Risk Factors for Patient-Important Upper Gastrointestinal Bleeding

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dc.contributor.authorDeane, A.M.
dc.contributor.authorLauzier, F.
dc.contributor.authorAdhikari, N.K.J.
dc.contributor.authorLamontagne, F.
dc.contributor.authorHeels-Ansdell, D.
dc.contributor.authorThabane, L.
dc.contributor.authorWilliamson, D.
dc.contributor.authorKanji, S.
dc.contributor.authorBarletta, J.F.
dc.contributor.authorFinfer, S.
dc.contributor.authorArabi, Y.
dc.contributor.authorOstermann, M.
dc.contributor.authorMarshall, J.C.
dc.contributor.authorZytaruk, N.L.
dc.contributor.authorHardie, M.
dc.contributor.authorHammond, N.E.
dc.contributor.authorGuyatt, G.
dc.contributor.authorWhite, K.C.
dc.contributor.authorBurns, K.E.A.
dc.contributor.authorDionne, J.C.
dc.contributor.authoret al.
dc.date.issued2025
dc.description.abstractRationale: Patient-important gastrointestinal bleeding is an endpoint developed by patients and family members; however, risk factors for this outcome are unknown. Objectives: We sought to identify risk factors for patientimportant upper gastrointestinal bleeding among invasively ventilated adults. Methods: 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. Measurements and Main Results: 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, <5 × 10⁹/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 500ml/d. There was no interaction between enteral nutrition and pantoprazole (interaction P = 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 500ml/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]). Conclusions: Several factors are associated with the risk of patient-important upper gastrointestinal bleeding during invasive ventilation.
dc.description.statementofresponsibilityAdam M. Deane, François Lauzier, Neill K. J. Adhikari, François Lamontagne, Diane Heels-Ansdell, Lehana Thabane, David Williamson, Salmaan Kanji, Jeffrey F. Barletta, Simon Finfer, Yaseen Arabi, Marlies Ostermann, John C. Marshall, Nicole L. Zytaruk, Miranda Hardie, Naomi E. Hammond, Gordon Guyatt, Kyle C. White, Karen E. A. Burns, Joanna C. Dionne, Paul J. Young, and Deborah J. Cook, for the Canadian Critical Care Trials Group and the Australian and New Zealand Intensive Care Society Clinical Trials Group
dc.identifier.citationAmerican Journal of Respiratory and Critical Care Medicine, 2025; 211(9):1671-1680
dc.identifier.doi10.1164/rccm.202411-2245oc
dc.identifier.issn1073-449X
dc.identifier.issn1535-4970
dc.identifier.orcidDeane, A.M. [0000-0002-7620-5577]
dc.identifier.urihttps://hdl.handle.net/2440/148042
dc.language.isoen
dc.publisherAmerican Thoracic Society
dc.relation.granthttp://purl.org/au-research/grants/nhmrc/GNT1124675
dc.rightsCopyright © 2025 by the American Thoracic Society. This article is open access and distributed under the terms of the Creative Commons Attribution 4.0 International License (https://creativecommons.org/licenses/by/4.0/). For reprints, please contact Diane Gern (dgern@thoracic.org).
dc.source.urihttps://doi.org/10.1164/rccm.202411-2245oc
dc.subjectcritical illness; gastrointestinal bleeding; risk; stress ulcer prophylaxis
dc.subject.meshHumans
dc.subject.meshGastrointestinal Hemorrhage
dc.subject.meshRespiration, Artificial
dc.subject.meshAPACHE
dc.subject.meshRisk Factors
dc.subject.meshAdult
dc.subject.meshAged
dc.subject.meshMiddle Aged
dc.subject.meshIntensive Care Units
dc.subject.meshFemale
dc.subject.meshMale
dc.subject.meshProton Pump Inhibitors
dc.subject.meshPantoprazole
dc.titleRisk Factors for Patient-Important Upper Gastrointestinal Bleeding
dc.typeJournal article
pubs.publication-statusPublished online

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