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 4, August 2012, pages 149-155

Clinical Risk Characteristics of Upper Gastrointestinal Hemorrhage Severity: A Multivariable Risk Analysis

**Table 1.** Classification of Hypovolemic Shock Manifestation and Fluid Resuscitation
	Class I	Class II	Class III	Class IV
BV: blood volume; *CNS: central nervous system. Abstracted and simplified from The American College of Surgeons, 2008 [33].
Blood loss (mL)	Up to 750	750 - 1,500	1,500 - 2,000	> 2,000
Blood loss (%BV*)	Up to 15%	15-30%	30-40%	> 40%
Pulse rate (/min)	< 100	100 - 120	120 - 140	> 140
Blood pressure (mmHg)	Normal	Normal	Decreased	Decreased
Pulse pressure (mmHg)	Normal or increased	Decreased	Decreased	Decreased
Respiratory rate (/min)	14 - 20	20 - 30	30 - 40	> 35
Urine output (mL/h)	> 30	20 - 30	5 - 15	Negligible
CNS**/mental status	Slightly anxious	Mildly anxious	Anxious and confused	Confused and lethargic
Fluid replacement	Crystalloid	Crystalloid	Crystalloid and blood	Crystalloid and blood

Table 1. Classification of Hypovolemic Shock Manifestation and Fluid Resuscitation

Class I

Class II

Class III

Class IV

*BV: blood volume; **CNS: central nervous system. Abstracted and simplified from The American College of Surgeons, 2008 [33].

Blood loss (mL)

Up to 750

750 - 1,500

1,500 - 2,000

> 2,000

Blood loss (%BV*)

Up to 15%

15-30%

30-40%

> 40%

Pulse rate (/min)

< 100

100 - 120

120 - 140

> 140

Blood pressure (mmHg)

Normal

Decreased

Pulse pressure (mmHg)

Normal or increased

Decreased

Respiratory rate (/min)

14 - 20

20 - 30

30 - 40

> 35

Urine output (mL/h)

> 30

20 - 30

5 - 15

Negligible

CNS**/mental status

Slightly anxious

Mildly anxious

Anxious and confused

Confused and lethargic

Fluid replacement

Crystalloid

Crystalloid and blood

**Table 2.** Demographic and Clinical Profiles of Patients With Upper Gastrointestinal Hemorrhage, by Severity Definition
Characteristics	Mild (n = 241)	Moderate (n = 631)	Severe (n = 112)	P-value*
*P-value from chi-squared for trend (categorical data), or two-way ANOVA by rank (numerical data).
Demographics
Male	164 (68.1)	408 (64.7)	79 (70.5)	0.968
Age (year) (mean ± SD)	54.4 ± 17.9	60.3 ± 14.7	58.1 ± 13.8	0.009
Mode of presentation
Hematemesis	111 (46.1)	286 (45.3)	58 (51.8)	0.467
Coffee ground vomiting	63 (26.1)	110 (17.4)	23 (20.5)	0.051
Hematochezia	19 (7.9)	38 (6.0)	8 (7.1)	0.586
Melena	108 (44.8)	401 (63.6)	65 (58.0)	< 0.001
Syncope	26 (10.8)	136 (21.6)	30 (26.8)	< 0.001
Hemodynamics
Pulse (/min) (mean ± SD)	89.8 ± 16.6	91.6 ± 15.6	93.4 ± 16.5	0.024
SBP (mmHg) (mean ± SD)	128.0 ± 20.9	120.8 ± 20.6	89.4 ± 16.5	< 0.001
Biochemicals
Hemoglobin (g/dL) (mean ± SD)	11.4 ± 2.4	7.0 ± 2.1	7.4 ± 2.8	< 0.001
BUN (mmol/L) (mean ± SD)	23.7 ± 16.2	36.6 ± 21.7	37.5 ± 22.6	< 0.001
Co-morbidities
Cirrhosis	14 (5.8)	101 (16.0)	26 (23.2)	< 0.001
Hepatic failure	0 (0)	6 (1.0)	2 (1.8)	0.064
Cardiac failure	0 (0)	6 (1.0)	3 (2.7)	0.017
Renal failure	4 (1.7)	53 (8.4)	12 (10.7)	< 0.001
Clinical outcomes
Rebleed	6 (2.5)	41 (6.5)	17 (15.2)	< 0.001
Dead	0 (0)	1 (0.2)	19 (17.0)	< 0.001

Table 2. Demographic and Clinical Profiles of Patients With Upper Gastrointestinal Hemorrhage, by Severity Definition

Characteristics

Mild (n = 241)

Moderate (n = 631)

Severe (n = 112)

P-value*

n (%)

*P-value from chi-squared for trend (categorical data), or two-way ANOVA by rank (numerical data).

