5% and 39.4%, respectively. For the prediction of endoscopic intervention, the specificity of LABBS ≥3 and GBS ≥12 was 68.8% and 61.4%, with sensitivities of 46.8% and 53.8%, respectively Conclusions: The inclusion of plasma lactate in the scoring system enhances the prediction of endoscopic findings that require intervention. A higher LABBS is associated with the presence of high-risk Forrest ulcers necessitating therapeutic measures. Moreover, LABBS is straightforward to calculate, making it practical for use in emergency settings. We recommend the adoption of this simple, lactate-based scoring system for risk stratification and decision-making in patients presenting with NVUGIB.