Validation of the C-WATCH score for predicting severity in patients with upper gastrointestinal bleeding at a tertiary public hospital in Lima, Peru

Espinoza-Ríos J.; Ruiz-Cortez R.; Santiago B.; Tenorio J.H.-M. · BMC Gastroenterology (2026) · DOI: 10.1186/s12876-026-04963-7

Resumen

Background: Upper gastrointestinal bleeding (UGIB) remains one of the most common emergencies in gastroenterology, with mortality rates reaching 14% in some settings. Despite advances in management, mortality has remained relatively unchanged. Several risk stratification tools, including Glasgow-Blatchford, AIMS65, and Rockall scores, are used to predict adverse outcomes. More recently, the C-WATCH score has been proposed as a simplified alternative. We aimed to validate the ability of the C-WATCH score to predict severity in patients with UGIB in a tertiary public hospital in Lima, Peru. Methods: We conducted a prospective diagnostic accuracy study comparing the discriminative performance of C-WATCH, AIMS65, Glasgow-Blatchford, and Rockall (pre- and post-endoscopic) scores. The outcomes assessed included 30-day mortality, the need for transfusion of ≥ 2 units of packed red blood cells and rebleeding. Discrimination was assessed using area under the receiver operating characteristic curve (AUROC) and pairwise comparisons were performed using the DeLong test. Results: A total of 235 patients were included; 59.6% (n = 140) were male, with a mean age of 61.0 ± 16.5 years. The thirty-day mortality rate was 4.7% (n = 11). The most frequent etiologies were gastric ulcers (31.1%, n = 73), esophageal varices (25.1%, n = 59), and duodenal ulcers (16.6%, n = 39). For mortality prediction, the AUROC was highest for C-WATCH (0.83, 95% CI 0.72–0.94), followed by AIMS65 (0.81, 95% CI 0.70–0.93), post-endoscopic Rockall (0.80, 95% CI 0.72–0.88), Glasgow-Blatchford (0.69, 95% CI 0.53–0.85) and pre-endoscopic Rockall (0.63, 95% CI 0.47–0.79). However, pairwise comparisons using the DeLong test showed no statistically significant differences between C-WATCH and comparator scores after Bonferroni correction. Similar findings were obtained for predicting transfusion ≥ 2 units. All scores demonstrated poor performance for rebleeding prediction (AUROC < 0.58) and no statistically significant differences. Conclusions: C-WATCH score demonstrated comparable performance for predicting 30-day mortality and transfusion requirements compared with AIMS65, Glasgow-Blatchford, and Rockall scores. All scores showed limited ability to predict rebleeding. © The Author(s) 2026.

Instituciones: Universidad Peruana Cayetano Heredia