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

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Authors:
  • Krag, Mette ;
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    Anaesthesiology and Intensive Care, Department of Clinical Research, Faculty of Health Sciences, SDU
  • Perner, Anders ;
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    Rigshospitalet
  • Wetterslev, Jørn ;
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    Rigshospitalet
  • Wise, Matt P ;
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    Rigshospitalet
  • Borthwick, Mark ;
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    unknown
  • Bendel, Stepani ;
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    unknown
  • McArthur, Colin ;
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    unknown
  • Cook, Deborah ;
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    unknown
  • Nielsen, Niklas ;
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    unknown
  • Pelosi, Paolo ;
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    unknown
  • Keus, Frederik ;
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    unknown
  • Guttormsen, Anne Berit ;
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    unknown
  • Moller, Alma D ;
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    unknown
  • Møller, Morten Hylander
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    unknown
Editor:
Bestle, Morten
DOI:
10.1007/s00134-015-3725-1
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.
Type:
Journal article
Language:
English
Published in:
Intensive Care Medicine, 2015, Vol 41, Issue 5, p. 833-45
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; Journal Article; Research Support, Non-U.S. Gov't
Main Research Area:
Science/technology
Publication Status:
Published
Review type:
Peer Review
Submission year:
2015
Scientific Level:
Scientific
ID:
274745822

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