A presentation by Søren Marker at the 2017 meeting of the Scandinavian Society of Anaestesiology and Intensive Care Medicine. All available content from SSAI2017: https://scanfoam.org/ssai2017/ Delivered in collaboration between scanFOAM, SSAI & SFAI.

1. The Stress Ulcer Prophylaxis in the Intensive Care Unit Score
The SUP-ICU Score
A clinical prediction rule of gastrointestinal bleeding
in the ICU
Søren Marker, MD
Dept. of Intensive Care 4131, Rigshospitalet, Copenhagen
08.09.17

2. Thank you to the Acta Anaesthesiologica
Scandinavica Foundation for this research
grant!
The SUP-ICU Score – A clinical prediction rule of GI bleeding in the ICU

3. The SUP-ICU trial
• Design: Ongoing internationational placebo-
controlled RCT
• Population: 3350 ICU patients
• Intervention: IV PPI (pantoprazole)
• Comparator: IV placebo (saline)
• Primary outcome: 90-day mortality
• Setting:
Søren MarkerThe SUP-ICU Score – A clinical prediction rule of GI bleeding in the ICU

4. The SUP-ICU Score
Background
• Use of clinical prediction rules to identify patients
with high risk of GI bleeding is not standard
• Surviving Sepsis Campaign Guidelines 2016
recommends SUP for high risk patients
Søren MarkerThe SUP-ICU Score – A clinical prediction rule of GI bleeding in the ICU

5. Objective
• To develop and validate a clinical prediction rule –
the SUP-ICU score – which can be used upon ICU
admission to identify ICU patients with high risk of
developing GI bleeding during ICU stay
Søren MarkerThe SUP-ICU Score – A clinical prediction rule of GI bleeding in the ICU

6. Working hypothesis
• The SUP-ICU score can be used to estimate the
risk of developing GI bleeding during ICU stay
Søren MarkerThe SUP-ICU Score – A clinical prediction rule of GI bleeding in the ICU

7. Study population
• All 1675 patients included in the placebo-group in
the SUP-ICU trial
Søren MarkerThe SUP-ICU Score – A clinical prediction rule of GI bleeding in the ICU

8. Candidate variables
• Variables readily available at baseline which may
increase the risk of GI bleeding……
Krag et al. ICM 2015
Søren MarkerThe SUP-ICU Score – A clinical prediction rule of GI bleeding in the ICU
Risk factors for clinically important GI
bleedning
OR (95% CI)
3 or more co-existing diseases 8.9 (2.7-28.2)
Dialysis 6.9 (2.7-17.5)
Chronic liver failure 6.7 (3.3-17.6)
Acute coagulopathy 5.2 (2.3-11.8)
Chronic coagulopathy 4.2 (1.7-10.2)
Use of acid suppressants 3.6 (1.3-10.2)
SOFA score 1.4 (1.2-1.5)
(Shock) 2.3 (1.0-5.4)

9. Outcome measure
• Clinically important* GI bleeding during ICU stay.
(*Definition: overt (hematemesis, coffee ground emesis, melena, hematochezia or bloody
nasogastric aspirate) GI bleeding AND ≥1 of the following features within 24 hours of GI
bleeding: 1) spontaneous drop of systolic, mean arterial pressure or diastolic blood pressure
of 20 mmHg or more, 2) start of vasopressor or a 20% increase in vasopressor dose 3)
decrease in hemoglobin of at least 2 g/dl (1.24 mmol/L), or 4) transfusion of 2 units of
packed red blood cells or more)
Søren MarkerThe SUP-ICU Score – A clinical prediction rule of GI bleeding in the ICU

10. Development of the SUP-ICU Score
Søren MarkerThe SUP-ICU Score – A clinical prediction rule of GI bleeding in the ICU
Labarère et al. ICM 2014

11. Timeline
• Fall 2017: Finalising
protocol
• Spring 2018: Development
of the score
• Fall 2018: Submission to
international peer reviewed
journal
Søren MarkerThe SUP-ICU Score – A clinical prediction rule of GI bleeding in the ICU

12. Søren MarkerThe SUP-ICU Score – A clinical prediction rule of GI bleeding in the ICU
Research group
Søren Marker
Anders Perner
Jørn Wetterslev
Anders Granholm
Mette Krag
Aksel KG Jensen
Morten Hylander Møller

13. Søren MarkerThe SUP-ICU Score – A clinical prediction rule of GI bleeding in the ICU
Thank you!
Søren Marker, MD, PhD-student
Dept. of Intensive Care 4131
Rigshospitalet, Copenhagen
Email: soeren.marker@gmail.com