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Clinical scoring systems for determining the prognosis of gastrointestinal bleeding
H Hussain1, S Lapin, M S Cappell
1Division of Gastroenterology, Maimonides Medical Center, Brooklyn, New York, USA.
Insights
Predicting gastrointestinal (GI) bleeding prognosis involves assessing numerous risk factors. While a single comprehensive scale remains elusive, ongoing advancements offer hope for improved patient outcome prediction.
Area of Science:
- Gastroenterology
- Internal Medicine
- Critical Care Medicine
Background:
- Prognosis of gastrointestinal (GI) bleeding is multifactorial, necessitating careful patient evaluation for risk stratification.
- Prompt triage and thorough history/physical examination are crucial for identifying severe GI bleeding and mortality risks.
Purpose of the Study:
- To review factors influencing GI bleeding prognosis and the development of prognostic scales.
- To highlight the need for a universally applicable multivariable scale for assessing GI bleeding severity and predicting outcomes.
Main Methods:
- Review of clinical factors associated with increased morbidity and mortality in GI bleeding.
- Analysis of patient characteristics, comorbidities, and laboratory/endoscopic findings.
- Discussion of existing multivariable prognostic scales and their limitations.
Main Results:
- Key risk factors for severe GI bleeding and mortality include advanced age, comorbidities (pulmonary, liver, renal disease, cancer), physiologic stress, low hematocrit, melena/hematochezia, and prolonged prothrombin time.
- Hospitalized patients needing significant blood transfusions or experiencing hypotension/shock often require surgery.
- High APACHE II scores, esophageal varices, active bleeding, and endoscopic stigmata predict rebleeding and surgery.
Conclusions:
- Despite progress, a single, comprehensive multivariable prognostic scale for GI bleeding is not yet achieved.
- Continued research aims to develop a universally applicable scale for accurate severity assessment and prognosis.
- Effective management of GI bleeding relies on prompt risk factor evaluation and triage.
Abstract:
The prognosis of GI bleeding depends upon many factors. Patients should be evaluated carefully for risk factors. To avoid complications from GI bleeding, triage should be performed promptly after patient presentation. The history and physical examination should emphasize analysis of risk factors for severe GI bleeding and mortality. Factors that increase the morbidity and mortality include: age greater than 60 years; underlying comorbidity such as pulmonary diseases, liver diseases, renal diseases, encephalopathy, or cancer; physiologic stress from major surgery, trauma, or sepsis; coexisting disease in three organ systems; low hematocrit; melena or hematochezia; and prolonged prothrombin time. Hospitalized patients who require more than five units of packed erythrocytes transfusion or who develop hypotension or hypovolemic shock are more likely to need surgery. Patients with a high APACHE II score, the presence of esophageal varices, active bleeding, or other endoscopic stigmata of recent hemorrhage are more likely to rebleed and undergo surgery. The proliferation of multivariable prognostic scales, as described herein, provides ample evidence that the goal of developing a single comprehensive multivariable scale to accurately assess severity of disease and to determine prognosis of GI bleeding is still not achieved. Yet significant progress has occurred in this field, leading to the hope of developing a universally applicable multivariable scale.