Upper gastrointestinal bleeding (UGIB) remains a significant cause of morbidity and mortality worldwide, particularly in the non-variceal subset where peptic ulcers, erosive disease, and other lesions predominate. Accurate risk stratification in non-variceal upper gastrointestinal hemorrhage (NVUGIH) is critical to guiding clinical decision-making, optimizing resource utilization, and improving patient outcomes. Over the years, several prognostic scoring systems have been developed; among them, the Glasgow-Blatchford Score (GBS) and the Complete Rockall Score (CRS) are among the most widely studied. The Glasgow-Blatchford Score, introduced in 2000, is designed primarily to identify patients who require clinical intervention, such as blood transfusion or endoscopic therapy, without relying on endoscopic findings. It incorporates parameters such as haemoglobin, blood urea nitrogen, blood pressure, pulse, and signs of melena or syncope. In contrast, the Rockall scoring system has two forms: a pre-endoscopic (clinical) Rockall score and a post-endoscopic (complete) Rockall score. The CRS combines clinical risk factors (age, shock, comorbidities) with endoscopic findings (diagnosis, stigmata of bleeding) to provide a more comprehensive assessment of mortality risk [1]. Despite the widespread adoption of both scores, their comparative performance in NVUGIH remains subject to debate. A large international multicentre prospective study demonstrated that although the GBS had high accuracy for predicting intervention or death (AUROC 0.86), its discriminative power for rebleeding or length of stay was limited; meanwhile, the full Rockall score performed less well for intervention (AUROC 0.70) but had modest value for other outcomes [2]. A recent systematic review and meta-analysis focusing specifically on non-variceal bleeding synthesized data from multiple studies and showed no significant difference between GBS and CRS in predicting mortality or rebleeding. However, GBS appeared to outperform CRS in forecasting the need for blood transfusion and surgical intervention [1,3]. Several single-centre and regional studies also reflect this nuanced performance. In a cohort of 237 patients with UGIB, researchers found that the Rockall score was superior to GBS for predicting mortality (AUC 0.806 vs. 0.750), while GBS showed better performance for identifying patients needing transfusion (AUC 0.810 vs. 0.675) [4]. Similar trends were observed in a large Portuguese study of 420 NVUGIH patients: the CRS had the strongest discriminatory ability for mortality (AUC ~0.756), and also performed reasonably well for rebleeding (AUC ~0.735), whereas GBS was most useful in predicting transfusion requirements (AUC ~0.785) [5,6]. In resource-limited settings and varied populations, validation studies have yielded mixed results. For instance, a prospective Indian study involving 300 patients found that the Rockall score (AUROC = 0.728) predicted mortality better than GBS, while GBS was more sensitive for predicting the need for transfusion and interventions [7]. An Egyptian cohort similarly showed that GBS had excellent diagnostic performance for predicting transfusion requirement, but both pre-endoscopic and complete Rockall scores were more useful in mortality and recurrent bleeding stratification [8]. Clinical guidelines also reflect the complexity of choosing an optimal score. The NICE guideline for UGIB notes that although full Rockall score has reasonable sensitivity for mortality, the overall discriminatory power (AUC) of both Rockall and GBS scores shows considerable variability (full Rockall AUC 0.67–0.84 in different cohorts) [9]. Moreover, despite statistical validation, some studies suggest that endoscopist judgment (“clinical intuition”) may be as useful as risk scores in real-world practice, particularly for predicting rebleeding or death, underscoring the complementary role of clinical assessment [10]. Taken together, the literature suggests that neither GBS nor CRS is perfect: each has strengths in certain domains (transfusion, mortality, intervention), but both may have limited performance for rebleeding or other outcomes. Given these nuances and the variability of results across settings, there is a clear need to evaluate their predictive accuracy in specific patient populations. In particular, prospective data from Indian tertiary centres are relatively scarce, and validating these scores in such contexts can help guide local clinical protocols. To study the effectiveness of prediction of outcomes, like mortality, rebleeding and need for surgical intervention by Glascow Blatchford score and Complete Rockall score in patients diagnosed with non-variceal upper gastrointestinal bleeding.

Study Design: Prospective Analytical Study Study Period: January 2019 to May 2019 Sample: 220 patients Inclusion criteria: • All patients with age >18 years with upper gastrointestinal bleeding unrelated to varices as confirmed by endoscopy Exclusion criteria: • Patients with upper gastrointestinal bleeding due to varices • Patients with primary coagulopathy and bleeding disorders • Age < 18 years • Patients not willing to participate in the study Statistical Methods Data obtained from the study were summarized using appropriate descriptive statistics. Continuous variables were expressed as mean values with standard deviation, while categorical variables were presented in the form of tables and graphical representations such as bar charts and pie diagrams. Statistical analysis was performed using Statistical Package for the Social Sciences (SPSS), version 16.0. Receiver Operating Characteristics (ROC) curves with 95% Confidence Interval (CI) were plotted to assess the predictive performance of the Glasgow-Blatchford Score and Complete Rockall Score for clinical outcomes. Diagnostic accuracy was evaluated using the Area Under the Curve (AUC). Comparison of AUC values between the scoring systems was carried out using the Z-test. An AUC value greater than 0.7 was considered statistically significant, indicating acceptable discriminatory ability.

