Incidence and risk factors for gastrointestinal bleeding among patients admitted to medical intensive care units

Abstract

Objectives: To identify incidence and risk factors for new-onset gastrointestinal bleeding (GIB) in a medical intensive care unit (ICU), a topic for which there is a paucity of recent studies.

Design: Retrospective cohort study.

Setting: Medical ICUs at our tertiary-care hospital, from 2007 to 2013.

Patients: Patients who developed clinically significant GIB after entering the ICU.

Interventions: Univariable and multivariable analyses.

Main outcome measures: Incidence and risk factors for development of GIB.

Results: 4439 patients entered the medical ICU without a pre-existing GIB and 58 (1.3%) developed GIB while in the ICU. Risk factors included length of ICU stay (OR per additional day 1. 06; 95% CI 1.04 to 1.09) and elevated creatinine on ICU admission (OR 2.35; 95% CI 1.18 to 4.68, p=0.02). Elevated bilirubin on ICU admission (OR 2.08; 95% CI 0.97 to 4.47, p=0.06), and elevated aspartate transaminase (AST) on ICU admission (OR 2.20; 95% CI 0.96 to 5.03, p=0.06) trended towards increased risk of GIB that did not meet statistical significance. Age, gender, admission coagulation studies and mechanical ventilation were not predictive of GIB. Among those patients with new-onset GIB in the ICU, 47% died during that hospitalisation, as compared with those 30% of those without a GIB, p<0.01.

Conclusions: Onset of GIB is now an infrequent occurrence in the ICU setting; however those with elevated bilirubin, AST and creatinine upon admission, and with longer length of ICU stay appear at increased risk and may benefit from closer monitoring.

Keywords: DIAGNOSTIC AND THERAPEUTIC ENDOSCOPY; GASTROINTESTINAL BLEEDING.