Predicting Adverse Outcomes in Upper Gastrointestinal Bleeding: A Focus on Blood Urea Nitrogen-Based Ratios and Age-Adjusted Shock Index.

Background/Aim: Rapid risk stratification is crucial in managing upper gastrointestinal bleeding (UGIB). This study evaluated the prognostic value of the age-adjusted shock index (ASI), blood urea nitrogen (BUN)/haemoglobin ratio and BUN/platelet ratio for predicting adverse clinical outcomes. Materials and Methods: This single-centre retrospective observational cohort study included 204 adult patients (age ≥ 18 years) presenting to the emergency department with UGIB between 1 January 2022 and 31 December 2022. Patients with oesophageal variceal bleeding, lower gastrointestinal sources, trauma, pregnancy, malignancy, prior diagnosis at another institution or incomplete data were excluded. Receiver operating characteristic (ROC) curve analysis was the primary statistical method used to determine prognostic performance. Results: Among the 204 included patients, the intensive care unit (ICU) admission rate was 14%, and the in-hospital mortality rate was 5.4%. ROC curve analyses for in-hospital mortality revealed statistically significant predictive capabilities across all evaluated parameters. The BUN/haemoglobin ratio demonstrated an area under the curve (AUC) of 0.779 at an optimal cut-off of > 8.45, yielding a high negative predictive value (NPV) of 97.26%. The BUN/platelet ratio produced an AUC of 0.747 at a cut-off of > 0.17, with an NPV of 98.32%. Additionally, the ASI achieved an AUC of 0.780 at an optimal cut-off of > 61.72 and an NPV of 98.03%. Conclusion: The ASI, BUN/haemoglobin and BUN/platelet ratios are rapid, inexpensive and easily calculable parameters upon admission. Their notably high NPVs make them effective complementary tools to established scoring systems, aiding clinicians in safely identifying low-risk patients who can be managed in the general ward rather than the ICU.