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

Krag, Mette; Perner, Anders; Wetterslev, Jorn; Wise, Matt P.; Borthwick, Mark; Bendel, Stepani; McArthur, Colin; Cook, Deborah; Nielsen, Niklas LU and Pelosi, Paolo, et al. (2015) In Intensive Care Medicine 41(5). p.833-845
Abstract
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. 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. 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... (More)
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. 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. 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. 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. (Less)
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keywords
Stress ulcer prophylaxis, Gastrointestinal bleeding, Proton pump, inhibitors, Histamine-2 receptor antagonists, Critically ill patients, Intensive care
in
Intensive Care Medicine
volume
41
issue
5
pages
833 - 845
publisher
Springer
external identifiers
  • wos:000353841600009
  • scopus:84928801013
ISSN
0342-4642
DOI
10.1007/s00134-015-3725-1
language
English
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yes
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0d428e39-5bd9-446d-838f-219294c4700f (old id 7432515)
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2015-07-03 07:08:40
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2017-09-17 03:52:51
@article{0d428e39-5bd9-446d-838f-219294c4700f,
  abstract     = {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. 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. 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. 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.},
  author       = {Krag, Mette and Perner, Anders and Wetterslev, Jorn and Wise, Matt P. and Borthwick, Mark and Bendel, Stepani and McArthur, Colin and Cook, Deborah and Nielsen, Niklas and Pelosi, Paolo and Keus, Frederik and Guttormsen, Anne Berit and Moller, Alma D. and Moller, Morten Hylander},
  issn         = {0342-4642},
  keyword      = {Stress ulcer prophylaxis,Gastrointestinal bleeding,Proton pump,inhibitors,Histamine-2 receptor antagonists,Critically ill patients,Intensive care},
  language     = {eng},
  number       = {5},
  pages        = {833--845},
  publisher    = {Springer},
  series       = {Intensive Care Medicine},
  title        = {Prevalence and outcome of gastrointestinal bleeding and use of acid suppressants in acutely ill adult intensive care patients},
  url          = {http://dx.doi.org/10.1007/s00134-015-3725-1},
  volume       = {41},
  year         = {2015},
}