ArticleBMC gastroenterology2026
Validation of the C-WATCH score for predicting severity in patients with upper gastrointestinal bleeding at a tertiary public hospital in Lima, Peru.
Article in BMC gastroenterology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. Not yet cited in PubMed.
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Corrections and comments
- Erratum issued
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4 authors.
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Abstract
backgroundUpper gastrointestinal bleeding (UGIB) remains one of the most common emergencies in gastroenterology, with mortality rates reaching 14% in some settings. Despite advances in management, mortality has remained relatively unchanged. Several risk stratification tools, including Glasgow-Blatchford, AIMS65, and Rockall scores, are used to predict adverse outcomes. More recently, the C-WATCH score has been proposed as a simplified alternative. We aimed to validate the ability of the C-WATCH score to predict severity in patients with UGIB in a tertiary public hospital in Lima, Peru.
methodsWe conducted a prospective diagnostic accuracy study comparing the discriminative performance of C-WATCH, AIMS65, Glasgow-Blatchford, and Rockall (pre- and post-endoscopic) scores. The outcomes assessed included 30-day mortality, the need for transfusion of ≥ 2 units of packed red blood cells and rebleeding. Discrimination was assessed using area under the receiver operating characteristic curve (AUROC) and pairwise comparisons were performed using the DeLong test.
resultsA total of 235 patients were included; 59.6% (n = 140) were male, with a mean age of 61.0 ± 16.5 years. The thirty-day mortality rate was 4.7% (n = 11). The most frequent etiologies were gastric ulcers (31.1%, n = 73), esophageal varices (25.1%, n = 59), and duodenal ulcers (16.6%, n = 39). For mortality prediction, the AUROC was highest for C-WATCH (0.83, 95% CI 0.72-0.94), followed by AIMS65 (0.81, 95% CI 0.70-0.93), post-endoscopic Rockall (0.80, 95% CI 0.72-0.88), Glasgow-Blatchford (0.69, 95% CI 0.53-0.85) and pre-endoscopic Rockall (0.63, 95% CI 0.47-0.79). However, pairwise comparisons using the DeLong test showed no statistically significant differences between C-WATCH and comparator scores after Bonferroni correction. Similar findings were obtained for predicting transfusion ≥ 2 units. All scores demonstrated poor performance for rebleeding prediction (AUROC < 0.58) and no statistically significant differences.
conclusionsC-WATCH score demonstrated comparable performance for predicting 30-day mortality and transfusion requirements compared with AIMS65, Glasgow-Blatchford, and Rockall scores. All scores showed limited ability to predict rebleeding.
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