Zinner et al defined an Illness Severity Index Score for patients in the Intensive Care Unit (ICU). This can help identify a patient at risk for upper gastrointestinal hemorrhage and who may benefit from interventions to reduce that risk. The authors are from the Johns Hopkins and Baltimore City Hospitals.
Patient population: adults in the intensive care unit
Number of systems in index: 9
System
Criteria
pulmonary
mechanical ventilatory assistance for > 24 hours postoperatively, OR documented respiratory insufficiency OR pneumonia
shock
hypotension with systolic blood pressure < 90 mm Hg from any cause, OR required use of cardiovascular pressors
sepsis
documented systemic infection AND positive blood cultures
cardiac
congestive heart failure OR myocardial infarction OR significant arrhythmia requiring drugs for control
renal
acute renal failure (creatinine > 3 mg/dL, OR BUN > 50 mg/dL)
central nervous system
obtunded mental status from a defined neurological cause OR coma
steroid use
hydrocortisone acetate or equivalent > 250 mg per day
coagulopathy
platelet count < 50,000 per µL, OR "a prothrombin time of < 30% of that of the control group"
hepatic
bilirubin > 5 mg/dL, OR documented hepatitis
where:
• For sepsis, I read the criteria as requiring both evidence of systemic infection and positive blood culture.
• The "prothrombin time" sounds like prothrombin activity. Since this may not be available, I have somewhat arbitrarily substituted a PT > 2 times the upper limit of normal.
illness severity index score =
= SUM(systems with criteria present)
Interpretation:
• minimum score: 0
• maximum score: 9
• A high score is associated with a higher rate of acute upper gastrointestinal bleeding if no prophylactic steps are taken.
Index Score
Percent with Bleeding if Untreated
0 – 2
11%
3 – 6
34%
7 - 9
50%
from Figure 2, page 216
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