Sengupta and Tapper developed a rule for predicting 30-day mortality in a patient with lower gastrointestinal bleeding. This can help to identify a patient who may benefit from more aggressive management. The authors are from the University of Chicago and the University of Maryland.
Patient selection: lower GI bleeding admitted to the hospital
Outcome: 30-day mortality
Parameters:
(1) age in years
(2) dementia
(3) chronic kidney disease
(4) metastatic cancer
(5) systemic anticoagulant use
(6) chronic pulmonary disease
(7) admission hematocrit in percent
(8) admission serum albumin in g/dL
Parameter
Finding
Points
age in years
< 30 years
-2
30 to 39
-1
40 to 49
0
50 to 59
1
60 to 69
2
70 to 79
3
80 to 90
4
> 90
5
dementia
no
0
yes
5
chronic kidney disease
no
0
yes
2
metastatic cancer
no
0
yes
5
systemic anticoagulant use
no
0
yes
1
chronic pulmonary disease
no
0
yes
2
admission hematocrit
< 20 percent
3
20 to 29 percent
1
30 to 39 percent
0
>= 40 percent
-1
admission serum albumin
< 2.0 g/dL
13
2.0 to 2.9 g/dL
7
3.0 to 3.9 g/dL
0
>= 4.0 g/dL
-7
total score =
= SUM(points for all 8 parameters)
Interpretation:
• minimum score: -10
• maximum score: 36
• The higher the score the greater the risk of 30-day mortality.
Total Score
30-Day Mortality
-10 to 1
4%
2 to 4
5-7%
5 to 8
9-10%
>= 9
25%
where:
• The final group shows mortality rate ranging from 25% (at 9) to > 50% up to 100%.
Performance:
• The area under the ROC curve is 0.72.
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