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Intensive Care Med. 2015 May;41(5):833-45. doi: 10.1007/s00134-015-3725-1. Epub 2015 Apr 10.

Prevalence and outcome of gastrointestinal bleeding and use of acid suppressants in acutely ill adult intensive care patients.

Collaborators (137)

Timmins A, Raynes A, Gibson AA, Moller AD, Oldner A, Perner A, Walden AP, Parsons A, Richter A, Tilsley A, Tippett A, Lindhardt A, Guttormsen AB, Robertson A, Lindqvist B, Majholm B, Sjøbø B, Loughlin C, McKenzie C, Battle C, Vaity C, Tai CK, Lundin CR, Brocke C, McArthur C, French C, Lodahl D, Sapsford D, Cook D, Solanki D, Ulic D, Beach D, Curtis EW, Matheson E, Graham-Clarke E, Smith EL, Pelayo E, AlShamsi FE, Keus F, Perkins G, Kincaid G, Anderzon G, Barton G, Fletcher G, Smorzaniuk H, Friberg H, Betsch HM, Bundgaard H, Jidbratt H, Christensen H, Brunetti I, Parry-Jones J, Molony J, Nielsen JS, Elkjaer JM, Thomson J, Weston J, Nilsson JC, West J, Oxlade J, Price J, Adams J, Muscedere J, Santamaria J, Laake JH, Cranshaw J, Landa J, Wetterslev J, Schwartz K, Davies K, Nwosu K, Gladas K, Vlahovic K, Madsen KR, Madsen LM, Julien L, Poulsen LM, Dunsmure L, Newby L, Vijayakumar M, Kamper MK, Shankar-Hari M, Sellert-Rydberg M, Borthwick M, Suvela M, Weis M, Krog MB, Madden M, Lindholm MG, Wise MP, Elliott M, Reinikainen M, Krag M, Gillies M, Barker M, Backlund M, Naysmith M, Bestle M, Freundlich M, Møller MH, Blackstock MJ, Wyke-Joseph M, Edwards N, Nowell N, Nielsen N, Breum O, Ralley O, Moswela O, Pelosi P, Zolfaghari P, Young P, Berezowicz PS, van der Voort PH, Young P, Parke R, Laru-Sompa R, Hall RI, Medici R, Svensson R, Bates S, Karlsson S, Hovilehto S, Bihari S, Obel S, Leivdal S, Pålsson S, Bendel S, Dyrskog SE, Fleury S, Ramsay S, Iversen S, Singh S, Odeberg-Wernerman S, Gunter U, Glaister V, Alhazzani W, Samaroo Y.

Author information

1
Department of Intensive Care 4131, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark.

Abstract

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.

PMID:
25860444
DOI:
10.1007/s00134-015-3725-1
[Indexed for MEDLINE]

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