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, Kristian Rørbæk Madsen (Medlem af forfattergruppering)

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

Resumé

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.

OriginalsprogEngelsk
TidsskriftIntensive Care Medicine
Vol/bind41
Udgave nummer5
Sider (fra-til)833-45
ISSN0342-4642
DOI
StatusUdgivet - 2015

Fingeraftryk

Acids
Intensive Care Units
Liver Failure
Comorbidity
Liver Diseases
Odds Ratio
Confidence Intervals

Citer dette

Krag, Mette ; Perner, Anders ; Wetterslev, Jørn ; Wise, Matt P ; Borthwick, Mark ; Bendel, Stepani ; McArthur, Colin ; Cook, Deborah ; Nielsen, Niklas ; Pelosi, Paolo ; Keus, Frederik ; Guttormsen, Anne Berit ; Moller, Alma D ; Møller, Morten Hylander ; SUP-ICU co-authors ; Madsen, Kristian Rørbæk. / Prevalence and outcome of gastrointestinal bleeding and use of acid suppressants in acutely ill adult intensive care patients. I: Intensive Care Medicine. 2015 ; Bind 41, Nr. 5. s. 833-45.
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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.",
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} and Madsen, {Kristian R{\o}rb{\ae}k}",
year = "2015",
doi = "10.1007/s00134-015-3725-1",
language = "English",
volume = "41",
pages = "833--45",
journal = "Intensive Care Medicine",
issn = "0342-4642",
publisher = "Heinemann",
number = "5",

}

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 & Madsen, KR 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

Prevalence and outcome of gastrointestinal bleeding and use of acid suppressants in acutely ill adult intensive care patients. / Krag, Mette; Perner, Anders; Wetterslev, Jørn; Wise, Matt P; Borthwick, Mark; Bendel, Stepani; McArthur, Colin; Cook, Deborah; Nielsen, Niklas; Pelosi, Paolo; Keus, Frederik; Guttormsen, Anne Berit; Moller, Alma D; Møller, Morten Hylander; SUP-ICU co-authors; Madsen, Kristian Rørbæk (Medlem af forfattergruppering).

I: Intensive Care Medicine, Bind 41, Nr. 5, 2015, s. 833-45.

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

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

A2 - Madsen, Kristian Rørbæk

PY - 2015

Y1 - 2015

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.

U2 - 10.1007/s00134-015-3725-1

DO - 10.1007/s00134-015-3725-1

M3 - Journal article

VL - 41

SP - 833

EP - 845

JO - Intensive Care Medicine

JF - Intensive Care Medicine

SN - 0342-4642

IS - 5

ER -