Author(s):

Elton Dajti 1 2, Leonardo Frazzoni 3, Sílvia Castellet-Farrús 4, Jordi Guardiola 4, Emanuele Sinagra 5, Andrea Anderloni 6, Francesco Ferrara 7, Paraskevas Gkolfakis 8, Marine Camus Duboc 9, Francesco Vito Mandarino 10, Anahita Sadeghi 11, Vicente Lorenzo-Zúñiga 12, Sandra Perez 13, Konstantinos Triantafyllou 14, Maria Paula Curado 15, Antonio Facciorusso 16, Giulia Collatuzzo 2, Cesare Hassan 17 18, Franco Radaelli 19, Lorenzo Fuccio 12; ALIBI Study Group

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  Abstract

  Background: Lower gastrointestinal bleeding (LGIB) is a common condition linked to increased morbidity, healthcare costs, and mortality. Currently, no prospectively validated prognostic model exists to predict mortality in patients with LGIB. Our aim was to develop and validate a risk score that could accurately predict in-hospital mortality of patients admitted for LGIB.

  Methods: Patient data from a nationwide cohort study in 15 centers in Italy (2019-2020) were used to derive the risk score, the Acute Lower gastrointestinal Bleeding and In-hospital mortality (ALIBI) score; the model was then externally validated in a cohort of consecutive patients hospitalized for LGIB in 12 centers from six countries (Italy, Spain, France, Greece, Iran, and Brazil) from 2022 to 2024. The main outcome was in-hospital mortality; we also reported rebleeding rates and the in-hospital mortality rate stratified by risk score and timing of colonoscopy. RESULTS : Among 1198 patients in the derivation cohort, 105 (8.8%) re-bled and 41 (3.4%) died. Age, Charlson Co-morbidity Index, in-hospital onset, hemodynamic instability, and creatinine level were independent predictors of in-hospital mortality. The model demonstrated excellent discrimination (area under the receiver operating curve [AUROC] 0.81, 95%CI 0.75-0.87) and calibration. In the validation cohort (n = 752 patients), the model's good discrimination (AUROC 0.79, 95%CI 0.72-0.86) and calibration were confirmed. Patients were categorized as low (0-4 points; 1% mortality), intermediate (5-9 points; 4.6% mortality), or high risk (10-13 points; 19.1% mortality). CONCLUSION : A new validated score effectively predicts in-hospital mortality in patients with LGIB, aiding in their risk stratification and management.

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• DOI: 10.1055/a-2541-2312
• Epub 2025 Feb 17