This AIMS65 score calculator determines in-hospital upper GI bleeding mortality rate based on patient age, albumin, INR, systolic blood pressure and mental status.
How does the AIMS65 score calculator work?
This health tool stratifies mortality risk in patients diagnosed with bleeding in the upper gastro intestinal tract. The AIMS65 doesn’t rely on endoscopic data but on clinical and laboratory data. It was found that hospital cost and length of stay were correlated with the high scores.
The five risk factors accounted for in the AIMS65 score are:
■ Albumin <3 g/dL (30 g/L) – serum albuminemia is part of evaluation for patients with upper gastrointestinal bleeding and hypoalbuminemia is caused by depletion of albumin due to hemorrhage;
■ INR >1.5 – the international normalized ratio standardizes the results from the prothrombin time test and offer information about coagulation processes in the body;
■ Mental status alteration* – this can be observed after significant loss of blood;
■ Systolic blood pressure ≤90 mm Hg – low blood pressure indicates the patient may not be hemodynamically stable;
■ Age ≥65 years – the greater the age, the higher the mortality risk from UGIB.
*Mental status alteration is defined as a Glasgow Coma Scale (GCS) score lower than 14 or any elements from the following description, after a physician evaluation: patient is disoriented, lethargic in stupor or coma.
The name of the model is actually the mnemonic of the risk factors: Albumin, INR, Mental status, Systolic blood pressure, Age ≥65.
There are available two more bleeding risk tools that evaluate patient presentation and status, the Rockall score and the Glasgow-Blatchford Score (GBS), the former being found to have greater sensitivity and negative predictive value for low risk bleeding.
Although AIMS65 remains a better predictor of mortality risk, the GBS is more specific in predicting need for intervention through endoscopic treatment or surgery.
AIMS65 score interpretation
When either of the five risk factors is present, one point is awarded. Therefore, the final score ranges between 0 and 5, where 0 means the patient does not have any of the risk factors and carries a mortality risk of 0.3% and 5 means the patient has all the risk factors and carries a mortality risk of 24.5%.
The correlation between final scores and in-hospital mortality rate can be consulted in the table below:
| AIMS65 Score | In-hospital mortality rate |
| 0 | 0.3% |
| 1 | 1.2% |
| 2 | 5.3% |
| 3 | 10.3% |
| 4 | 16.5% |
| 5 | 24.5% |
UGIB guidelines
Bleeding in the upper gastrointestinal tract may arise from esophagus, stomach or duodenum and is considered a medical emergency. Its severity can vary and it can lead up to insufficient circulating blood and shock.
The most common causes include peptic ulcers, esophageal varices, gastric erosions, malignancy, Mallory-Weiss tear or duodenitis. NSAID and SSRI medication also increases the risk of UGIB.
Presentation differs with the gravity of the bleeding, often with hematemesis (vomiting blood) and melena (blood in stool). Diagnosis is based on clinical evaluation (blood pressure, heart rate, respiratory rate), blood tests (hemoglobin, albumin, INR, BUN, creatinine) and in some cases endoscopy of the upper digestive tract, to determine the hemorrhage source.
In some cases, endoscopic therapy is applied to reduce risk of bleeding recurring. In most cases fluid replacement is required accompanied or not by blood transfusion. Proton pump inhibitors to reduce gastric acid secretion and increase clot formation are given.
In cases with recurrent or refractory bleeding, surgery may be required.
References
1) Saltzman JR, Tabak YP, Hyett BH, Sun X, Travis AC, Johannes RS. (2011) A simple risk score accurately predicts in-hospital mortality, length of stay, and cost in acute upper GI bleeding. Gastrointest Endosc; 74(6):1215-24.
2) Thandassery RB et al. (2015) Clinical Application of AIMS65 Scores to Predict Outcomes in Patients with Upper Gastrointestinal Hemorrhage. Clin Endosc; 48(5): 380–384.
3) Stanley AJ, Laine L, Dalton HR, Ngu JH, Schultz M, Abazi R, Zakko L, Thornton S, Wilkinson K, Khor CJ, Murray IA, Laursen SB; International Gastrointestinal Bleeding Consortium. (2017) Comparison of risk scoring systems for patients presenting with upper gastrointestinal bleeding: international multicentre prospective study. BMJ; 356:i6432.
07 Jun, 2017