This calculator is for general information and education. It is not medical advice and does not replace the judgment of a doctor, nurse or pharmacist who knows the full clinical picture.
Vomiting blood, black tarry stools or fainting need emergency care: call 911.
Five simple items
Upper gastrointestinal bleeding comes from the esophagus, stomach or duodenum, most often from a peptic ulcer or from varices in people with cirrhosis. AIMS65, published by John Saltzman and colleagues in 2011, uses five items available within the first hours to estimate the risk of dying in hospital. Each item present scores one point:
- Albumin below 3.0 g/dL (30 g/L)
- INR above 1.5
- altered Mental status: a Glasgow score below 14, disorientation, lethargy or stupor
- Systolic blood pressure of 90 mmHg or less
- age 65 or older
Mortality by score
In the validation cohort, in-hospital mortality rose steeply with the score:
| AIMS65 score | In-hospital mortality |
|---|---|
| 0 | 0.3% |
| 1 | 1.2% |
| 2 | 5.3% |
| 3 | 10.3% |
| 4 | 16.5% |
| 5 | 24.5% |
A score of 2 or more is generally considered high risk. These patients need close monitoring, often in an intensive or step-down unit, and an endoscopy within 24 hours, or sooner if they are unstable.
Worked example
A 72-year-old with an albumin of 3.2 g/dL, an INR of 1.2, normal consciousness and a systolic pressure of 110 mmHg scores one point, for age. The expected in-hospital mortality is about 1%. If the same patient became confused and their pressure fell to 88 mmHg, the score would rise to 3 and the risk to about 10%.
AIMS65 or Glasgow-Blatchford?
The two scores answer different questions. The Glasgow-Blatchford score predicts whether a patient will need a transfusion, endoscopic therapy or surgery, and a score of 0 or 1 identifies people who can safely be managed at home. AIMS65 is easier to remember and better at predicting death, which makes it useful for deciding the level of care. Guidelines such as those of the American College of Gastroenterology favor the Glasgow-Blatchford score for early discharge decisions.
Why albumin and INR matter
Low albumin reflects poor nutrition, chronic illness or liver disease, and a raised INR often signals cirrhosis or anticoagulant treatment. Both point to a patient less able to withstand blood loss, which is why they predict mortality even more than the severity of the bleed itself.