AIMS65 Score for Upper GI Bleeding Mortality

Patients with acute upper GI bleeding.

• The AIMS65 Score for Upper GI Bleeding Mortality was designed to predict mortality in adults presenting with acute upper GI bleeding.
• Does not rely on endoscopic data and can be easily calculated in the ED.
• Each letter of the mnemonic (including “65”) represents an equally weighted risk factor that is cumulative in predicting severity of upper GI bleeding.
• Mortality increases with each positive risk factor.
• Cost and length of stay (LOS) also correlate closely with higher scores.
• Altered mental status is defined as Glasgow Coma Scale (GCS) score <14 or a physician designation of “disoriented,” “lethargy,” “stupor,” or “coma.”
• Of the 5 components, albumin was the single most predictive factor of mortality, perhaps as a surrogate of comorbid disease.
• The Glasgow-Blatchford Score (GBS) has demonstrated greater sensitivity and negative predictive value for low risk bleeding; therefore, a low AIMS65 score should not be used to dictate discharge (Yaka 2013).
• A large multinational prospective trial demonstrated the GBS to be superior to the AIMS65 in predicting need for intervention (transfusion, endoscopic treatment, IR, or surgery) or rebleeding, although the AIMS65 remained a better predictor of mortality (Stanley 2017).
• Due to its retrospective development from a large database, correlation with endoscopic outcomes, rebleeding rates, and transfusion requirements is not known.

Point to Keep in Mind

• Only a small fraction (1.7%) of patients in the model were cirrhotic, although the AIMS65 score remains predictive of mortality in patients with liver disease (Gaduputi 2014).

• Simple and quick to calculate.
• Uses information available prior to endoscopy.
• Highly predictive of mortality, cost, and LOS.
• Validated in a very large cohort.