Factors and outcomes of stress ulcer related gastrointestinal bleeding in various intensive care units: a retrospective cohort study

Abstract ObjectiveThe purpose of this study is to evaluate the differences of risk factors and outcomes between stress ulcer (SU) patients from neurocritical care unit (NCU) and those from general intensive care unit (GICU).MethodsThe study included consecutive SU patients admitted in our hospital from January 1, 2016 to January 1, 2020. Clinically important stress-related gastrointestinal bleeding (CIB) and death at discharge were chosen as primary endpoints. Pearson Chi-Square test, or Mann-Whitney U test were used to compare the differences of corresponding variables between groups, and multiple logistic regression modals were performed to detect risk factors of primary endpoint events.ResultsA total of 261 eligible SU patients (149 from NCU group and 112 from GICU group) were enrolled, with 88 (33.7%) women and a median age of 65(53–76) years. 136 (52.1%) SU patients experienced CIB, with 68 cases in each group. Compared with the SU patients from GICU, the patients from NCU were older and had a higher proportion of hypertension and previous stroke (all P < 0.05), but a lower rate of coronary heart disease, previous peptic ulcer disease, administration of glucocorticoids or the equivalent, hepatic failure, renal failure, and coagulopathy (all P < 0.05). Similarly, the CIB patients from NCU group had a higher rate of previous stroke, but a lower rate of coronary heart disease, administration of glucocorticoids or the equivalent, renal failure, and coagulopathy, compared with those CIB patients from GICU group (all P < 0.05). A significantly lower mortality was observed in SU patients from NCU group than those from GICU group (16.2% versus 29.7%, P = 0.009), while there was no significant difference for death of CIB patients between NCU group and GICU group (30.9% versus 41.8%, P = 0.188). Four independent risk factors of death, including administration of glucocorticoids or the equivalent, with an odds ratio (OR) of 2.439 and 95% confidence intervals (CIs), 1.131 to 5.259, blood transfusion (OR = 3.329, 95%CI, 1.558–7.112), respiratory failure (OR = 3.405, 95%CI,1.610–7.198), and CIB (OR = 3.793, 95%CI, 1.529–9.414) were identified in the multiple logistic regression modal. The use of nasogastric tube (OR = 5.209, 95%CI, 2.820–9.620), respiratory failure (OR = 3.672, 95%CI, 1.620–8.325) and international standardized ratio＞1.5 (OR = 2.119, 95CI, 1.023–4.389) were associated with a greater risk of CIB, while SU prophylaxis with proton pump inhibitors (OR = 0.277;95%CI, 0.100-0.768) served as the only protective factor for CIB.ConclusionCIB was a serious complication that increased the risk of death similarly for critically ill patients both from NCU and GICU, and SU prophylaxis could help to decrease CIBs. The use of nasogastric tube, respiratory failure and INR＞1.5 were associated with a higher risk of CIB.