title: Risk factors for gastrointestinal bleeding in critically ill patients. Canadian Critical Care Trials Group.
abstract: BACKGROUND
  The efficacy of prophylaxis against stress ulcers in preventing gastrointestinal bleeding in critically ill patients has led to its widespread use. The side effects and cost of prophylaxis, however, necessitate targeting preventive therapy to those patients most likely to benefit.
  
  
  METHODS
  We conducted a prospective multicenter cohort study in which we evaluated potential risk factors for stress ulceration in patients admitted to intensive care units and documented the occurrence of clinically important gastrointestinal bleeding (defined as overt bleeding in association with hemodynamic compromise or the need for blood transfusion).
  
  
  RESULTS
  Of 2252 patients, 33 (1.5 percent; 95 percent confidence interval, 1.0 to 2.1 percent) had clinically important bleeding. Two strong independent risk factors for bleeding were identified: respiratory failure (odds ratio, 15.6) and coagulopathy (odds ratio, 4.3). Of 847 patients who had one or both of these risk factors, 31 (3.7 percent; 95 percent confidence interval, 2.5 to 5.2 percent) had clinically important bleeding. Of 1405 patients without these risk factors, 2 (0.1 percent; 95 percent confidence interval, 0.02 to 0.5 percent) had clinically important bleeding. The mortality rate was 48.5 percent in the group with bleeding and 9.1 percent in the group without bleeding (P < 0.001).
  
  
  CONCLUSIONS
  Few critically ill patients have clinically important gastrointestinal bleeding, and therefore prophylaxis against stress ulcers can be safely withheld from critically ill patients unless they have coagulopathy or require mechanical ventilation.
authors.affiliation: Faculty of Health Sciences, McMaster University, Hamilton, Ont., Canada.
authors.forename: D J
authors.initials: DJ
authors.lastname: Cook
authors.forename: H D
authors.initials: HD
authors.lastname: Fuller
authors.forename: G H
authors.initials: GH
authors.lastname: Guyatt
authors.forename: J C
authors.initials: JC
authors.lastname: Marshall
authors.forename: D
authors.initials: D
authors.lastname: Leasa
authors.forename: R
authors.initials: R
authors.lastname: Hall
authors.forename: T L
authors.initials: TL
authors.lastname: Winton
authors.forename: F
authors.initials: F
authors.lastname: Rutledge
authors.forename: T J
authors.initials: TJ
authors.lastname: Todd
authors.forename: P
authors.initials: P
authors.lastname: Roy
mesh_terms: D000368:Aged; D000897:Anti-Ulcer Agents / Q000627:therapeutic use; D016001:Confidence Intervals; D016638:Critical Illness / Q000401:mortality; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000209:etiology* / Q000517:prevention & control; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010437:Peptic Ulcer / Q000209:etiology / Q000517:prevention & control; D010438:Peptic Ulcer Hemorrhage / Q000517:prevention & control; D011446:Prospective Studies; D012044:Regression Analysis; D012307:Risk Factors; D013312:Stress, Physiological / Q000209:etiology / Q000517:prevention & control
chemical_list: D000897:Anti-Ulcer Agents