Table: 1. Baseline Demographic and Clinical Characteristics Parameter Category n (%) / Mean ± SD Gender Distribution Male 167 (75.90%) Female 53 (24.10%) Age (Years) Age Range 19 – 88 years Mean Age (Overall) 54.6 years Mean Age (Male) 52.2 years Mean Age (Female) 46.4 years Admission Status Ward 174 (79%) ICU 46 (21%) Use of Bleeding-Promoting Drugs Present 146 (61.8%) Associated Comorbidities Present 168 (76.36%) Table: 2. Hemodynamic and Hematological Profile Parameter Category n (%) Systolic Blood Pressure on Admission (mmHg) >100 mmHg 154 (70%) 80–100 mmHg 40 (18.2%) <80 mmHg 26 (11.8%) Hemoglobin Level (g/dl) >10 g/dl 75 (34%) 8–10 g/dl 62 (28.2%) <8 g/dl 83 (37.8%) Endoscopy Requirement Emergency Endoscopy Done 66 (30%) Etiology of Upper GI Bleeding Gastric erosions 102 (46.36%) Peptic ulcer disease 74 (33.63%) Tumor 22 (10%) Stomal ulcer 8 (3.6%) Dieulafoy lesion 6 (2.72%) Mallory-Weiss tear 6 (2.72%) Hemobilia 2 (0.9%) Table: 3. Management, Outcomes and Hospital Stay Parameter Category n (%) Blood Transfusion Requirement Required 119 (54%) >2 Units 26 (11.86%) Treatment Modality Medical Management Only 159 (72%) Endoscopic Treatment 55 (25%) Interventional Radiology 5 (2%) Emergency Surgery 1 (0.45%) Outcome Complete Recovery 173 (78.63%) Re-bleeding 40 (18.18%) Mortality 7 (3.18%) Duration of Hospital Stay <2 days 87 (39.54%) 2–5 days 79 (35.90%) >5 days 54 (24.54%) Table: 4. Risk Stratification Based on Rockall Score and Glasgow–Blatchford Score No. of Patients Percentage Rockall Score Low Risk (0-2) 92 41.20% Moderate (3-4) 77 35.30% High (>5) 51 23.50% Glascow Blatchford Score Low Risk 98 44.8%% High Rik 122 44.20% Table: 5. Diagnostic Performance of Complete Rockall Score (CRS) and Glasgow–Blatchford Score (GBS) in Predicting Mortality, Rebleeding and Need for Surgery Outcome Scoring System Values Specificity Sensitivity Mortality CRS 1 0.73 0.76 GBS 9 0.47 0.66 Rebleed CRS 2 0.32 0.87 GBS 11 0.95 0.19 Surgery CRS 2 0.35 0.87 GBS 6 0.86 0.23 Figure: 1. Management, Outcomes and Hospital Stay In the present study, a total of 220 patients presenting with non-variceal upper gastrointestinal bleeding (NVUGIH) were evaluated. The majority of the study population comprised males (75.90%), with females accounting for 24.10%. The overall mean age of presentation was 54.6 years, while the mean age among males and females was 52.2 and 46.4 years, respectively, indicating that NVUGIH was more prevalent in the middle-aged population. Most patients were admitted directly to the ward (79%), whereas 21% required intensive care admission at the time of presentation. Bleeding-promoting drugs such as antiplatelets, anticoagulants, and NSAIDs were reported in 61.8% of the patients, and 76.36% of the study population had associated comorbidities, reflecting a significant burden of multimorbidity among NVUGIH patients. On admission, hemodynamic instability was noted in a subset of patients. Approximately 30% presented with systolic blood pressure <100 mmHg, of which 11.8% were severely hypotensive (SBP <80 mmHg). Anemia was common at presentation, with more than one-third (37.8%) of patients having hemoglobin levels <8 g/dl. Only 30% of patients underwent emergency endoscopy, indicating selective use based on clinical severity. Gastric erosions (46.36%) and peptic ulcer disease (33.63%) were the leading causes identified on endoscopy, followed by tumors (10%), stomal ulcers (3.6%), Dieulafoy lesion (2.72%), Mallory–Weiss tears (2.72%), and hemobilia (0.9%). Regarding management, more than half of the patients (54%) required blood transfusion, and 11.86% required transfusion of more than two units. Medical management alone was sufficient in the majority (72%), whereas 25% underwent therapeutic endoscopic intervention. A very small proportion required advanced intervention—2% managed with interventional radiology and only 0.45% required emergency surgery. Clinical outcomes revealed that 78.63% recovered completely, while 18.18% experienced rebleeding. The overall in-hospital mortality was relatively low (3.18%). The duration of hospital stay was <2 days in 39.54% of patients, whereas 24.54% required prolonged hospitalization (>5 days), typically due to comorbid conditions, persistent bleed, or need for transfusion and critical management. Risk stratification demonstrated that according to the Rockall Score, 41.20% were low-risk (0–2), 35.30% were moderate risk (3–4), and 23.50% belonged to the high-risk category (>5). The Glasgow–Blatchford Score (GBS) categorized 44.8% of patients as low risk and 55.2% as high risk, indicating a comparatively higher proportion of patients flagged as severe at presentation. On comparing diagnostic performance, the Complete Rockall Score (CRS) showed superior sensitivity over GBS in predicting mortality (76% vs. 66%), rebleeding (87% vs. 19%), and need for surgical intervention (87% vs. 23%). Conversely, GBS demonstrated higher specificity in predicting rebleeding (95%) and need for surgery (86%). These findings suggest that CRS is a better tool for identifying high-risk patients requiring active intervention for adverse outcomes, whereas GBS is more effective in predicting patients unlikely to require invasive procedures due to its higher specificity. Overall, both scoring systems were valuable in risk stratification, but CRS demonstrated higher clinical utility in predicting mortality and need for aggressive management, whereas GBS was useful in identifying low-intervention candidates.

