Score identifies patients who might benefit from acid-suppressive medication to prevent nosocomial GI bleeding
From the April ACP Hospitalist, copyright © 2013 by the American College of Physicians
"Researchers have created a scoring system, based on risk factors for nosocomial gastrointestinal (GI) bleeding, to identify non-critically ill hospitalized patients who may benefit from acid-suppressive medication.
Researchers conducted a cohort study using adult patients admitted to an academic medical center from 2004 through 2007 to determine the incidence of nosocomial GI bleeding occurring outside of the intensive care unit. Of the 75,723 patients in the cohort, 80% were randomly assigned to a derivation set (n=60,578) and 20% were randomly assigned to a validation set (n=15,145). Results appeared in the Jan. 13 Journal of General Internal Medicine.
Nosocomial GI bleeding occurred in 203 (0.2%) admissions. Independent risk factors for bleeding included age older than 60 years (odds ratio [OR], 2.2; 95% CI, 1.5 to 3.2), male sex (OR, 1.6; 95% CI, 1.2 to 2.2), liver disease (OR, 2.1; 95% CI, 1.3 to 3.3), acute renal failure (OR, 1.9; 95% CI, 1.3 to 2.7), sepsis (OR, 1.6; 95% CI, 1.03 to 2.4), being on a medicine service (OR, 2.7; 95% CI, 1.8 to 4.1), prophylactic anticoagulants (OR,1.7; 95% CI, 1.2 to 2.4), and combinations of coagulopathy (varied).
A risk score for each patient was derived by totaling the points assigned to each risk factor. Risk factors included:
Researchers conducted a cohort study using adult patients admitted to an academic medical center from 2004 through 2007 to determine the incidence of nosocomial GI bleeding occurring outside of the intensive care unit. Of the 75,723 patients in the cohort, 80% were randomly assigned to a derivation set (n=60,578) and 20% were randomly assigned to a validation set (n=15,145). Results appeared in the Jan. 13 Journal of General Internal Medicine.
Nosocomial GI bleeding occurred in 203 (0.2%) admissions. Independent risk factors for bleeding included age older than 60 years (odds ratio [OR], 2.2; 95% CI, 1.5 to 3.2), male sex (OR, 1.6; 95% CI, 1.2 to 2.2), liver disease (OR, 2.1; 95% CI, 1.3 to 3.3), acute renal failure (OR, 1.9; 95% CI, 1.3 to 2.7), sepsis (OR, 1.6; 95% CI, 1.03 to 2.4), being on a medicine service (OR, 2.7; 95% CI, 1.8 to 4.1), prophylactic anticoagulants (OR,1.7; 95% CI, 1.2 to 2.4), and combinations of coagulopathy (varied).
A risk score for each patient was derived by totaling the points assigned to each risk factor. Risk factors included:
Age more than 60 = 2 points; Male = 2 points; Acute renal failure = 2 points; Liver disease = 2 points; Sepsis = 2 points; Prophylactic anticoagulation = 2 points; Coagulopathy = 3 points and Medicine service = 3 points.
The risk scoring system identified a high-risk group of patients (score ≥12) in which the number-needed-to-treat score with acid-suppressive medication to prevent one bleeding event was 48. The researchers noted that the risk model derived from these factors may help clinicians direct acid-suppressive medication to those most likely to benefit.
“Rather than employing a one-size-fits-all approach, our study provides guidance for clinicians in targeting acid-suppressive therapy to those non-ICU-based patients who stand to benefit most, while avoiding the unnecessary cost and risk associated with this therapy in those with extremely low risk of bleeding,” the researchers wrote."
The risk scoring system identified a high-risk group of patients (score ≥12) in which the number-needed-to-treat score with acid-suppressive medication to prevent one bleeding event was 48. The researchers noted that the risk model derived from these factors may help clinicians direct acid-suppressive medication to those most likely to benefit.
“Rather than employing a one-size-fits-all approach, our study provides guidance for clinicians in targeting acid-suppressive therapy to those non-ICU-based patients who stand to benefit most, while avoiding the unnecessary cost and risk associated with this therapy in those with extremely low risk of bleeding,” the researchers wrote."