Demographics

Male

164 (68.1)

408 (64.7)

79 (70.5)

0.968

Age (year) (mean ± SD)

54.4 ± 17.9

60.3 ± 14.7

58.1 ± 13.8

0.009

Mode of presentation

Hematemesis

111 (46.1)

286 (45.3)

58 (51.8)

0.467

Coffee ground vomiting

63 (26.1)

110 (17.4)

23 (20.5)

0.051

Hematochezia

19 (7.9)

38 (6.0)

8 (7.1)

0.586

Melena

108 (44.8)

401 (63.6)

65 (58.0)

< 0.001

Syncope

26 (10.8)

136 (21.6)

30 (26.8)

< 0.001

Hemodynamics

Pulse (/min) (mean ± SD)

89.8 ± 16.6

91.6 ± 15.6

93.4 ± 16.5

0.024

SBP (mmHg) (mean ± SD)

128.0 ± 20.9

120.8 ± 20.6

89.4 ± 16.5

< 0.001

Biochemicals

Hemoglobin (g/dL) (mean ± SD)

11.4 ± 2.4

7.0 ± 2.1

7.4 ± 2.8

< 0.001

BUN (mmol/L) (mean ± SD)

23.7 ± 16.2

36.6 ± 21.7

37.5 ± 22.6

< 0.001

Co-morbidities

Cirrhosis

14 (5.8)

101 (16.0)

26 (23.2)

< 0.001

Hepatic failure

0 (0)

6 (1.0)

2 (1.8)

0.064

Cardiac failure

0 (0)

6 (1.0)

3 (2.7)

0.017

Renal failure

4 (1.7)

53 (8.4)

12 (10.7)

< 0.001

Clinical outcomes

Rebleed

6 (2.5)

41 (6.5)

17 (15.2)

< 0.001

Dead

0 (0)

1 (0.2)

19 (17.0)

< 0.001

**Table 3.** Risk of Increasing in Severity of Upper Gastrointestinal Hemorrhage (Odds Ratio and 95% Confidence Interval), by Demographic and Clinical Profiles
Characteristics	OR*	95%CI	P-value
*Odds ratio from multivariable ordinal continuation ratio logistic regression.
Demographics
Male	0.99	0.73 - 1.36	0.996
Age (year)
< 60	1.00	ref
≥ 60	1.27	0.94 - 1.73	0.120
Mode of presentation
Hematemesis	1.30	0.93 - 1.84	0.129
Coffee ground	0.87	0.57 - 1.31	0.500
Hematochezia	0.87	0.47 - 1.59	0.651
Melena	1.10	0.79 - 1.53	0.574
Syncope	1.29	0.89 - 1.87	0.179
Hemodynamics
Pulse (/min)
< 100	1.00	ref
≥ 100	1.72	1.21 - 2.45	0.003
SBP (mmHg)
< 100	11.01	7.41 - 16.36	< 0.001
≥ 100	1.00
Biochemicals
Hemoglobin (g/dL)
< 10	13.82	9.40-20.33	< 0.001
≥ 10	1.00	ref
BUN (mmol/L)
< 35	1.00	ref
≥ 35	1.73	1.25 - 2.40	0.001
Co-morbidities
Cirrhosis	2.03	1.32-3.11	0.001
Hepatic failure	5.50	1.14 - 26.64	0.034
Cardiac failure	4.07	0.83 - 19.90	0.083
Renal failure	1.26	0.68 - 2.35	0.466

Table 3. Risk of Increasing in Severity of Upper Gastrointestinal Hemorrhage (Odds Ratio and 95% Confidence Interval), by Demographic and Clinical Profiles

Characteristics

OR*

95%CI

P-value

*Odds ratio from multivariable ordinal continuation ratio logistic regression.

Demographics

Male

0.99

0.73 - 1.36

0.996

Age (year)

< 60

1.00

ref

≥ 60

1.27

0.94 - 1.73

0.120

Mode of presentation

Hematemesis

1.30

0.93 - 1.84

0.129

Coffee ground

0.87

0.57 - 1.31

0.500

Hematochezia

0.87

0.47 - 1.59

0.651

Melena

1.10

0.79 - 1.53

0.574

Syncope

1.29

0.89 - 1.87

0.179

Hemodynamics

Pulse (/min)

< 100

1.00

ref

≥ 100

1.72

1.21 - 2.45

0.003

SBP (mmHg)

< 100

11.01

7.41 - 16.36

< 0.001

≥ 100

1.00

Biochemicals

Hemoglobin (g/dL)

< 10

13.82

9.40-20.33

< 0.001

≥ 10

1.00

ref

BUN (mmol/L)

< 35

1.00

ref

≥ 35

1.73

1.25 - 2.40

0.001

Co-morbidities

Cirrhosis

2.03

1.32-3.11

0.001

Hepatic failure

5.50

1.14 - 26.64

0.034

Cardiac failure

4.07

0.83 - 19.90

0.083

Renal failure

1.26

0.68 - 2.35

0.466