Zimmerman identified risk factors associated with mortality in patients presenting with acute upper gastrointestinal (GI) hemorrhage. These factors can help identify patients who may require more aggressive therapy. The authors are from Hadassah University Hospital in Jerusalem.
Parameters:
(1) age
(2) blood in the gastric aspirate (as coffeeground material or fresh blood) on admission
(3) serum creatinine
(4) serum aminotransferases
(5) persistent or recurrent bleeding
(6) history of cancer
(7) systolic blood pressure
Factors at presentation associated with increased risk of mortality:
(1) age >= 75 years
(2) a history of cancer
(3) blood in the gastric aspirate
(4) systolic blood pressure <= 90 mm Hg
|
Parameter |
Adjusted Odds Ratio |
95% CI |
p value |
|
age >= 75 years |
11.2 |
2.1 to 59.4 |
0.005 |
|
history of cancer |
12.1 |
2.4 to 60.7 |
0.003 |
|
blood in gastric aspirate |
9.6 |
1.3 to 69.9 |
0.025 |
|
systolic BP <= 90 mm Hg |
6.4 |
1.5 to 27.6 |
0.013 |
from Table 7, page 330
Factors associated with an increased overall risk of bleeding:
(1) age >= 75 years
(2) blood in the gastric aspirate
(3) serum creatinine >= 150µmol/L (>= 1.7 mg/dL)
(4) elevated serum aminotransferases (either AST or ALT, or both)
(5) persistent or recurrent bleeding after initial endoscopy
|
Parameter |
Adjusted Odds Ratio |
95% CI |
p value |
|
age >= 75 years |
12.7 |
1.9 to 84.4 |
0.009 |
|
blood in gastric aspirate |
18.9 |
1.8 to 203.7 |
0.016 |
|
serum creatinine |
14.8 |
2.6 to 83.5 |
0.002 |
|
serum aminotransferases |
20.2 |
2.9 to 140.4 |
0.002 |
|
persistent or recurrent bleeding |
57.3 |
7.2 to 153.9 |
0.0001 |
from Table 8, page 330
Specialty: Gastroenterology
