Lee et al identified risk factors for adult respiratory distress syndrome (ARDS) in a patient with bleeding esophageal varices. ARDS may necessitate an ICU admission and increases the risk of mortality. The authors are from Royal Prince Alfred Hospital in Sydney, Australia.
Patient selection: patient with bleeding esophageal varices (presumably with cirrhosis)
Risk factors for ARDS:
(1) sepsis
(2) need for 2 or more sclerotherapy sessions to control bleeding
(3) hypoalbuminemia (<= 2.5 g/dL used in implementation, see Table 3)
(4) use of balloon tamponade
Parameter |
Finding |
Points |
sepsis |
absent |
0 |
|
present |
1 |
number of endoscopic treatments needed to control bleeding |
0 or 1 |
0 |
|
2 or more |
1 |
serum albumin |
> 2.5 g/dL |
0 |
|
<= 2.5 g/dL |
1 |
balloon tamponade |
no |
0 |
|
yes |
1 |
where:
• The need for multiple endoscopies to control bleeding and/or use of balloon tamponade suggests more severe bleeding. A patient may have repeat endoscopies to check for rebleeding but only active treatments should be counted.
• The coefficients for the logistic regression equation are given in Table 4 but not the constant.
total number of risk factors =
= SUM(points for all 4 parameters)
Interpretation:
• minimum number of risk factors: 0
• maximum number of risk factors: 4
• The risk of ARDS increases with the number of risk factors present.
Specialty: Critical Care, Emergency Medicine