Helicobacter pylori infection is not associated with an increased hemorrhagic risk in patients in the intensive care unit.
BACKGROUND
The potential role of Helicobacter pylori in acute stress ulcer in patients in an intensive care unit (ICU) is controversial. The aim of this study was to determine the frequency of H. pylori infection in ICU patients by antigen detection on rectal swabs, and to analyze the potential relationship between the presence of H. pylori and the risk of digestive gastrointestinal bleeding.


METHODS
In this prospective, multicenter, epidemiological study, the inclusion criteria were as follows: patients admitted to the 12 participating ICU for at least two days, who were free of hemorrhagic shock and did not receive more than four units of red blood cells during the day before or the first 48 hours after admission to the ICU. Rectal swabs were obtained within the first 24 hours of admission to the ICU and were tested for H. pylori antigens with the ImmunoCard STAT! HpSA kit. The following events were analyzed according to H. pylori status: gastrointestinal bleeding, unexplained decline in hematocrit, and the number of red cell transfusions.


RESULTS
The study involved 1,776 patients. Forty-nine patients (2.8%) had clinical evidence of upper digestive bleeding. Esophagogastroduodenoscopy was performed in 7.6% of patients. Five hundred patients (28.2%) required blood transfusion. H. pylori antigen was detected in 6.3% of patients (95% confidence interval 5.2 to 7.5). H. pylori antigen positivity was associated with female sex (p < 0.05) and with a higher Simplified Acute Physiology Score II (SAPS II; p < 0.05). H. pylori antigen status was not associated with the use of fiber-optic gastroscopy, the need for red cell transfusions, or the number of red cell units infused.


CONCLUSIONS
This large study reported a small percentage of H. pylori infection detected with rectal swab sampling in ICU patients and showed that the patients infected with H. pylori had no additional risk of gastrointestinal bleeding. Thus H. pylori does not seem to have a major role in the pathogenesis of acute stress ulcer in ICU patients.
Robert
René
R
Réanimation Médicale, CHU Poitiers, 2 rue de la milèterie, BP 577 86021 Poitiers cedex France. r.robert@chu-poitiers.fr
Gissot
Valérie
V
Pierrot
Marc
M
Laksiri
Leila
L
Mercier
Emmanuelle
E
Prat
Gwenael
G
Villers
Daniel
D
Vincent
Jean-François
JF
Hira
Michel
M
Vignon
Philippe
P
Charlot
Patrick
P
Burucoa
Christophe
C
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000097:blood / Q000453:epidemiology*; D016481:Helicobacter Infections / Q000097:blood / Q000453:epidemiology*; D016480:Helicobacter pylori; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors