PURPOSE: To describe the prevalence of, risk factors for, and prognostic importance of gastrointestinal (GI) bleeding and use of acid suppressants in acutely ill adult intensive care patients. METHODS: We included adults without GI bleeding who were acutely admitted to the intensive care unit (ICU) during a 7-day period. The primary outcome was clinically important GI bleeding in ICU, and the analyses included estimations of baseline risk factors and potential associations with 90-day mortality. RESULTS: A total of 1,034 patients in 97 ICUs in 11 countries were included. Clinically important GI bleeding occurred in 2.6 % (95 % confidence interval 1.6-3.6 %) of patients. The following variables at ICU admission were independently associated with clinically important GI bleeding: three or more co-existing diseases (odds ratio 8.9, 2.7-28.8), co-existing liver disease (7.6, 3.3-17.6), use of renal replacement therapy (6.9, 2.7-17.5), co-existing coagulopathy (5.2, 2.3-11.8), acute coagulopathy (4.2, 1.7-10.2), use of acid suppressants (3.6, 1.3-10.2) and higher organ failure score (1.4, 1.2-1.5). In ICU, 73 % (71-76 %) of patients received acid suppressants; most received proton pump inhibitors. In patients with clinically important GI bleeding, crude and adjusted odds for mortality were 3.7 (1.7-8.0) and 1.7 (0.7-4.3), respectively. CONCLUSIONS: In ICU patients clinically important GI bleeding is rare, and acid suppressants are frequently used. Co-existing diseases, liver failure, coagulopathy and organ failures are the main risk factors for GI bleeding. Clinically important GI bleeding was not associated with increased adjusted 90-day mortality, which largely can be explained by severity of comorbidity, other organ failures and age.
PURPOSE: To describe the prevalence of, risk factors for, and prognostic importance of gastrointestinal (GI) bleeding and use of acid suppressants in acutely ill adult intensive care patients. METHODS: We included adults without GI bleeding who were acutely admitted to the intensive care unit (ICU) during a 7-day period. The primary outcome was clinically important GI bleeding in ICU, and the analyses included estimations of baseline risk factors and potential associations with 90-day mortality. RESULTS: A total of 1,034 patients in 97 ICUs in 11 countries were included. Clinically important GI bleeding occurred in 2.6 % (95 % confidence interval 1.6-3.6 %) of patients. The following variables at ICU admission were independently associated with clinically important GI bleeding: three or more co-existing diseases (odds ratio 8.9, 2.7-28.8), co-existing liver disease (7.6, 3.3-17.6), use of renal replacement therapy (6.9, 2.7-17.5), co-existing coagulopathy (5.2, 2.3-11.8), acute coagulopathy (4.2, 1.7-10.2), use of acid suppressants (3.6, 1.3-10.2) and higher organ failure score (1.4, 1.2-1.5). In ICU, 73 % (71-76 %) of patients received acid suppressants; most received proton pump inhibitors. In patients with clinically important GI bleeding, crude and adjusted odds for mortality were 3.7 (1.7-8.0) and 1.7 (0.7-4.3), respectively. CONCLUSIONS: In ICU patients clinically important GI bleeding is rare, and acid suppressants are frequently used. Co-existing diseases, liver failure, coagulopathy and organ failures are the main risk factors for GI bleeding. Clinically important GI bleeding was not associated with increased adjusted 90-day mortality, which largely can be explained by severity of comorbidity, other organ failures and age.
Authors: Lars B Holst; Nicolai Haase; Jørn Wetterslev; Jan Wernerman; Anne B Guttormsen; Sari Karlsson; Pär I Johansson; Anders Aneman; Marianne L Vang; Robert Winding; Lars Nebrich; Helle L Nibro; Bodil S Rasmussen; Johnny R M Lauridsen; Jane S Nielsen; Anders Oldner; Ville Pettilä; Maria B Cronhjort; Lasse H Andersen; Ulf G Pedersen; Nanna Reiter; Jørgen Wiis; Jonathan O White; Lene Russell; Klaus J Thornberg; Peter B Hjortrup; Rasmus G Müller; Morten H Møller; Morten Steensen; Inga Tjäder; Kristina Kilsand; Suzanne Odeberg-Wernerman; Brit Sjøbø; Helle Bundgaard; Maria A Thyø; David Lodahl; Rikke Mærkedahl; Carsten Albeck; Dorte Illum; Mary Kruse; Per Winkel; Anders Perner Journal: N Engl J Med Date: 2014-10-01 Impact factor: 91.245
Authors: P H van der Voort; R W van der Hulst; D F Zandstra; A A Geraedts; A van der Ende; G N Tytgat Journal: Intensive Care Med Date: 2001-01 Impact factor: 17.440
Authors: Mette Krag; Anders Perner; Jørn Wetterslev; Matt P Wise; Morten Hylander Møller Journal: Intensive Care Med Date: 2015-06-03 Impact factor: 17.440
Authors: M Dietrich; C J Reuß; C Beynon; A Hecker; C Jungk; D Michalski; C Nusshag; K Schmidt; M A Weigand; M Bernhard; T Brenner Journal: Anaesthesist Date: 2020-01 Impact factor: 1.041