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

Mette Krag; Anders Perner; Jørn Wetterslev; Matt P Wise; Mark Borthwick; Stepani Bendel; Colin McArthur; Deborah Cook; Niklas Nielsen; Paolo Pelosi; Frederik Keus; Anne Berit Guttormsen; Alma D Moller; Morten Hylander Møller; SUP-ICU co-authors

doi:10.1007/s00134-015-3725-1

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

Mette Krag, Anders Perner, Jørn Wetterslev, Matt P Wise, Mark Borthwick, Stepani Bendel, Colin McArthur, Deborah Cook, Niklas Nielsen, Paolo Pelosi, Frederik Keus, Anne Berit Guttormsen, Alma D Moller, Morten Hylander Møller, SUP-ICU co-authors

Institut for Klinisk Medicin

118 Citationer (Scopus)

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.

Originalsprog	Engelsk
Tidsskrift	Intensive Care Medicine
Vol/bind	41
Udgave nummer	5
Sider (fra-til)	833-45
Antal sider	13
ISSN	0342-4642
DOI	https://doi.org/10.1007/s00134-015-3725-1
Status	Udgivet - 1 maj 2015

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10.1007/s00134-015-3725-1

Citationsformater

Krag, M., Perner, A., Wetterslev, J., Wise, M. P., Borthwick, M., Bendel, S., McArthur, C., Cook, D., Nielsen, N., Pelosi, P., Keus, F., Guttormsen, A. B., Moller, A. D., Møller, M. H., & SUP-ICU co-authors (2015). Prevalence and outcome of gastrointestinal bleeding and use of acid suppressants in acutely ill adult intensive care patients. Intensive Care Medicine, 41(5), 833-45. https://doi.org/10.1007/s00134-015-3725-1

Krag, M, Perner, A, Wetterslev, J, Wise, MP, Borthwick, M, Bendel, S, McArthur, C, Cook, D, Nielsen, N, Pelosi, P, Keus, F, Guttormsen, AB, Moller, AD, Møller, MH & SUP-ICU co-authors 2015, 'Prevalence and outcome of gastrointestinal bleeding and use of acid suppressants in acutely ill adult intensive care patients', Intensive Care Medicine, bind 41, nr. 5, s. 833-45. https://doi.org/10.1007/s00134-015-3725-1

@article{b8ddb0f169b94ce9ad698c0fe7290090,

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

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.",

keywords = "Acute Disease, Adult, Aged, Confounding Factors (Epidemiology), Female, Gastrointestinal Hemorrhage, Humans, Intensive Care Units, Male, Middle Aged, Prevalence, Prognosis, Proton Pump Inhibitors, Risk Factors, Stomach Ulcer",

author = "Mette Krag and Anders Perner and J{\o}rn Wetterslev and Wise, {Matt P} and Mark Borthwick and Stepani Bendel and Colin McArthur and Deborah Cook and Niklas Nielsen and Paolo Pelosi and Frederik Keus and Guttormsen, {Anne Berit} and Moller, {Alma D} and M{\o}ller, {Morten Hylander} and {SUP-ICU co-authors}",

year = "2015",

month = may,

day = "1",

doi = "10.1007/s00134-015-3725-1",

language = "English",

volume = "41",

pages = "833--45",

journal = "European Journal of Intensive Care Medicine",

issn = "0935-1701",

publisher = "Springer",

number = "5",

}

TY - JOUR

T1 - Prevalence and outcome of gastrointestinal bleeding and use of acid suppressants in acutely ill adult intensive care patients

AU - Krag, Mette

AU - Perner, Anders

AU - Wetterslev, Jørn

AU - Wise, Matt P

AU - Borthwick, Mark

AU - Bendel, Stepani

AU - McArthur, Colin

AU - Cook, Deborah

AU - Nielsen, Niklas

AU - Pelosi, Paolo

AU - Keus, Frederik

AU - Guttormsen, Anne Berit

AU - Moller, Alma D

AU - Møller, Morten Hylander

AU - SUP-ICU co-authors

PY - 2015/5/1

Y1 - 2015/5/1

N2 - 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.

AB - 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.

KW - Acute Disease

KW - Adult

KW - Aged

KW - Confounding Factors (Epidemiology)

KW - Female

KW - Gastrointestinal Hemorrhage

KW - Humans

KW - Intensive Care Units

KW - Male

KW - Middle Aged

KW - Prevalence

KW - Prognosis

KW - Proton Pump Inhibitors

KW - Risk Factors

KW - Stomach Ulcer

U2 - 10.1007/s00134-015-3725-1

DO - 10.1007/s00134-015-3725-1

M3 - Journal article

C2 - 25860444

SN - 0935-1701

VL - 41

SP - 833

EP - 845

JO - European Journal of Intensive Care Medicine

JF - European Journal of Intensive Care Medicine

IS - 5

ER -

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

Abstract

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