title: Prevalence and outcome of gastrointestinal bleeding and use of acid suppressants in acutely ill adult intensive care patients.
abstract: OBJECTIVE
  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.
authors: Department of Intensive Care 4131, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark.
authors: Mette
authors: M
authors: Krag
authors: Anders
authors: A
authors: Perner
authors: Jørn
authors: J
authors: Wetterslev
authors: Matt P
authors: MP
authors: Wise
authors: Mark
authors: M
authors: Borthwick
authors: Stepani
authors: S
authors: Bendel
authors: Colin
authors: C
authors: McArthur
authors: Deborah
authors: D
authors: Cook
authors: Niklas
authors: N
authors: Nielsen
authors: Paolo
authors: P
authors: Pelosi
authors: Frederik
authors: F
authors: Keus
authors: Anne Berit
authors: AB
authors: Guttormsen
authors: Alma D
authors: AD
authors: Moller
authors: Morten Hylander
authors: MH
authors: Møller
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D015986:Confounding Factors, Epidemiologic; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology*; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011379:Prognosis; D054328:Proton Pump Inhibitors / Q000009:adverse effects* / Q000627:therapeutic use*; D012307:Risk Factors; D013276:Stomach Ulcer / Q000188:drug therapy*
chemical_list: D054328:Proton Pump Inhibitors