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Critical Care |

Predictors for Need of Critical Care Monitoring in Patients With Acute Gastrointestinal Hemorrhage (GIH)

Amitesh Agarwal, MD; Marlow Hernandez, DO; Gustavo Ferrer, MD
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University of Texas Medical Branch at Galveston, Galveston, TX


Chest. 2014;145(3_MeetingAbstracts):189A. doi:10.1378/chest.1790418
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Abstract

SESSION TITLE: Critical Care Posters III

SESSION TYPE: Poster Presentations

PRESENTED ON: Saturday, March 22, 2014 at 01:15 PM - 02:15 PM

PURPOSE: To identify risk factor on admission in patients with acute GIH, to predict need of critical care monitoring.

METHODS: It was a retrospective study; Data was collected from 15 Intensive care units. 484 patients were included from Jan 2009 till Dec 2011 during separate hospital admissions for GIH. Demographic and physiologic variables were extracted from the medical records of patients admitted with GIH. We modified the previously established “physiologic criteria for ICU need” by Inayet at all (Chest 2000) and determine if patient met any of the modified ICU admission criteria from admission to time of discharge. A multiple logistic regression model was subsequently used to adjust for confounding parameters, and to identify parameters that independently predicted meeting modified ICU admission criteria and death.

RESULTS: Out of 484 patients 179 were admitted to ICU and 305 were admitted to the general medicine floors. 49 patients satisfied at least one ICU admission criteria during hospitalization. 35 out of 49 of Criteria positive patients were admitted to the ICU. In patients, who never fulfilled ICU admission criteria, length of stay was significantly longer for 2 days (4.3 vs. 6.3 days; p value <0.05), If they were admitted to the ICU vs. regular floor. Using multiple logistic regression models, of all the variables, only admission Blood Pressure (Diastolic BP < 54), Acute Renal Failure, Tachycardia (Pulse > 91), History of GI malignancy, were independently associated with subsequently meeting ICU admission criteria. The sensitivity for predicting meeting ICU admission criteria after having one or more of these four present in the ED was 85%, and specificity was 48% with an area under the ROC curve of 0.71. The strongest predictors of death were Hypotension and Myocardial Infarction (odds ratio 27 and 22 respectively; p value< 0.05).

CONCLUSIONS: Patients presented with hypotension, age > 58, History of of GI malignancy, acute renal failure, were more likely to develop physiologic instability requiring critical care monitoring.

CLINICAL IMPLICATIONS: Our data would help to triage GIH patient for appropriate level of care and to predict mortality.

DISCLOSURE: The following authors have nothing to disclose: Amitesh Agarwal, Marlow Hernandez, Gustavo Ferrer

No Product/Research Disclosure Information


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