From the Guidelines
The BLEED classification system is defined as a risk assessment tool that predicts the likelihood of adverse in-hospital outcomes, including recurrent hemorrhage, need for surgery, and death, in patients with acute lower gastrointestinal bleeding, and consists of five key factors: ongoing bleeding, low systolic blood pressure, elevated prothrombin time, erratic mental status, and unstable comorbid disease. The BLEED classification system is a valuable tool for triaging patients with acute lower gastrointestinal bleeding into those at high risk and those at low risk of adverse in-hospital outcomes 1. This system has been proposed as a means of predicting outcome in patients hospitalized with acute lower gastrointestinal bleeding, and has been found to be predictive of outcome when applied at the point of initial evaluation in the emergency department 1. The key factors included in the BLEED classification system are:
- Ongoing bleeding
- Low systolic blood pressure
- Elevated prothrombin time
- Erratic mental status
- Unstable comorbid disease These factors are used to assess the risk of adverse outcomes in patients with acute lower gastrointestinal bleeding, and can help guide clinical decisions regarding the need for hospitalization, ICU admission, and aggressive intervention 1. It is worth noting that other studies have investigated the use of artificial neural networks (ANN) and multiple logistic regression (MLR) models in predicting clinical outcome in patients admitted to the hospital with acute lower gastrointestinal bleeding, and have found that these models may have higher predictive accuracy than the BLEED classification system 1. However, the BLEED classification system remains a widely used and valuable tool for risk assessment in patients with acute lower gastrointestinal bleeding.
From the FDA Drug Label
Major bleeding ‡§22 (0.7)15 (0.5) Critical site bleeding7 (0.2)4 (0.1) Fatal bleeding ¶3 (<0.1)1 (<0.1) Clinically relevant non-major bleeding events (CRNM)93 (2.9)34 (1. 1) ‡ Defined as clinically overt bleeding associated with a drop in hemoglobin of ≥2 g/dL, a transfusion of ≥2 units of packed red blood cells or whole blood, bleeding at a critical site, or with a fatal outcome.
The definition of BLEED (Bleeding Classification) is:
- Major bleeding: clinically overt bleeding associated with a drop in hemoglobin of ≥2 g/dL, a transfusion of ≥2 units of packed red blood cells or whole blood, bleeding at a critical site, or with a fatal outcome.
- Critical site bleeding: bleeding at a critical site.
- Fatal bleeding: adjudicated death with the primary cause of death from bleeding.
- Clinically relevant non-major bleeding events (CRNM): bleeding events that do not meet the criteria for major bleeding but are still clinically significant. 2
From the Research
Definition of BLEED
- The BLEED classification is a tool used to predict outcomes in patients with acute upper and lower gastrointestinal hemorrhage 3.
- It is based on the following criteria:
- Ongoing bleeding
- Low systolic blood pressure
- Elevated prothrombin time
- Erratic mental status
- Unstable comorbid disease
Application of BLEED Classification
- The BLEED classification can be applied at the initial emergency department evaluation and before admission to predict hospital outcomes for patients with acute upper or lower GI hemorrhage 3.
- It has been shown to identify patients at high risk of in-hospital complications, such as recurrent GI hemorrhage, surgery to control the source of hemorrhage, and hospital mortality 3.
Comparison with Other Bleeding Risk Scores
- The BLEED classification is different from other bleeding risk scores, such as HAS-BLED, HEMORR(2)HAGES, and ATRIA, which are used to predict bleeding risk in patients with atrial fibrillation undergoing anticoagulation 4, 5, 6, 7.
- These scores have been shown to have varying degrees of predictive performance, with HAS-BLED performing best in predicting clinically relevant bleeding in patients with atrial fibrillation 7.