Utility of the Shock Index and Other Risk-Scoring Tools in Patients with Gastrointestinal Bleeding

Abstract

Patients with upper gastrointestinal (GI) bleeding frequently require hospitalization and have a mortality rate that ranges from 6% to 14%. These patients need rapid clinical assessment to determine the urgency of endoscopy and the need for endoscopic treatment. Risk-scoring tools, such as the Rockall score and the Glasgow-Blatchford score, are commonly used in this assessment. These tools clearly help identify high-risk patients but do not necessarily have good predictive value in identifying important outcomes. Their diagnostic accuracy in identifying rebleeding and mortality ranges from poor to fair. The shock index (heart rate divided by systolic blood pressure) provides an integrated assessment of the cardiovascular status. It can be easily calculated during the initial evaluation of patients and monitoring after treatment. The shock index has been used in a few studies in patients with acute GI bleeding, including studies to determine which patients need emergency endoscopy, to predict complications after corrosive ingestions, to identify delayed hemorrhage following pancreatic surgery, and to evaluate the utility of angiograms to identify sites of GI bleeding. Not all studies have found the shock index to be useful in patients with GI bleeding, however. This may reflect the unpredictable natural history of various etiologies of GI bleeding, comorbidity that may influence blood pressure and/or heart rate, and inadequate data acquisition. The shock index needs more formal study in patients with GI bleeding admitted to medical intensive care units. Important considerations include the initial response to resuscitation, persistent bleeding following initial treatment, and rebleeding following a period of stabilization. In addition, it needs correlation with other risk-scoring tools.

Rockall Score Larger Than 7 as a Reliable Criterion for the Selection of Indications for Preventive Transarterial Embolization in a Subgroup of High-Risk Elderly Patients After Primary Endoscopic Hemostasis for Non-Variceal Upper Gastrointestinal Bleeding

“…In the current study, the patient condition in both groups was quite similar before repeated hemostasis including the incidence of comorbid conditions, level of blood loss, shock index and coagulation status. There is evidence that in cases of severe gastrointestinal hemorrhage, the shock index is > 1 [ 30 ], complying with the data from our study where the median shock index was > 1 in both groups. Nevertheless, more studies are needed to acquire strong evidence.…”

“…The clinical Rockall score according to the author’s definition [ 28 ] has a maximum value of 7 points, and according to a recent study is sensitive in the prediction of mortality; however, the Glasgow-Blatchford score was more sensitive in the prediction of other outcomes, including the risk of re-bleeding [ 27 ]. Similar scoring systems were reported to be sensitive in the prognostication of high-risk patients and comparable with the Glasgow-Blatchford score when predicting in-patient mortality as well as predicting the need for endoscopic intervention [ 25 , 29 , 30 ] ( Table 7 ). Still, the Glasgow-Blatchford score and the Rockall score are superior considering their sensitivity in predicting the re-bleeding rate [ 8 , 24 ].…”

Correlation between the Glasgow-Blatchford score, shock index, and Forrest classification in patients with peptic ulcer bleeding

“…The SI can provide a comprehensive assessment of cardiovascular status and can be used to estimate the amount of blood loss and degree of shock (normal range: 0.5 to 0.7) [7]. A study by Rassameehiran et al showed that the SI was a good tool to identify patients with the potential for short-term adverse outcomes when they presented with upper gastrointestinal bleeding, and the SI was performed, as well as other risk-scoring tools, for gastrointestinal bleeding [22].…”

“…The shock index (SI) is the ratio of the heart rate to systolic blood pressure, and it is a clinical indicator of hemodynamic status. The SI can be used for the initial monitoring of patients with gastrointestinal bleeding and define treatment and provide an early warning of persistent bleeding or rebleeding after initial therapy [7]. Few studies have investigated the use of the SI in assessing upper gastrointestinal bleeding, and the relationship between the SI and other commonly used risk scores (e.g., the GBS) remains unclear.…”

Daily Usage of Proton Pump Inhibitors May Reduce the Severity of Critical Upper Gastrointestinal Bleeding in Elderly Patients

“…Using the hemoglobin values recorded on the patients' medical records before bleeding and at the time of UGIB diagnosis, we calculated each patient's estimated bleeding volume using Nadler's equation, which can enable assessment of the individual's total blood volume [14]. The SI was calculated by dividing the heart rate by the systolic blood pressure [15].…”