title: [Bleeding origin, patient-related risk factors, and prognostic indicators in patients with acute gastrointestinal hemorrhages requiring intensive care treatment. A retrospective analysis from 1999 to 2010].
abstract: BACKGROUND
  Gastrointestinal bleeding (GIB) is a common problem in elderly patients involving severe comorbidities and concomitant antiplatelet or anticoagulatory therapy. The risk factors and prognostic indicators of patients with severe GIB requiring intensive care medical treatment have not been well evaluated.
  
  
  METHODS
  A retrospective analysis of 7,376 patients from the medical intensive care unit (ICU) at the University Hospital Aachen was carried out between 1999 and 2010.
  
  
  RESULTS
  Of 614 patients admitted to the ICU because of acute GIB, 463 (75%) presented with upper GIB (UGIB) and 151 (25%) with lower GIB (LGIB). Despite early endoscopic intervention and ICU treatment, UGIB had a mortality rate of 16%, whereas LGIB showed a significantly better prognosis (mortality <5%) in the ICU setting. Risk factors for OGIB-related mortality were hemodynamic instability, organ failure, comorbidities (especially liver cirrhosis), and rebleeding. In total, 218 patients (36%) were treated with antiplatelet or anticoagulatory drugs, which were associated with a favorable prognosis in the UGIB group. Elevated serum lactate levels upon admission were superior in predicting mortality than established indicators of prognosis such as the Rockall or the Glasgow-Blatchford score.
  
  
  CONCLUSIONS
  Despite successful endoscopic intervention, severe acute UGIB is associated with a significant mortality rate of 16% in the ICU setting, determined by hemodynamic failure, organ dysfunction, and comorbidities. The serum lactate levels of patients with GIB on the day of admission to the ICU are prognostic.
authors.affiliation: Medizinische Klinik III, Universitätsklinikum Aachen.
authors.forename: A
authors.initials: A
authors.lastname: Koch
authors.forename: L
authors.initials: L
authors.lastname: Buendgens
authors.forename: H
authors.initials: H
authors.lastname: Dückers
authors.forename: J
authors.initials: J
authors.lastname: Bruensing
authors.forename: M
authors.initials: M
authors.lastname: Matthes
authors.forename: J
authors.initials: J
authors.lastname: Kunze
authors.forename: H H
authors.initials: HH
authors.lastname: Lutz
authors.forename: T
authors.initials: T
authors.lastname: Luedde
authors.forename: J J W
authors.initials: JJ
authors.lastname: Tischendorf
authors.forename: C
authors.initials: C
authors.lastname: Trautwein
authors.forename: F
authors.initials: F
authors.lastname: Tacke
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000009:adverse effects / Q000627:therapeutic use; D002423:Cause of Death; D015897:Comorbidity; D003422:Critical Care / Q000379:methods*; D016099:Endoscopy, Gastrointestinal; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000139:chemically induced / Q000209:etiology* / Q000401:mortality / Q000628:therapy*; D005858:Germany; D006785:Hospitals, University; D006801:Humans; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects / Q000627:therapeutic use; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D055815:Young Adult
chemical_list: D000925:Anticoagulants; D010975:Platelet Aggregation Inhibitors