The Zinner index was modified by Lugo et al for use with children in the pediatric intensive care unit to predict the risk for acute upper gastrointestinal hemorrhage. A child at high risk for bleeding may benefit from prophylactic measures to reduce the risk.


Patient population: children in the intensive care unit (ICU)


Number of systems in index: 10




respiratory insufficiency (requiring nasal CPAP or mechanical ventilation); OR > 24 hours of mechanical ventilation during the postoperative period


at least 2 of the following: hypotension with systolic blood pressure < -2 SD below mean for age, oliguria, poor peripheral perfusion;

OR inotropic drugs required to maintain blood pressure or cardiac output


at least 2 of the following: clinical symptoms; leukocytosis or leukopenia; positive blood cultures

heart failure

acute heart failure OR significant arrhythmia requiring drugs or pacemaker to control

acute renal failure

creatinine > 2 times upper limit of normal reference range for age, OR BUN > 2 times upper limit of normal reference range for age

neurologic alterations

obtunded mental status OR coma OR seizures

steroid use

methylprednisone > 2 mg/kg per day, or equivalent

coagulation disorders

platelet count < 50,000 per µL, OR a prothrombin activity of < 50% OR DIC

liver alterations

bilirubin > 5 mg/dL, OR AST > 2 times upper limit of normal reference range OR ALT > 2 times upper limit of normal reference range

metabolic acidosis

arterial pH < 7.3 with plasma bicarbonate < 17 mmol/L



• Prothrombin activity may not be readily available. I've substituted a prothrombin time (PT) > 2 times the upper limit of the normal reference range.


number of risk factors =

= SUM(criteria present)



• minimum score: 0

• maximum score: 10

• The higher the score the greater the risk for upper gastrointestinal hemorrhage.


Number of Risk Factors

Frequency Upper GI Hemorrhage

0 – 2


3 – 6


7 - 10


after Table 5, page 1088, Lopez-Herce (1992)


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