Prediction of Esophagogastroduodenoscopy Therapeutic Usefulness for In-ICU Suspected Upper Gastrointestinal Bleeding: the SUGIBI Score Study

Overview

Journal Ann Intensive Care

Specialty Critical Care

Date 2024 Feb 15

PMID 38361004

Authors

Victor Penaud

Thibault Vieille

Tomas Urbina

Vincent Bonny

Paul Gabarre

Louai Missri

Maxime Gasperment

Jean-Luc Baudel

Nicolas Carbonell

Alexandra Beurton

Sayma Chaibi

Aurelia Retbi

Muriel Fartoukh

Gael Piton

Bertrand Guidet

Eric Maury

Hafid Ait-Oufella

Jeremie Joffre

Affiliations

Soon will be listed here.

Abstract

Background: Suspected upper gastrointestinal bleeding (SUGIB) is a common issue during ICU stay. In the absence of specific guidelines on the indication and timing of esophagogastroduodenoscopy (EGD), there is substantial variability in EGD indication depending on accessibility and clinical presentation. This study aimed to investigate factors associated with the need for per-EGD hemostatic therapy and to create a score predicting therapeutic benefit of emergency bedside EGD in ICU patients with SUGIB.

Methods: We conducted a retrospective study in our ICU to identify factors associated with the need for hemostatic procedure during EGD performed for SUGIB. From this observational cohort, we derived a score predicting the need for hemostasis during EGD, the SUGIBI score. This score was subsequently validated in a retrospective multicenter cohort.

Results: Two hundred fifty-five patients not primarily admitted for GI bleeding who underwent a bedside EGD for SUGIB during their ICU stay were analyzed. The preeminent EGD indication were anemia (79%), melena (19%), shock (14%), and hematemesis (13%). EGD was normal in 24.7% of cases, while primary lesions reported were ulcers (23.1%), esophagitis (18.8%), and gastritis (12.5%). Only 12.9% of patients underwent hemostatic endotherapy during EGD. A SUGIBI score < 4 had a negative predictive value of 95% (91-99) for hemostatic endotherapy [AUC of 0.81; 0.75-0.91 (p < 0.0001)]. The SUGIBI score for predicting the need for an EGD-guided hemostatic procedure was next validated in a multicenter cohort with an AUC of 0.75 (0.66-0.85) (p < 0.0001), a score < 4 having a negative predictive value of 95% (92-97).

Conclusions: Our study shows that the therapeutic usefulness of bedside emergency EGD for SUGIB in critically ill patients is limited to a minority of patients. The SUGIBI score should help clinicians stratify the probability of a therapeutic EGD.

Citing Articles

Navigating gastrointestinal endoscopy challenges in the intensive care unit: A mini review.

Jagirdhar G, Elmati P, Pattnaik H, Shah M, Surani S World J Crit Care Med. 2024; 13(4):100121.

PMID: 39655307 PMC: 11577537. DOI: 10.5492/wjccm.v13.i4.100121.

References

Rehman A, Iscimen R, Yilmaz M, Khan H, Belsher J, Gomez J . Prophylactic endotracheal intubation in critically ill patients undergoing endoscopy for upper GI hemorrhage. Gastrointest Endosc. 2009; 69(7):e55-9. PMC: 2737482. DOI: 10.1016/j.gie.2009.03.002. View

Kumar S, Ramos C, Garcia-Carrasquillo R, Green P, Lebwohl B . Incidence and risk factors for gastrointestinal bleeding among patients admitted to medical intensive care units. Frontline Gastroenterol. 2017; 8(3):167-173. PMC: 5558277. DOI: 10.1136/flgastro-2016-100722. View

Maury E, Tankovic J, Ebel A, Offenstadt G . An observational study of upper gastrointestinal bleeding in intensive care units: is Helicobacter pylori the culprit?. Crit Care Med. 2005; 33(7):1513-8. DOI: 10.1097/01.ccm.0000168043.60624.3e. View

Russotto V, Myatra S, Laffey J, Tassistro E, Antolini L, Bauer P . Intubation Practices and Adverse Peri-intubation Events in Critically Ill Patients From 29 Countries. JAMA. 2021; 325(12):1164-1172. PMC: 7988368. DOI: 10.1001/jama.2021.1727. View

Lapinsky S . Endotracheal intubation in the ICU. Crit Care. 2015; 19:258. PMC: 4470089. DOI: 10.1186/s13054-015-0964-z. View

