Cosgrove and Riou identified comorbid diseases associated with mortality in patients with upper gastrointestinal hemorrhage. These can help identify patients who require more aggressive management and monitoring. The authors are from SUNY-HSC in New York and Yale University.


Comorbid conditions associated with increased mortality:

(1) Child class C cirrhosis or acute hepatic failure

(2) disseminated carcinoma

(3) severe coagulopathy

(4) severe cardiac or peripheral vascular disease

(5) acute renal failure

(6) acute respiratory failure

(7) multiple organ failures (more than 1 of the above)


The presence of one or more of these conditions indicated a poor prognosis. The rate of mortality in 128 patients was 86% if a comorbid condition was present and less than 4% if these were absent.


NOTE: The role of comorbid diseases is included in previous algorithms such as the Rockall or Bordley risk scores.


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