Imperiale et al identified risk factors associated with hospital mortality for a patient with acute upper gastrointestinal bleeding. These can help to identify a patient who may benefit from more aggressive management. The authors are from Roudebush Veterans Affairs Medical Center, Indiana University, Veterans Affairs Puget Sound Health Care System, the University of Washington, Durham Veterans Affairs Medical Center and Duke University.
Parameters:
(1) APACHE II score
(2) esophageal varices
(3) stigmata of recent hemorrhage seen at endoscopy (active bleeding, visible vessel, fresh blood and/or blood clot)
Parameter
Finding
Points
APACHE II score
< 11
0
>= 11
1
esophageal varices
absent
0
present
1
stigmata of recent hemorrhage
absent
0
present
1
total number of risk factors =
= SUM(points for all 3 parameters)
Interpretation:
• minimum number of risk factors: 0
• maximum number of risk factors: 3
• The risk of hospital death increases with the number of risk factors present.
Total Score
Risk of Mortality
0
low (1-2%)
1
intermediate (4-5%)
2 or 3
high (22-25%)
A second outcome was hospital death plus a new or worsening comorbidity. This outcome had 4 risk factors - the 3 listed above plus clinical instability on admission.
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