Tryba et al identified risk factors associated with acute upper gastrointestinal bleeding in critically ill patients. The risk score for a patient can help determine if prophylaxis is indicated and can help gauge its effectiveness. The authors are from the Medizinische Hochschule in Hannover, Germany.
Parameters:
(1) primary, very significant: 10 factors scored from 7 to 20 points
(2) secondary, moderate significance: 8 factors scored from 2 to 5 points
(3) tertiary, dependent on the presence of primary and secondary risk factors: 6 factors scored 2 points
|
Level |
Parameter |
Points |
|
severe |
history of peptic ulcer disease |
20 |
|
|
acute renal insufficiency (serum creatinine > 600 µmol/L) |
15 |
|
|
acute renal insufficiency (serum creatinine 300 - 600 µmol/L) |
7 |
|
|
severe bacterial infection |
10 |
|
|
severe multiple trauma |
10 |
|
|
cardiogenic shock |
10 |
|
|
pancreatic disease |
10 |
|
|
kidney disease |
10 |
|
|
gastrointestinal disease |
10 |
|
|
respiratory insufficiency |
7 |
|
moderate |
transplantation (kidney) |
5 |
|
|
coagulopathy in shock |
5 |
|
|
neurogenic shock |
5 |
|
|
intracranial pressure increase in a hospitalized patient |
5 |
|
|
heparin therapy |
3 |
|
|
hemoglobin < 10 g/dL for > 1 hour |
3 |
|
|
RR < 100 for > 1 hour |
3 |
|
|
corticosteroid therapy |
2 |
|
dependent |
relaparotomy (re-operation) |
2 |
|
|
ileus |
2 |
|
|
septic shock |
2 |
|
|
hypovolemic shock |
2 |
|
|
anaphylactic shock |
2 |
|
|
cerebral trauma |
2 |
where:
• I am not sure what "RR" refers to. In the modification for children (next section) the corresponding parameter is a low systolic blood pressure.
risk score =
= SUM(points for all 24 indicators)
Interpretation:
• minimum score: 0
• maximum score: 152
• A high score is associated with a high risk of bleeding.
|
Risk Score |
Risk Upper GI Bleeding (without prophylaxis) |
|
0 – 9 |
0% |
|
10 – 19 |
12.4% |
|
20 – 29 |
19.2% |
|
30 - 39 |
22.2% |
|
> 39 |
35.8% |
Specialty: Gastroenterology
