Gastroenterol Res

Gastroenterology Research, ISSN 1918-2805 print, 1918-2813 online, Open Access

Article copyright, the authors; Journal compilation copyright, Gastroenterol Res and Elmer Press Inc

Journal website http://www.gastrores.org

Original Article

Volume 5, Number 6, December 2012, pages 219-226

Upper Gastrointestinal Hemorrhage: Development of the Severity Score

Figure 1. Distribution of UGIH severity scores by criterion-classified severity levels. Vertical lines in box represent medians. Box boundaries represent 25th and 75th percentiles.

Figure 2. Discrimination of urgency based on UGIH severity scores. Dash line: mild (non-urgent) vs. moderate (urgent). Solid line: moderate (urgent) vs. severe (emergent). Vertical dotted lines represent boundaries (cut-off points) of the scores.

**Table 1.** Characteristics of Patients With Upper Gastrointestinal Hemorrhage, Criterion-Classified into Three Severity Levels
Patient characteristics	Mild	Moderate	Severe	P-value^*
*P-value from chi-squared for linear trends, or two-way ANOVA by rank. SD: standard deviation; SBP: systolic blood pressure; BUN: blood urea nitrogen.
Demographics
Male (n, %)	175 (68.6)	427 (64.3)	87 (70.2)	0.871
Age (year)	54.6 ± 18.0	60.4 ± 14.8	58.4 ± 14.2	0.010
Mode of presentation (n, %)
Hematemesis	117 (45.9)	299 (45.0)	66 (53.2)	0.315
Coffee ground vomiting	67 (26.3)	114 (17.2)	26 (21.0)	0.048
Hematochezia	20 (7.8)	40 (6.0)	8 (6.5)	0.462
Melena	113 (44.3)	421 (63.4)	69 (55.7)	0.001
Syncope	28 (11.0)	144 (21.7)	34 (27.4)	< 0.001
Hemodynamics
Pulse (/min)	89.8 ± 16.3	91.4 ± 15.7	93.1 ± 17.7	0.022
SBP (mmHg)	128.6 ± 21.6	120.6 ± 20.5	88.5 ± 17.0	< 0.001
Biochemicals
Hemoglobin (g/dL)	11.4 ± 2.4	7.0 ± 2.1	7.4 ± 2.9	< 0.001
BUN (mg/dL)	23.9 ± 16.5	36.5 ± 21.7	37.6 ± 22.5	< 0.001
Co-morbidities (n, %)
Cirrhosis	14 (5.5)	106 (16.0)	28 (22.6)	< 0.001
Hepatic failure	0 (0)	6 (0.9)	2 (1.6)	0.071
Cardiac failure	1 (0.4)	6 (0.9)	4 (3.2)	0.024
Renal failure	4 (1.6)	53 (8.0)	12 (9.7)	< 0.001
Clinical outcomes (n, %)
Re-bleeding	6 (2.4)	42 (6.3)	18 (14.5)	< 0.001
Dead	0 (0)	1 (0.2)	24 (19.4)	< 0.001

Table 1. Characteristics of Patients With Upper Gastrointestinal Hemorrhage, Criterion-Classified into Three Severity Levels

Patient characteristics

Mild

Moderate

Severe

P-value^*

n = 255
mean ± SD

n = 664
mean ± SD

n = 124
mean ± SD

*P-value from chi-squared for linear trends, or two-way ANOVA by rank. SD: standard deviation; SBP: systolic blood pressure; BUN: blood urea nitrogen.

Demographics

Male (n, %)

175 (68.6)

427 (64.3)

87 (70.2)

0.871

Age (year)

54.6 ± 18.0

60.4 ± 14.8

58.4 ± 14.2

0.010

Mode of presentation (n, %)

Hematemesis

117 (45.9)

299 (45.0)

66 (53.2)

0.315

Coffee ground vomiting

67 (26.3)

114 (17.2)

26 (21.0)

0.048

Hematochezia

20 (7.8)

40 (6.0)

8 (6.5)

0.462

Melena

113 (44.3)

421 (63.4)

69 (55.7)

0.001

Syncope

28 (11.0)

144 (21.7)

34 (27.4)

< 0.001

Hemodynamics

Pulse (/min)

89.8 ± 16.3

91.4 ± 15.7

93.1 ± 17.7

0.022

SBP (mmHg)

128.6 ± 21.6

120.6 ± 20.5

88.5 ± 17.0

< 0.001

Biochemicals

Hemoglobin (g/dL)

11.4 ± 2.4

7.0 ± 2.1

7.4 ± 2.9

< 0.001

BUN (mg/dL)

23.9 ± 16.5

36.5 ± 21.7

37.6 ± 22.5

< 0.001

Co-morbidities (n, %)

Cirrhosis

14 (5.5)

106 (16.0)

28 (22.6)

< 0.001

Hepatic failure

0 (0)

6 (0.9)

2 (1.6)

0.071

Cardiac failure

1 (0.4)

6 (0.9)

4 (3.2)

0.024

Renal failure

4 (1.6)

53 (8.0)

12 (9.7)

< 0.001

Clinical outcomes (n, %)

Re-bleeding

6 (2.4)

42 (6.3)

18 (14.5)

< 0.001

Dead

0 (0)

1 (0.2)

24 (19.4)

< 0.001

**Table 2.** Significant Predictors of Upper Gastrointestinal Hemorrhage Severity and Assigned Item Score
Predictors	Category	OR	95% CI	P-value	Coefficient^*	Score
*Coefficients from multivariable continuation ratio logistic regression. OR: odds ratio; CI: confidence interval; ref: reference category; BUN: blood urea nitrogen.
Age (year)	≥ 60	1.57	1.13 - 2.18	0.007	0.45	1
	< 60	1.00	ref			0
Pulse (/min)	≥ 100	1.56	1.11 - 2.19	0.011	0.44	1
	< 100	1.00	ref			0
Systolic pressure (mmHg)	< 100	97.49	54.86 - 173.25	< 0.001	4.58	10.5
	≥ 100	1.00	ref			0
Hemoglobin (g/dL)	< 10	15.00	10.48 - 21.46	< 0.001	2.71	6
	≥ 10	1.00	ref			0
BUN (mg/dL)	≥ 35	2.22	1.57 - 3.14	< 0.001	0.80	2
	< 35	1.00	Ref			0
Cirrhosis	yes	2.55	1.58 - 4.14	< 0.001	0.94	2
	no	1.00	Ref			0
Hepatic failure	yes	8.12	1.66 - 39.67	0.010	2.09	4.5
	no	1.00	ref			0

Table 2. Significant Predictors of Upper Gastrointestinal Hemorrhage Severity and Assigned Item Score

Predictors

Score-classified urgency levels		Score range	Criterion-classified severity levels			Risk estimation validity^*
			Mild	Moderate	Severe	Over	Correct	Under
			n = 247	n = 650	n = 116	(%)	(%)	(%)
*Percentage of total patients. SD: standard deviation; IQR: Inter-quartile range.
Mean ± SD			3.0 ± 3.5	8.3 ± 3.3	16.1 ± 4.2
IQR**			0 - 6	7-9	13.5-19.5
Non-urgent	n = 215	< 4	174	39	2	-	17.2	4.0
Urgent	n = 677	4 - 16	71	571	35	7.0	56.4	3.5
Emergent	n = 121	> 16	2	40	79	4.1	7.8	-
					Total	11.1	81.4	7.5