Risk Factors for Patient-Important Upper Gastrointestinal Bleeding.

IF 19.3 1区医学 Q1 CRITICAL CARE MEDICINE

American journal of respiratory and critical care medicine Pub Date : 2025-04-18

Adam 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, Deborah J Cook

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引用次数: 0

Abstract

Rationale: Patient-important gastrointestinal bleeding is an endpoint developed by patients and family members; however, risk factors for this outcome are unknown.

Objective: To identify risk factors for patient-important upper gastrointestinal bleeding among invasively ventilated adults.

Methods: This pre-planned 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%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 [1.35, 3.12]), severe thrombocytopenia (platelet count <50 × 10⁹/L) (HR 2.21 [1.24, 3.94]) and platelet inhibitor drugs (HR 1.69 [1.11, 2.56]). A lower bleeding risk was associated with pantoprazole (HR 0.36 [0.25, 0.54]) and enteral nutrition (HR 0.81 [0.68, 0.97]) for every 500 mL/day increase. There was no interaction between enteral nutrition and pantoprazole (interaction p value=0.94). Allocation to pantoprazole was associated with a lower risk of patient-important upper gastrointestinal bleeding irrespective of the volume of enteral nutrition (HR 0.36 [0.22, 0.58] for 500ml/day, and HR 0.36 [0.18, 0.72] for no enteral nutrition). The association of enteral nutrition and bleeding was similar with pantoprazole (HR 0.82 [0.63, 1.07]) or without pantoprazole (HR 0.81 [0.66, 1.00]).

Conclusions: Several factors are associated with the risk of patient-important upper gastrointestinal bleeding during invasive ventilation.

本刊更多论文

患者重要上消化道出血的危险因素。

理由：患者重要的胃肠道出血是由患者和家庭成员发展的终点；然而，导致这一结果的风险因素尚不清楚。目的：探讨有创通气成人患者重要上消化道出血的危险因素。方法：对国际试验数据库进行预先计划的回归分析，评估前3天患者重要上消化道出血的基线和时变危险因素，考虑疾病严重程度和竞争死亡风险。测量结果和主要结果：4821例患者中有131例（2.7%）在ICU发生了患者重要的上消化道出血。基线APACHE II评分（风险比[HR] 1.24 [95%CI 1.12, 1.37]每增加5个点），以及以下与患者重要出血风险增加相关：收缩性药物或血管加压药物（HR 2.05[1.35, 3.12]），严重血小板减少（血小板计数9/L）（HR 2.21[1.24, 3.94]）和血小板抑制剂药物（HR 1.69[1.11, 2.56]）。泮托拉唑（HR 0.36[0.25, 0.54]）和肠内营养（HR 0.81[0.68, 0.97]）每增加500 mL/天，出血风险降低。肠内营养与泮托拉唑无交互作用（交互作用p值=0.94）。分配泮托拉唑与患者重要上消化道出血的风险较低相关，与肠内营养量无关（500ml/天的HR为0.36[0.22,0.58]，无肠内营养的HR为0.36[0.18,0.72]）。肠内营养与出血的相关性与泮托拉唑组（HR 0.82[0.63, 1.07]）和未使用泮托拉唑组（HR 0.81[0.66, 1.00]）相似。结论：在有创通气过程中，有几个因素与患者重要的上消化道出血的风险相关。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

American journal of respiratory and critical care medicine 医学-呼吸系统

CiteScore

27.30

自引率

4.50%

发文量

1313

审稿时长

3-6 weeks

期刊介绍： The American Journal of Respiratory and Critical Care Medicine focuses on human biology and disease, as well as animal studies that contribute to the understanding of pathophysiology and treatment of diseases that affect the respiratory system and critically ill patients. Papers that are solely or predominantly based in cell and molecular biology are published in the companion journal, the American Journal of Respiratory Cell and Molecular Biology. The Journal also seeks to publish clinical trials and outstanding review articles on areas of interest in several forms. The State-of-the-Art review is a treatise usually covering a broad field that brings bench research to the bedside. Shorter reviews are published as Critical Care Perspectives or Pulmonary Perspectives. These are generally focused on a more limited area and advance a concerted opinion about care for a specific process. Concise Clinical Reviews provide an evidence-based synthesis of the literature pertaining to topics of fundamental importance to the practice of pulmonary, critical care, and sleep medicine. Images providing advances or unusual contributions to the field are published as Images in Pulmonary, Critical Care, Sleep Medicine and the Sciences. A recent trend and future direction of the Journal has been to include debates of a topical nature on issues of importance in pulmonary and critical care medicine and to the membership of the American Thoracic Society. Other recent changes have included encompassing works from the field of critical care medicine and the extension of the editorial governing of journal policy to colleagues outside of the United States of America. The focus and direction of the Journal is to establish an international forum for state-of-the-art respiratory and critical care medicine.