Utility of the Shock Index for Risk Stratification in Patients with Acute Upper Gastrointestinal Bleeding

Objectives: Patients with upper gastrointestinal bleeding (UGIB) frequently require hospitalization, and a small but significant percentage of these patients have adverse outcomes. Risk-scoring tools can help clinicians organize care and make predictions about outcomes. The shock index (heart rate divided by systolic blood pressure) has been used in multiple acute disorders and has the potential to identify patients with UGIB who are at risk for adverse outcomes. Methods: We retrospectively reviewed the electronic medical records of patients admitted with UGIB between January 1, 2012 and December 31, 2015. We collected information about patient demographics, presenting symptoms, underlying clinical disorders, endoscopic results, and outcomes. We calculated risk scores using the Glasgow-Blatchford score, the pre-endoscopy Rockall score, the full Rockall score, the AIMS65 (albumin, international normalized ratio, mental status, systolic blood pressure, age older than 65 years) score, and the shock index. Results: This study included 214 admissions for acute UGIB. The mean age was 59.0 +/- 15.9 years, 64.5% were men, the mean hemoglobin was 9.2 +/- 3.1 g/dL, and the mean shock index was 0.78 +/- 0.21 bpm/mmHg. The mean shock index was significantly increased in patients requiring endoscopic therapy, admission to the intensive care unit, blood component transfusion, and red blood cell transfusion. Classification of patients by a shock index > 0.7 preferentially selected patients with these adverse short-term outcomes. Among the scoring tools evaluated in this study, the shock index was the best predictor of the need for endoscopic therapy. Conclusions: The shock index is a good tool to identify patients with the potential for short-term adverse outcomes when they present with UGIB. It performs as well as other risk-scoring tools for GI bleeding and has the potential for serial use during hospitalization to identify changes in the clinical course.