Hoffmann et al developed the Cologne-WATCH (C-WATCH) for evaluating patients with upper gastrointestinal bleeding. This can help to identify a patient who is at high risk for complications who requires urgent clinical management. The authors are from University Hospital of Cologne.
Patient selection: acute upper gastrointestinal bleeding with hematemesis, melena, hematochezia and/or drop in hemoglobin
The names of the tests performed match the name C-WATCH (CRP, WBC, ALT, thrombocytes, creatinine, hemoglobin).
Parameters:
(1) C-reactive protein (CRP) in mg/L (see note after table)
(2) white blood cell count per µL
(3) serum ALT in U/L
(4) platelet count per µL
(5) serum creatinine in mg/dL
(6) hemoglobin in g/dL
|
Parameter |
Finding |
Points |
|
CRP |
<= 5 mg/L (see note) |
0 |
|
|
> 5 mg/L (see note) |
1 |
|
WBC count |
<= 11,300 per µL |
0 |
|
|
> 11,300 per µL |
1 |
|
serum ALT |
<= 35 and female |
0 |
|
|
> 35 and female |
1 |
|
|
<= 50 and male |
0 |
|
|
> 50 and male |
1 |
|
serum creatinine |
<= 0.9 mg/dL and female |
0 |
|
|
> 0.9 mg/dL and female |
1 |
|
|
<= 1.1 mg/dL and male |
0 |
|
|
> 1.1 mg/dL and male |
1 |
|
platelet count (thrombocytes) |
>= 150,000 per µL |
0 |
|
|
50,000 to 149,000 |
1 |
|
|
< 50,000 per µL |
2 |
|
hemoglobin |
male and >= 14 g/dL |
0 |
|
|
female and >= 12 g/dL |
0 |
|
|
male and 10 to 13.9 |
1 |
|
|
female and 10 to 11.9 |
1 |
|
|
< 10 g/dL |
2 |
where:
• There is a discrepancy in the CRP reference range. In Table 1 it is given as < 5 mg/L but elsewhere as 5 mg/dL. The < 5 mg/L appears to match other sources. The data in Table 1 with 66 mg/dL would be 660 mg/L which is a high value. Also the logistic regression model references the upper limit of normal as the cutoff.
total score =
= SUM(points for all 6 parameters)
Interpretation:
• minimum score: 0
• maximum score: 8
• The higher the score the greater the risk of complications.
|
Total Score |
Percent with Complications |
|
0 |
3% |
|
1 |
5% |
|
2 |
10% |
|
3 |
18% |
|
4 |
30% |
|
5 |
45% |
|
6 |
62% |
|
7 |
76% |
|
8 |
86% |
Performance:
• The area under the ROC curve was 0.72 in the development set and 0.70 in the validation set.
The score above is derived from the logistic regression model:
|
Parameter |
Finding |
Points |
|
CRP |
<= ULN |
0 |
|
|
> ULN |
0.739 |
|
WBC count |
<= ULN |
0 |
|
|
> ULN |
0.9 |
|
serum ALT |
<= ULN for gender |
0 |
|
|
> ULN for gender |
0.615 |
|
serum creatinine |
<= ULN |
0 |
|
|
> ULN |
0.766 |
|
platelet count (thrombocytes) |
>= 150,000 per µL |
0 |
|
|
50,000 to 149,000 |
0.609 |
|
|
< 50,000 per µL |
1.038 |
|
hemoglobin |
male and >= 14 g/dL |
0 |
|
|
female and >= 12 g/dL |
0 |
|
|
male and 10 to 13.9 |
0.93 |
|
|
female and 10 to 11.9 |
0.93 |
|
|
< 10 g/dL |
1.09 |
X =
= SUM(points for all 6 parameters) - 3.564
probability of a complication =
= 1 / (1 + EXP((-1) * X))
Specialty: Gastroenterology
