Tammaro et al reported a risk score for a patient with non-variceal upper GI bleeding. This can help to identify a patient who may require more aggressive management. The authors are from multiple institutions in Italy.
Patient selection: non-variceal upper GI bleeding
Parameters:
(1) general condition
(2) pulse in beats per minute
(3) systolic blood pressure in mm Hg
(4) hemoglobin in g/dL
Parameter
Finding
Points
general condition
poor (impending shock or >= 3 comorbidities)
1
intermediate (2 comorbidities and no postural hypotension)
2
good (0 or 1 comorbidities, no debilitation, without postural hypotension)
3
pulse
< 90 beats/minute
3
90-110 beats per minute
2
> 110 beats per minute
1
systolic blood pressure
< 90 mm Hg
1
90-110 mm Hg
2
> 110 mm Hg
3
hemoglobin
< 9 g/dL
1
9 to 10 g/dL
2
> 10 g/dL
3
total score = T score =
= SUM(points for all of the parameters)
Interpretation:
• minimum score: 3
• maximum score: 12
Score
Risk Group
30-day Mortality
3 to 6
high
1.6%
7 to 9
intermediate
9.3%
10 to 12
low
20.4%
Performance:
• The area under the ROC curve for 30-day mortality was 0.78.
• The area under the ROC curve for high risk stigmata was 0.72.
• The area under the ROC curve for re-bleeding was 0.64.
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