Chen et al identified risk factors associated with mortality in a patient with cirrhosis and acute upper gastrointestinal hemorrhage. These can help identify patients who may benefit from more aggressive management. The authors are from Chang Gung Memorial Hospital and University in Taipei, Taiwan.
Patient selection: cirrhosis (usually due to chronic viral hepatitis B) with acute upper gastrointestinal bleeding from varices
Parameters:
(1) Child-Pugh score (from 5 to 15)
(2) mean arterial blood pressure in mm Hg
(3) serum creatinine in mg/dL
(4) APACHE III score
(5) SOFA score
|
Parameter |
Finding |
Points |
|
Child-Pugh score |
<= 10 |
0 |
|
|
> 10 |
1 |
|
mean arterial pressure |
>= 80 mm Hg |
0 |
|
|
< 80 mm Hg |
1 |
|
serum creatinine |
<= 1.5 mg/dL |
0 |
|
|
> 1.5 mg/dL |
1 |
|
APACHE III |
<= 79 |
0 |
|
|
> 79 |
1 |
|
SOFA score |
<= 9 |
0 |
|
|
> 9 |
1 |
total number of risk factors =
= SUM(points for all 5 factors)
Interpretation:
• minimum number of risk factors: 0
• maximum number of risk factors: 5
• The presence of each factor was associated with a rate of mortality from 84-91%. Mortality if a risk factor was absent ranged from 22 to 45%, reflecting the seriousness of the underlying disease.
• The effect of hypotension and renal failure reflect impact of multi-organ failure in the critically ill.
• The SOFA score was recommended as the single best measure since it was easier and cheaper to measure than the APACHE III score.
• The probability model (see previous section) can also be used to assess prognosis.
|
Performance at Cutoff |
Sensitivity |
Specificity |
|
APACHE III |
90% |
75% |
|
SOFA score |
80% |
83% |
|
serum creatinine |
82% |
75% |
|
Child-Pugh |
81% |
67% |
|
mean arterial pressure |
71% |
73% |
Specialty: Gastroenterology
ICD-10: ,
