Halo 194 (Jan 2018)
Zinner's score for acute mucous lesion bleeding risk assessment in critically ill surgical patient
Abstract
Introduction Critically ill patients are at risk of GI hemorrhage from acute mucosal lesion or primarily gastric or duodenal ulcers. Increased gastric acidity and a decrease in gastric mucosal barrier is believed to be the cause. The longer the gastric pH remains below 4 the greater the risk of hemorrhage. Patients most at risk include critically ill (sepsis, burn, trauma including neuro-trauma) patients requiring >48 hours of mechanical ventilation, patients with a coagulopathy, prior history of GI hemorrhage, organ dysfunction (renal, hepatic, cardiac), or with hypotension/shock. Zinner et al defined an Illness Severity Index Score for patients in the Intensive Care Unit (ICU). This can help identify a patient at risk for upper gastrointestinal hemorrhage and who may benefit from interventions to reduce that risk. Overall, we know that there is a good relationship between severity of illness (as determined by, for example, Apache II scores, SIRS score) and incidence of ulceration. Moreover, the longer a patient is in ICU, the more likely they are to have a GI bleeding. As many as 20% of patients may develop clinical GI hemorrhage and if surgery is required mortality can approach 80%. The aim of our study was to evaluate the relationship between Zinner score and bleeding from SRMD in severe trauma and critically ill patients. Methodology The series included 954 patients with severe trauma and critical illnesses, 124 among them with acute bleeding stress ulcers of the stomach and duodenum seen at the Intesive care unit of Clinic for Emergency Surgery, Emergency center, Clinical center of Belgrade, during a 10-year period. Results The incidence of bleeding is low and bleeding develops usually after 7 days of Intensive care unit stay. All of patients received prophylaxis. Thirteen patients underwent operation for control of massive bleeding that was unresponsive to intensive medical therapy. All ulcers were superficial and occurred during clinically stressful circumstances. Overall operative mortality was 54%, and this rate seemed to be related to multiple factors acting together. All patients with clinical significant bleeding were in the group of high Zinner score. Conclusion Zinner score appears to be a good predictor of bleeding in patients with severe trauma and criticall illnesses in Intensive care units.
