Risk Under Pressure: Gastrointestinal Bleeding in Critically Injured Trauma Patients

Background: Gastrointestinal bleeding (GiB) is associated with hypoperfusion, cytokine release, and alterations to the mucosal barrier frequently seen in the critical care population. Risk factors in the population at large have been well-studied, but few have specifically addressed the unique circumstances surrounding critically ill trauma patients. We aimed to evaluate the incidence and risk factors for GiB in the trauma critical care population. Study Design: We retrospectively analyzed patients admitted to the trauma intensive care unit at a level 1 trauma center from 3/2019 to 7/2023. We included patients mechanically ventilated for > 48 hours. Patients with GiB were matched (1:3) by age to control patients for case-control analysis. We compared demographics, management, and outcomes between cohorts. We conducted a conditional logistic regression to identify GiB predictors. Results: We reviewed 2,289 patients and identified 64 with a GiB. After matching, 256 patients met the inclusion criteria. The overall population was male (77%) and had a median age of 41, an Injury Severity Score of 22, and a mortality of 21%. Of 64 patients with GiB, 48 (75%) were clinically significant. Male sex (AOR=3.12, 95% CI 1.10-9.11, p=0.04), vasopressor use (AOR=3.16, 95% CI 1.25-8.02, p=0.02), corticosteroid use (AOR=2.45, 95% CI 1.06-5.67, p=0.04), need for renal replacement therapy (AOR=3.54, 95% CI 1.22-10.28, p=0.02), and enteral nutrition intolerance (AOR=3.86, 95% CI 1.49-9.99, p=0.01) were all identified as independent predictors for GIB. Conclusions: GiB remains a significant problem in critically ill populations. Identifying risk factors unique to the critical trauma patient may lead to earlier identification of susceptible patients and allow for more robust preventive measures to reduce incidence.