Chaudhuri D, Bishay K, Tandon P, Trivedi V, James P, Kelly E . Prophylactic endotracheal intubation in critically ill patients with upper gastrointestinal bleed: A systematic review and meta-analysis. JGH Open. 2020; 4(1):22-28. PMC: 7008165. DOI: 10.1002/jgh3.12195. View

Lee Y, Wang H, Wu M, Yang C, Chang Y, Lin J . Urgent bedside endoscopy for clinically significant upper gastrointestinal hemorrhage after admission to the intensive care unit. Intensive Care Med. 2003; 29(10):1723-8. DOI: 10.1007/s00134-003-1921-x. View

Blatchford O, Murray W, Blatchford M . A risk score to predict need for treatment for upper-gastrointestinal haemorrhage. Lancet. 2000; 356(9238):1318-21. DOI: 10.1016/S0140-6736(00)02816-6. View

Gralnek I, Stanley A, Morris A, Camus M, Lau J, Lanas A . Endoscopic diagnosis and management of nonvariceal upper gastrointestinal hemorrhage (NVUGIH): European Society of Gastrointestinal Endoscopy (ESGE) Guideline - Update 2021. Endoscopy. 2021; 53(3):300-332. DOI: 10.1055/a-1369-5274. View

10.

Cook D, Heyland D, Griffith L, Cook R, Marshall J, Pagliarello J . Risk factors for clinically important upper gastrointestinal bleeding in patients requiring mechanical ventilation. Canadian Critical Care Trials Group. Crit Care Med. 2000; 27(12):2812-7. DOI: 10.1097/00003246-199912000-00034. View

11.

Lewis J, Shin E, Metz D . Characterization of gastrointestinal bleeding in severely ill hospitalized patients. Crit Care Med. 2000; 28(1):46-50. DOI: 10.1097/00003246-200001000-00007. View

12.

Hayden S, Albert T, Watkins T, Swenson E . Anemia in critical illness: insights into etiology, consequences, and management. Am J Respir Crit Care Med. 2012; 185(10):1049-57. PMC: 5448578. DOI: 10.1164/rccm.201110-1915CI. View

13.

McGinley A, Pearse R . A national early warning score for acutely ill patients. BMJ. 2012; 345:e5310. DOI: 10.1136/bmj.e5310. View

14.

Smischney N, Seisa M, Kumar M, Deangelis J, Schroeder D, Diedrich D . Determinants of Endotracheal Intubation in Critically Ill Patients Undergoing Gastrointestinal Endoscopy Under Conscious Sedation. J Intensive Care Med. 2017; 34(6):480-485. DOI: 10.1177/0885066617736256. View

15.

Witting M, Magder L, Heins A, Mattu A, Granja C, Baumgarten M . ED predictors of upper gastrointestinal tract bleeding in patients without hematemesis. Am J Emerg Med. 2006; 24(3):280-5. DOI: 10.1016/j.ajem.2005.11.005. View

16.

Forgerini M, Urbano G, de Nadai T, Zapata-Cachafeiro M, Kemp R, Mastroianni P . EPIDEMIOLOGICAL PROFILE OF PATIENTS WITH NON-VARICEAL UPPER GASTROINTESTINAL BLEEDING SECONDARY TO PEPTIC DISEASE IN A TERTIARY REFERRAL BRAZILIAN HOSPITAL. Arq Gastroenterol. 2021; 58(2):202-209. DOI: 10.1590/S0004-2803.202100000-36. View

17.

Ovenden C, Plummer M, Selvanderan S, Donaldson T, Nguyen N, Weinel L . Occult upper gastrointestinal mucosal abnormalities in critically ill patients. Acta Anaesthesiol Scand. 2016; 61(2):216-223. DOI: 10.1111/aas.12844. View

18.

Bytzer P . Cost-effectiveness of gastroscopy. Ital J Gastroenterol Hepatol. 2000; 31(8):749-60. View

19.

Krag M, Perner A, Wetterslev J, Wise M, Borthwick M, Bendel S . Prevalence and outcome of gastrointestinal bleeding and use of acid suppressants in acutely ill adult intensive care patients. Intensive Care Med. 2015; 41(5):833-45. DOI: 10.1007/s00134-015-3725-1. View

20.

Verschoore T, Vandecandelaere S, Vandecandelaere P, Vanderplancke T, Bergs J . Risk factors for complications and mortality related to endoscopic procedures in adults. Acta Gastroenterol Belg. 2016; 79(1):39-46. View