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

Mette Krag, Anders Perner, Jorn Wetterslev, Matt Wise, Mark Borthwick, Stepani Bendel, Collin McArthur, Deborah Cook, Niklas Nielsen, Paolo Pelosi, Frederik Keus, Anne Guttormsen, Alma Moller, Morten Moller, Alan Timmins, Alastair Raynes, Alistair Gibson, Anders Oldner, Andrew Walden, Andrew ParsonsAnja Richter, Anna Tilsley, Anna Tippett, Anne Lindhardt, Arlene Robertson, Birgitta Lindqvist, Birgitte Majholm, Brit Sjobo, Catherine Loughlin, Catherine McKenzie, Ceri Battle, Charudatt Vaity, Cheh Tai, Christina Lundin, Claudia Brocke, Craig French, David Lodahl, David Sapsford, Dhanesh Solanki, Diana Ulic, Delores Beach, Edward Curtis, Elisha Matheson, Emma Graham-Clarke, Emma Smith, Emmanuel Pelayo, Fayez Alshamsi, Gavin Perkins, Gillian Kincaid, Goran Anderzon, Greg Barton, Greg Fletcher, Hannah Smorzaniuk, Hans Friberg, Hans Betsch, Helle Bundgaard, Henrieta Jidbratt, Henrik Christensen, Iole Brunetti, Jack Parry-Jones, James Molony, Jane Nielsen, Jeanie Elkjaer, Jennifer Thomson, Jennifer Western, Jens Nilsson, Jessica West, Joanne Oxlade, Joanne Price, John Adams, John Muscedere, John Santamaria, Jon Laake, Julius Cranshaw, June Landa, Kate Schwartz, Katie Davies, Katti Nwosu, Kirsty Gladas, Kris Vlahovic, Kristian Madsen, Line Madsen, Lisa Julien, Lone Poulsen, Louise Dunsmure, Lynette Newby, Madhankumar Vijayakumar, Maj Kamper, Manu Shankar-Hari, Marie Sellert-Rydberg, Markku Suvela, Markus Weis, Martin Krog, Mary Madden, Matias Lindholm, Matthew Elliott, Matti Reinikainen, Michael Gillies, Mike Barker, Minna Backlund, Morag Naysmith, Morten Bestle, Morten Freundlich, Murray Blackstock, Murray Wyke-Joseph, Natalie Edwards, Nicole Nowell, Olena Breum, Oliver Ralley, Olivia Moswela, Parjam Zolfaghari, Paul Young, Pawel Berezowicz, Peter van der Voort, Peter Young, Rachael Parke, Raili Laru-Sompa, Richard Hall, Roar Medici, Robert Svensson, Samantha Bates, Sari Karlsson, Seppo Hovilehto, Shailesh Bihari, Simon Bjorn-Praest, Siv Leivdal, Staffan Palsson, Stig Dyrskog, Susan Fleury, Susan Ramsay, Susanne Iversen, Suveer Singh, Suzanne Odeberg-Wernerman, Una Gunter, Victoria Glaister, Waleed Alhazzani, Yajur Samaroo

    Research output: Contribution to journalArticle

    104 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 languageEnglish
    Pages (from-to)833-845
    Number of pages13
    JournalIntensive Care Medicine
    Volume41
    Issue number5
    DOIs
    Publication statusPublished - 2015

    Fingerprint Dive into the research topics of 'Prevalence and outcome of gastrointestinal bleeding and use of acid suppressants in acutely ill adult intensive care patients'. Together they form a unique fingerprint.

  • Cite this

    Krag, M., Perner, A., Wetterslev, J., Wise, M., Borthwick, M., Bendel, S., McArthur, C., Cook, D., Nielsen, N., Pelosi, P., Keus, F., Guttormsen, A., Moller, A., Moller, M., Timmins, A., Raynes, A., Gibson, A., Oldner, A., Walden, A., ... Samaroo, Y. (2015). Prevalence and outcome of gastrointestinal bleeding and use of acid suppressants in acutely ill adult intensive care patients. Intensive Care Medicine, 41(5), 833-845. https://doi.org/10.1007/s00134-015-3725-1