Risk Factors for Patient-Important Upper Gastrointestinal Bleeding
<b>Rationale:</b> Patient-important gastrointestinal bleeding is an endpoint developed by patients and family members; however, risk factors for this outcome are unknown. <b>Objectives:</b> We sought to identify risk factors for patient-important upper gastrointestinal bleeding among invasively ventilated adults. <b>Methods:</b> This preplanned regression analysis of an international trial database evaluated baseline and time-varying risk factors in the preceding 3 days for patient-important upper gastrointestinal bleeding, accounting for illness severity and the competing risk of death. <b>Measurements and Main Results:</b> Patient-important upper gastrointestinal bleeding occurred in the ICU among 131 of 4,821 (2.7%) patients. Baseline APACHE II score-hazard ratio (HR), 1.24 (95% confidence interval [CI] = 1.12, 1.37) per 5-point increase-and the following were associated with greater risk of patient-important bleeding: inotropes or vasopressors (HR, 2.05 [95% CI = 1.35, 3.12]), severe thrombocytopenia (platelet count, <50 × 10<sup>9</sup>/L) (HR, 2.21 [95% CI = 1.24, 3.94]) and platelet inhibitor drugs (HR, 1.69 [95% CI = 1.11, 2.56]). A lower bleeding risk was associated with pantoprazole (HR, 0.36 [95% CI = 0.25, 0.54]) and enteral nutrition (HR, 0.81 [95% CI = 0.68, 0.97]) for every increase of 500 ml/d. There was no interaction between enteral nutrition and pantoprazole (interaction <i>P</i> = 0.94). Allocation to pantoprazole was associated with a lower risk of patient-important upper gastrointestinal bleeding regardless of the volume of enteral nutrition (for 500 ml/d: HR, 0.36 [95% CI = 0.22, 0.58]; for no enteral nutrition: HR, 0.36 [95% CI = 0.18, 0.72]). The association of enteral nutrition and bleeding was similar with pantoprazole (HR, 0.82 [95% CI = 0.63, 1.07]) or without pantoprazole (HR, 0.81 [95% CI = 0.66, 1.00]). <b>Conclusions:</b> Several factors are associated with the risk of patient-important upper gastrointestinal bleeding during invasive ventilation.
Authors
- Diane Heels‐Ansdell (ORCID: https://orcid.org/0000-0003-4362-801X)
- Nicole Zytaruk
- Simon R. Finfer (ORCID: https://orcid.org/0000-0002-2785-5864)
- François Lauzier (ORCID: https://orcid.org/0000-0002-6530-5513)
- Karen E. A. Burns (ORCID: https://orcid.org/0000-0002-9967-5424)
- Yaseen M. Arabi (ORCID: https://orcid.org/0000-0001-5735-6241)
- David R. Williamson (ORCID: https://orcid.org/0000-0003-3360-4831)
- M.J. Hardie (ORCID: https://orcid.org/0000-0003-2687-4622)
- Lehana Thabane (ORCID: https://orcid.org/0000-0003-0355-9734)
- Gordon Guyatt (ORCID: https://orcid.org/0000-0003-2352-5718)
- Jeffrey F. Barletta (ORCID: https://orcid.org/0000-0002-9054-8218)
- Salmaan Kanji (ORCID: https://orcid.org/0000-0003-0594-0360)
- Paul Jeffrey Young (ORCID: https://orcid.org/0000-0002-3428-3083)
- Neill K. J. Adhikari (ORCID: https://orcid.org/0000-0003-4038-5382)
- Marlies Ostermann (ORCID: https://orcid.org/0000-0001-9500-9080)
- Adam M. Deane (ORCID: https://orcid.org/0000-0002-7620-5577)
- Naomi E. Hammond (ORCID: https://orcid.org/0000-0002-6559-7747)
- Kyle White (ORCID: https://orcid.org/0000-0002-0129-8297)
- Joanna Colleen Dionne (ORCID: https://orcid.org/0000-0002-9401-6868)
- John C. Marshall
- François Lamontagne
Institutions
- Midwestern University (US)
- The University of Sydney (AU)
- St. Michael's Hospital (CA)
- The Royal Melbourne Hospital (AU)
- St Thomas' Hospital (GB)
- Université de Sherbrooke (CA)
- The University of Melbourne (AU)
- King's College London (GB)
- King Saud bin Abdulaziz University for Health Sciences (SA)
- University of Toronto (CA)
- Royal North Shore Hospital (AU)
- Ottawa Hospital (CA)
- Wellington Hospital (NZ)
- Princess Alexandra Hospital (AU)
- UNSW Sydney (AU)
- The George Institute for Global Health (AU)
- St. Thomas Hospital (CA)
- Medical Research Institute of New Zealand (NZ)
- Hôpital du Sacré-Cœur de Montréal (CA)
- Impact (CA)
- Université Laval (CA)
- Ottawa Hospital Research Institute (CA)
- Unity Health Toronto
- Imperial College London (GB)
- St. Joseph’s Healthcare Hamilton (CA)
- Université de Montréal (CA)
- McMaster University (CA)
Publication Details
- Journal
- American Journal of Respiratory and Critical Care Medicine
- Published
- 2025-04-18
- DOI
- https://doi.org/10.1164/rccm.202411-2245oc
- Citations
- 5
- Primary Topic
- Gastrointestinal Bleeding Diagnosis and Treatment
- Type
- article
- Field-Weighted Citation Impact
- 9.06