Prospective study of clinical bleeding in intensive care unit patients.
We investigated prospectively clinical bleeding in 1,328 consecutive patients admitted to a medical/surgical ICU over 1 yr. One hundred thirty-eight (10.4%) patients bled after ICU admission, and an additional 388 (29.2%) bled coincident with admission. The upper GI tract was the site of bleeding in 34.8% of patients whose bleeds commenced in the ICU, and accounted for 22% of total sites. Patients with clinical bleeding after ICU admission had a significantly (p less than .001) higher likelihood of death than those who did not bleed, and those with multiple bleeding sites had a higher mortality (54.9%) than those with single sites (31%) (p less than .006). Multiple logistic regression analyses revealed that risk ratios (RR) for bleeding after ICU admission were mechanical ventilation (RR = 1.82), nutritional failure (RR = 3.45), acute renal failure (RR = 3.36), antiulcer medication (RR = 3.36), and anticoagulants (RR = 4.19). No antibiotics could be specifically incriminated. This study defines the scope, characteristics, and importance of bleeding in ICU patients and establishes risk factors.
Brown
R B
RB
Division of Infectious Diseases, Baystate Medical Center, Springfield, MA 01199.
Klar
J
J
Teres
D
D
Lemeshow
S
S
Sands
M
M
D000368:Aged; D000900:Anti-Bacterial Agents / Q000009:adverse effects; D000897:Anti-Ulcer Agents / Q000009:adverse effects; D000925:Anticoagulants / Q000009:adverse effects; D003422:Critical Care; D005260:Female; D006470:Hemorrhage / Q000453:epidemiology* / Q000209:etiology / Q000401:mortality; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012121:Respiration, Artificial / Q000009:adverse effects; D012307:Risk Factors
D000900:Anti-Bacterial Agents; D000897:Anti-Ulcer Agents; D000925:Anticoagulants