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Annals of Intensive Care
Published in: Annals of Intensive Care 1/2024

Open Access 01-12-2024 | Esophagogastroduodenoscopy | Research

Prediction of esophagogastroduodenoscopy therapeutic usefulness for in-ICU suspected upper gastrointestinal bleeding: the SUGIBI score study

Authors: Victor Penaud, Thibault Vieille, Tomas Urbina, Vincent Bonny, Paul Gabarre, Louai Missri, Maxime Gasperment, Jean-Luc Baudel, Nicolas Carbonell, Alexandra Beurton, Sayma Chaibi, Aurélia Retbi, Muriel Fartoukh, Gaël Piton, Bertrand Guidet, Eric Maury, Hafid Ait-Oufella, Jérémie Joffre

Published in: Annals of Intensive Care | Issue 1/2024

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Abstract

Background

Suspected upper gastrointestinal bleeding (SUGIB) is a common issue during ICU stay. In the absence of specific guidelines on the indication and timing of esophagogastroduodenoscopy (EGD), there is substantial variability in EGD indication depending on accessibility and clinical presentation. This study aimed to investigate factors associated with the need for per-EGD hemostatic therapy and to create a score predicting therapeutic benefit of emergency bedside EGD in ICU patients with SUGIB.

Methods

We conducted a retrospective study in our ICU to identify factors associated with the need for hemostatic procedure during EGD performed for SUGIB. From this observational cohort, we derived a score predicting the need for hemostasis during EGD, the SUGIBI score. This score was subsequently validated in a retrospective multicenter cohort.

Results

Two hundred fifty-five patients not primarily admitted for GI bleeding who underwent a bedside EGD for SUGIB during their ICU stay were analyzed. The preeminent EGD indication were anemia (79%), melena (19%), shock (14%), and hematemesis (13%). EGD was normal in 24.7% of cases, while primary lesions reported were ulcers (23.1%), esophagitis (18.8%), and gastritis (12.5%). Only 12.9% of patients underwent hemostatic endotherapy during EGD. A SUGIBI score < 4 had a negative predictive value of 95% (91–99) for hemostatic endotherapy [AUC of 0.81; 0.75–0.91 (p < 0.0001)]. The SUGIBI score for predicting the need for an EGD-guided hemostatic procedure was next 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).

Conclusions

Our study shows that the therapeutic usefulness of bedside emergency EGD for SUGIB in critically ill patients is limited to a minority of patients. The SUGIBI score should help clinicians stratify the probability of a therapeutic EGD.
Appendix
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Metadata
Title
Prediction of esophagogastroduodenoscopy therapeutic usefulness for in-ICU suspected upper gastrointestinal bleeding: the SUGIBI score study
Authors
Victor Penaud
Thibault Vieille
Tomas Urbina
Vincent Bonny
Paul Gabarre
Louai Missri
Maxime Gasperment
Jean-Luc Baudel
Nicolas Carbonell
Alexandra Beurton
Sayma Chaibi
Aurélia Retbi
Muriel Fartoukh
Gaël Piton
Bertrand Guidet
Eric Maury
Hafid Ait-Oufella
Jérémie Joffre
Publication date
01-12-2024
Publisher
Springer International Publishing
Published in
Annals of Intensive Care / Issue 1/2024
Electronic ISSN: 2110-5820
DOI
https://doi.org/10.1186/s13613-024-01250-0

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