Bishay et al identified clinical factors associated with mortality for a patient with cirrhosis who presents with upper gastrointestinal bleeding. This can help to identify a patient who may benefit from more aggressive management. The authors are from the Ottawa Hospital and University of Ottawa.
Patient selection: cirrhosis with onset of upper gastrointestinal bleeding
Parameters from multivariate analysis:
(1) admission MELD score (OR 1.31 per point)
(2) bright red blood per rectum (OR 12.5)
Additional factors associated with mortality:
(1) 5 or more units of pRBCs required
(2) repeat esophagoduodenoscopy for re-bleed within 72 hours
(3) elevated WBC count
(4) INR >= 1.7
(5) serum total bilirubin >= 56.5 µmol/L
(6) severe hypoalbuminemia
(7) hypotension (systolic blood pressure <= 100 mm Hg)
(8) ICU admission
(9) acute kidney injury on admission
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