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

Department of Clinical Medicine

118 Citations (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.

Original language	English
Journal	Intensive Care Medicine
Volume	41
Issue number	5
Pages (from-to)	833-45
Number of pages	13
ISSN	0342-4642
DOIs	https://doi.org/10.1007/s00134-015-3725-1
Publication status	Published - 1 May 2015

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

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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, vol. 41, no. 5, pp. 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",

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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",

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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

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Keywords

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