Risk assessment after acute upper gastrointestinal haemorrhage.

Abstract

The aim of this study was to establish the relative importance of risk factors for mortality after acute upper gastrointestinal haemorrhage, and to formulate a simple numerical scoring system that categorises patients by risk. A prospective, unselected, multicentre, population based study was undertaken using standardised questionnaires in two phases one year apart. Further haemorrhage has been consistently described as the most important risk factor for mortality. It is generally accepted that the risk of rebleeding and death is related to many factors, which are not entirely independent of each other.While previous studies have served to indicate which variables are important in determining the risk of rebleeding and death, few attempts have been made to devise a simple and therefore clinically useful risk scoring system that makes use of readily available clinical information to categorise patients by risk. We have used a large uniform database to analyse the risk factors for mortality and we have used the analysis to construct a simple numerical risk scoring system. The primary purpose of this score is to allow case mix assessment for comparative audit. An understanding of the risk associated with any particular patient is an important initial step in the management process. MethodsThe data presented were collected as part of a national audit of the management and outcome of acute upper gastrointestinal haemorrhage. Four health regions in England (North

Development and Validation of a Scoring System to Identify Patients With Microscopic Colitis

“…This is similar to the methodology used to create other predictive scores in gastroenterology, including scores to predict peptic ulcer perforation, mortality after GI hemorrhage, and need for endoscopic intervention in patients with GI hemorrhage. (18)(19)(20) The primary aim of the study was to describe the performance of this diagnostic scoring system in predicting the presence of MC. The optimal cut off to diagnose MC was assessed for this scoring system using a receiver operating characteristics (ROC) curve as the point at which there was the best tradeoff between sensitivity and false positive rate, (21) and the total area under the curve was calculated.…”

Nonvariceal Upper Gastrointestinal Bleeding

“…[3][4][5] High risk lesions such as actively bleeding ulcers, non-bleeding visible vessels (NBVV) and adherent clots (Table III) require effective aggressive intervention to reduce re-bleeding which is associated with a 5-16 fold increase in mortality. 6,7 The re-bleeding rate of ulcers with a clean base or red or blue spots are low and endoscopic intervention is usually not recommended. [8][9][10] In fact, early endoscopy-based triage may permit safe and early discharge of "low risk" patients with no increased rate of re-bleeding or mortality.…”

Risk Factors for Rebleeding in Peptic Ulcer Bleeding: A Second Look at Second-Look Endoscopy

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Rebleeding, which occurs in 10-15 % of patients with peptic ulcer bleeding (PUB) [1], is associated with a twoto fivefold mortality increase, depending on the presence of other risk factors [2]. Therefore, identification of the predictors of rebleeding seems meaningful in order to identify high-risk patients needing close observation and rapid treatment in case of the development of rebleeding.

According to previous studies, hemodynamic shock, usually defined as a systolic blood pressure \100 mmHg, often combined with tachycardia [100 beats/min, is the most powerful pre-endoscopic predictor of rebleeding [3,4].

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“…Rebleeding, which occurs in 10-15 % of patients with peptic ulcer bleeding (PUB) [1], is associated with a twoto fivefold mortality increase, depending on the presence of other risk factors [2]. Therefore, identification of the predictors of rebleeding seems meaningful in order to identify high-risk patients needing close observation and rapid treatment in case of the development of rebleeding.…”