Lecleire et al identified prognostic factors for a noncirrhotic patient with acute upper gastrointestinal (GI) bleeding. These can help to identify a patient who may benefit from more aggressive management. The authors are from Rouen University, Le Havre Hospital, Amiens University, Brest University and Bordeaux-Pessac University in France.
Patient selection: noncirrhotic patient with upper GI bleeding
Parameters:
(1) age in years
(2) carcinoma of the digestive tract
(3) inpatient vs outpatient
(4) hematemesis
(5) therapy with corticosteroids
(6) hypoprothrombinemia
(7) surgery
(8) hemoglobin level
(9) respiratory status
(10) non-digestive tract carcinoma
|
Parameter |
Finding |
OR |
|
age in years |
<= 60 years |
1 |
|
|
> 60 years |
2.1 |
|
carcinoma of digestive tract |
absent |
1 |
|
|
present |
4.3 |
|
hospital status |
outpatient |
1 |
|
|
inpatient |
4.0 |
|
hematemesis |
absent |
1 |
|
|
present |
2.0 |
|
therapy with corticosteroids |
no |
1 |
|
|
yes |
2.3 |
|
prothrombin level |
>= 40% |
1 |
|
|
< 40% |
4.1 |
|
surgery |
no |
1 |
|
|
yes |
2.8 |
|
hemoglobin |
>= 8 g/dL |
1 |
|
|
< 8 g/dL |
1.6 |
|
respiratory status |
no insufficiency |
1 |
|
|
insufficiency present |
1.8 |
|
non-digestive tract carcinoma |
absent |
1 |
|
|
present |
1.7 |
where:
• Prothrombin activity is used in Europe. Usually this is done by correlating a coagulation test with various dilutions of prothrombin. Alternatively the factor can be measured.
• Carcinoma of the digestive tract include hepatocellular and pancreatic carcinomas.
• The first 6 items are the same risk factors as for a cirrhotic patient with acute upper GI hemorrhage.
• A patient with respiratory insufficiency probably will be receiving some form of respiratory support.
cumulative odds ratio of mortality =
= PRODUCT(OR for all 10 parameters)
Interpretation:
• minimum cumulative odds ratio: 1
• maximum cumulative odds ratio: 9,339
• The higher the number the greater the risk for mortality.
Specialty: Gastroenterology
