5-variable score predicting in-hospital mortality in acute upper GI bleeding. Superior to Rockall for mortality prediction (AUC 0.77). All variables available at admission.
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Guidelines & Evidence
Clinical Details
Section 1
When to Use
When to Use
Predicting in-hospital mortality in patients admitted with acute upper GI bleeding (UGIB).
Risk stratification for ICU admission vs. ward-based management.
Complementary to GBS (pre-endoscopic triage) and Rockall (rebleeding) — AIMS65 focuses on in-hospital mortality.
Applicable at the time of initial clinical assessment — all variables available on admission.
Key Comparison
AIMS65 outperforms Rockall score for in-hospital mortality prediction (AUC 0.77 vs 0.72) but is inferior to Glasgow-Blatchford for predicting need for intervention.
Section 2
Formula & Logic
Scoring Criteria (1 point each)
Albumin < 3.0 g/dL (+1)
INR > 1.5 (+1)
Mental status alteration (GCS < 14 or disorientation, stupor, or coma) (+1)
Systolic BP ≤ 90 mmHg (+1)
65 — Age ≥ 65 years (+1)
In-Hospital Mortality by Score
AIMS65 Score
In-Hospital Mortality
0
0.3%
1
1.2%
2
5.3%
3
10.2%
4
16.5%
5
24.5%
Section 3
Pearls/Pitfalls
Clinical Pearls
Score 0–1: Low mortality risk — generally suitable for ward-level care pending endoscopy.
Score ≥ 2: Increased mortality risk — consider HDU or ICU involvement and early specialist input.
Albumin is the single strongest predictor — reflects both nutritional status and hepatic synthetic function.
Unlike Rockall, AIMS65 requires no endoscopy, making it truly point-of-care.
Section 4
Next Steps
Clinical Actions
01
Score 0–1: Secure IV access, PPI, correct coagulopathy, urgent endoscopy within 24 hours.
All patients: Target Hb > 70 g/L (80 g/L in cardiovascular disease) before elective endoscopy.
04
Document H. pylori testing status and plan treatment if positive.
Section 5
Evidence Appraisal
Validation Metrics
Metric
Value
AUC (in-hospital mortality)
0.77
AUC vs Rockall (mortality)
Superior (0.77 vs 0.72)
Ease of use
All variables available on admission
Primary Reference
A simple risk score accurately predicts in-hospital mortality, length of stay, and cost in acute upper GI bleeding
Saltzman JR et al. • Gastrointestinal Endoscopy. 2011;74(6): 1215–1224
Section 6
Literature
Development
Developed by John Saltzman and colleagues at Brigham and Women's Hospital, Boston, published in Gastrointestinal Endoscopy (2011). The score was derived from a retrospective analysis of 29,222 hospitalised patients in the Perspective Database across 187 US hospitals. The acronym AIMS65 reflects its five variables: Albumin, INR, Mental status, Systolic BP, and age ≥ 65.
Clinical Position
AIMS65 was designed as a complementary tool to GBS and Rockall, focusing specifically on in-hospital mortality prediction rather than need for intervention or rebleeding. Its all-admission variables make it particularly useful in busy clinical settings where endoscopy-based scores are unavailable. Multiple validation studies have confirmed its superiority over Rockall for mortality prediction and comparability with GBS for overall risk stratification.
