Objectives: Upper gastrointestinal bleeding (UGIB) is a critical medical emergency with a potentially fatal outcome. Early risk stratification is essential for determining the need for urgent interventions. Current guidelines recommend the use of risk-stratification models, among which the ABC score was recently developed. We aimed to validate the performance of the ABC score in comparison with the well-established Glasgow–Blatchford score (GBS), AIMS65, and pre-endoscopic Rockall score (PreRS). Methods: This retrospective single-center study included adult patients (≥18 years) who presented to the emergency department of Incheon St. Mary’s Hospital with non-variceal UGIB between March 2019 and June 2022. The primary outcome was 30-day all-cause mortality. Secondary outcomes included a composite endpoint of hemostatic intervention (endoscopic, interventional radiologic, or surgical), hypotension (systolic blood pressure <90 mm Hg after 2 h), vasopressor use after 2 h, and rebleeding within 7 days. The predictive performance of the GBS, AIMS65, PreRS, and ABC scores was assessed using the area under the receiver operating characteristic curve (AUROC). Results: Of the 1597 enrolled patients, 116 (7.3%) died within 30 days. The ABC score demonstrated the highest performance (AUROC: 0.806; 95% confidence interval: 0.766–0.845) at predicting 30-day mortality, followed by the PreRS (0.734), GBS (0.679), and AIMS65 (0.558). The GBS had the highest AUROC (0.708), followed by the ABC (0.651), PreRS (0.626), and AIMS65 (0.529). Conclusions The ABC score outperformed conventional risk models at predicting the 30-day mortality among patients with non-variceal UGIB. However, its predictive power for the need for intervention was inferior to that of the GBS.

Background/Aims: Few multicenter studies have investigated the efficacy of hemostatic powders in gastrointestinal (GI) bleeding. We aimed to investigate the clinical outcomes of hemostatic powder therapy and the independent factors affecting rebleeding rates. Methods: We retrospectively recruited patients who underwent a new hemostatic adhesive powder (UI-EWD; Next-Biomedical) treatment for upper and lower GI bleeding between January 1, 2020 and March 1, 2023. We collected patients’ medical records and bleeding lesions. The primary outcomes were clinical and technical success rates, and the secondary outcomes were early, delayed, and refractory bleeding, mortality, and factors affecting early rebleeding rates. Results: This study enrolled 135 patients (age: 67.7±13.6 years, male: 74.1%) from five hospitals. Indications for UI-EWD were peptic ulcers (51.1%), post-procedure-related bleeding (23.0%), and tumor bleeding (19.3%). The clinical and technical success rates were both 97%. The early, delayed, and refractory rebleeding rates were 19.3%, 11.1%, and 12.8%, respectively. Initially elevated blood urea nitrogen (BUN) levels (p=0.014) and Forrest classification IA or IB compared with IIA or IIB (p=0.036) were factors affecting early rebleeding. Conclusions UI-EWD showed high clinical and technical success rates; however, rebleeding after UI-EWD therapy in patients with initially high BUN levels and active bleeding, according to the Forrest classification, should be considered.