Prospective validation of the BISHE score as a predictor of the need for massive transfusion in patients with upper gastrointestinal bleeding

Abstract Background: Emergency transfusion strategies for patients with upper gastrointestinal bleeding (UGIB) have not been well developed. The BISHE is a recently developed scoring system for prediction of patients likely to require massive transfusion but has not been validated. In this study, we evaluated the predictive ability of the BISHE score and that of a revised scoring system in an effort to improve care for patients with UGIB and allow better resource allocation. Methods: This prospective observational cohort study included patients who were admitted to our hospital between July 1, 2016 and June 30, 2019 and required massive transfusion (defined as receiving three units of red blood cells over one hour) in the emergency department. The predictive accuracy of the BISHE score and that of the revised scoring system were compared using area under the receiver-operating characteristic (AUROC) curve analysis. Results: Liver cirrhosis, an international normalized ratio >1.5, and hemoglobin <8.0 g/dL were independently associated (p<0.05) with requirement for massive transfusion. The revised scoring system discriminated successfully between patients with UGIB requiring massive transfusion and their counterparts who did not (AUROC 0.82, 95% confidence interval 0.78–0.86) and performed better than the BISHE score (AUROC 0.73, 95% confidence interval 0.69–0.76; p=0.004).Conclusions: Compared with the BISHE score, the revised scoring system was better able to identify patients likely to require massive transfusion.