The following is a summary of “Prediction of esophagogastroduodenoscopy therapeutic usefulness for in-ICU suspected upper gastrointestinal bleeding: the SUGIBI score study,” published in the February 2024 issue of Critical Care by Penaudet al.
Though standard in intensive care, unclear guidelines for esophagogastroduodenoscopy (EGD) in Suspected Upper Gastrointestinal Bleeding (SUGIB) lead to inconsistent use by doctors.
Researchers started a retrospective study to identify factors requiring hemostatic therapy during EGD and develop a score predicting its benefit for critically ill ICU patients with SUGIB.
They identified factors linked to the requirement for a hemostatic procedure during EGD for SUGIB in the ICU. The cohort developed a score forecasting the necessity for hemostasis during EGD, termed the SUGIBI score. The score underwent subsequent validation in a retrospective multicenter cohort.
The results showed that 255 patients not primarily admitted for GI bleeding underwent bedside EGD for SUGIB during their ICU stay. The main EGD indications were anemia (79%), melena (19%), shock (14%), and hematemesis (13%). EGD revealed normal findings in 24.7% of cases, while primary lesions included ulcers (23.1%), esophagitis (18.8%), and gastritis (12.5%). Only 12.9% of patients received hemostatic endotherapy during EGD. The negative predictive value for hemostatic endotherapy was 95% (91-99) when the SUGIB score was less than 4. The AUC was 0.81 (0.75-0.91; P<0.0001). The SUGIBI score for predicting the need for EGD-guided hemostatic procedure was then 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).
They concluded that for the limited EGD benefit for most critically ill SUGIB patients, the SUGIBI score aids in identifying those who benefit.
Source: annalsofintensivecare.springeropen.com/articles/10.1186/s13613-024-01250-0