Our results—showing that the Complete Rockall Score (CRS) had higher sensitivity for mortality, rebleeding and need for surgery while the Glasgow–Blatchford Score (GBS) demonstrated higher specificity for predicting rebleeding and requirement for intervention—are broadly consistent with prior comparative work but also show some important differences that are worth highlighting. Mokhtare et al. reported that the full Rockall score better predicted 1-month mortality while GBS was superior for predicting transfusion, rebleeding and need for endoscopic intervention, which mirrors our finding that CRS is more sensitive for mortality whereas GBS better “rules in/out” intervention-related outcomes [11]. The large multicentre prospective study by Stanley et al. similarly found that GBS had high accuracy for predicting need for hospital-based intervention or death, and that no score was especially good at predicting rebleeding or length of stay—again echoing our observation that GBS is useful for identifying patients who will require intervention while discrimination for rebleeding/mortality remains imperfect across scores [12]. A recent systematic review and meta-analysis that pooled non-variceal UGIB studies also concluded that GBS tended to outperform Rockall for predicting transfusion and surgical/interventional needs, whereas neither score performed strongly for mortality or rebleeding—supporting our interpretation that each score has complementary strengths rather than one clear overall superiority [13]. Larger contemporary cohorts and validation studies (for example, In et al. and Gu et al.) have emphasized that newer or alternative scores (ABC, MAP(ASH), AIMS65, CHAMPS) may outperform older systems for specific endpoints (mortality vs intervention), which may explain why CRS showed higher sensitivity in our cohort while other scores sometimes show better AUROC for mortality in other populations [14,15]. Studies focused on settings with high comorbidity burdens or older populations (e.g., Martínez-Cara, Park, Kim) have shown AIMS65 or combinations incorporating comorbidity and laboratory parameters can rival or exceed Rockall/GBS for mortality prediction; this suggests that differences in baseline population age, comorbidity, anticoagulant/antiplatelet use and time-to-endoscopy contribute substantially to between-study variability and likely account for some of the divergent test characteristics seen across reports [16–19]. Finally, methodological differences—sample size, single-centre vs multicentre design, inclusion of variceal bleeds, definitions and timing of outcomes (in-hospital vs 30-day mortality, definition of rebleed), and thresholds used for scores—explain much of the heterogeneity in reported sensitivity/specificity and AUROC values and caution against assuming any one score will behave identically across settings [11–15,20]. In practical terms, our findings support the contemporary view in the literature that clinicians should use GBS to identify low-risk patients suitable for conservative or outpatient management, while relying on CRS (or scores that emphasize age/comorbidity/laboratory derangement) when the priority is sensitivity for mortality and need for aggressive management; combining clinical judgement with score-specific thresholds and local resource considerations remains the most pragmatic approach.

We conclude that, the present study demonstrates that timely assessment and stratification of non-variceal upper gastrointestinal bleeding using validated scoring systems can significantly aid in predicting clinical outcomes and guiding management decisions. Most patients responded well to conservative and endoscopic management, with a high recovery rate (78.63%) and comparatively low mortality (3.18%). Although rebleeding occurred in 18.18% of cases, it was more frequently associated with higher risk categories identified by the Complete Rockall Score. CRS showed superior sensitivity in predicting mortality, rebleeding, and need for surgery, while the Glasgow–Blatchford Score proved more specific in identifying patients likely to require therapeutic interventions and transfusion. These findings emphasize that the two scoring systems complement each other, and their combined use enhances accuracy in clinical decision-making. Overall, risk stratification at presentation allows for optimal resource utilization, early targeted management, reduced morbidity, and improved clinical outcomes in patients with non-variceal upper GI bleeding.

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