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A novel scoring system for prediction of esophageal varices in critically ill patients

Authors Hanafy AS, Badawi R, Basha MAA, Selim A, Yousef M, Elnawasany S, Mansour L, Elkhouly RA, Hawash N, Abd-Elsalam S

Received 23 June 2017

Accepted for publication 17 October 2017

Published 7 December 2017 Volume 2017:10 Pages 315—325


Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Amy Norman

Peer reviewer comments 2

Editor who approved publication: Prof. Dr. Everson L.A. Artifon

Amr Shaaban Hanafy,1 Rehab Badawi,2 Mohammad Abdelkhalik Atia Basha,3 Amal Selim,4 Mohamed Yousef,2 Sally Elnawasany,2 Loai Mansour,2 Reham Abdelkader Elkhouly,2 Nehad Hawash,2 Sherief Abd-Elsalam2

1Internal Medicine Department, Hepatology Division, Zagazig University, Zagazig, 2Tropical Medicine Department, Tanta University, Tanta, 3Diagnostic Radiology Department, Zagazig University, Zagazig, 4Internal Medicine Department, Tanta University, Tanta, Egypt

Background and aims: Patients with advanced systemic illness or critically ill patients may present with upper gastrointestinal tract (GIT) bleeding which may need endoscopic intervention; however, this may expose them to unnecessary endoscopy. The aim was to validate a novel scoring system for risk stratification for urgency of GIT endoscopy in critically ill patients.
Methods: This is an observational study conducted from January 2013 to January 2016 to analyze 300 patients with critical medical conditions and presenting with upper gastrointestinal bleeding. Meticulous clinical, laboratory, and sonographic evaluations were performed to calculate Glasgow Blatchford score (GBS) and variceal metric score for risk stratification and prediction of the presence of esophageal varices (OV). Finally, this score was applied on a validation group (n=100).
Results: The use of GBS and variceal metric scores in critically ill patients revealed that patients who showed a low risk score value for OV (0–4 points) and GBS <2 can be treated conservatively and discharged safely without urgent endoscopy. In patients with a low risk for varices but GBS >2, none of them had OV on endoscopy. In patients with intermediate risk score value for OV (5–8 points) and with GBS >2, 33.33% of them had varices on endoscopy. In patients with high risk score value for varices (9–13) and GBS >2, endoscopy revealed varices in 94.4% of them. Finally, in patients with very high risk score for varices (14–17), endoscopy revealed varices in 100% of them.
Conclusion: GBS and variceal metric score were highly efficacious in identifying critically ill patients who will benefit from therapeutic endoscopic intervention.

Keywords: noninvasive, upper endoscopy, variceal metric score, Glasgow Blatchford, critically ill

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