ArticleBMJ open gastroenterology2026
Development and internal validation of the AGATE hybrid score for pre-endoscopic risk stratification in acute upper gastrointestinal bleeding: a single-centre, retrospective cohort study.
Article in BMJ open gastroenterology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
objectiveTo compare five established pre-endoscopic risk scores in acute upper gastrointestinal bleeding (AUGIB) and to derive a hybrid score (Acute Gastrointestinal Bleeding ABC-GBS Triage Evaluation (AGATE)) integrating mortality prediction and triage utility.
methodsWe conducted a single-centre retrospective cohort study at Kayseri City Hospital, Kayseri, Türkiye, including 5000 consecutive adults with endoscopically confirmed AUGIB (January 2020-January 2025). The primary outcome was 30-day mortality; secondary outcomes were therapeutic intervention and 30-day rebleeding. Age-Blood tests-Comorbidities (ABC), Mental status-ASA class-Pulse-Albumin-Systolic blood pressure-Haemoglobin (MAP(ASH)), Haematemesis-Heart rate-Haemoglobin-Blood pressure-Blood urea nitrogen, Glasgow-Blatchford score (GBS) and Albumin, INR, Mental status, Systolic blood pressure, Age ≥65 were calculated at presentation. AGATE was derived using multivariable logistic regression for the composite end point (mortality or intervention) and internally validated with 1000 bootstrap resamples.
resultsMortality was 9.2% (460/5000), intervention was required in 71.0% (3550/5000) and rebleeding occurred in 14.5% (725/5000). For mortality, ABC (area under the receiver operating characteristic curve (AUROC) 0.83, 95% CI 0.80 to 0.86) and MAP(ASH) (AUROC 0.81, 95% CI 0.78 to 0.84) demonstrated the highest discrimination; for intervention, GBS (AUROC 0.78, 95% CI 0.74 to 0.82) and MAP(ASH) (AUROC 0.77, 95% CI 0.73 to 0.80) demonstrated the highest discrimination. AGATE achieved AUROCs of 0.85 (95% CI 0.82 to 0.87) for mortality and 0.80 (95% CI 0.77 to 0.82) for intervention. For the composite end point, AGATE outperformed GBS (AUROC 0.86, 95% CI 0.83 to 0.88 vs 0.77 95% CI 0.74 to 0.80; p<0.001), with an optimism-corrected AUROC of 0.843. Using a low-risk cut-off (≤5), AGATE classified 38% (1900/5000) as low risk (0.3% mortality, 4.0% intervention), compared with 15% (750/5000) for GBS ≤1.
conclusionAGATE provides balanced pre-endoscopic triage by integrating predictors from ABC and GBS, expanding the low-risk group while maintaining very low short-term mortality. Prospective external validation in independent multicentre settings is required.
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