Upper gastrointestinal bleeding in severely burned patients: incidence, risk factors and outcome.

Abstract

Upper gastrointestinal bleeding (UGIB) is a rare complication of the ICU stay. Our objective was to study the epidemiological, clinical manifestations, and evolutionary characteristics of UGIB, and identify its risk factors in severely burned patients. This is a retrospective case-control study of burned patients in the ICU in Tunisia over a period of 6 years, including all adult patients with severe burns who presented at least one episode of gastrointestinal bleeding. The control group consisted of severely burned patients with no gastrointestinal bleeding during their ICU stay. The two groups were matched according to age, gender and extent of burns. The incidence of gastrointestinal bleeding was 2.3% with an average time of onset of 19±17 days. Esophagogastroduodenoscopy was performed in 45 patients showing bulbar ulcer, gastric ulcer, and oesophageal ulcerations in respectively 28, 8 and 3 patients. In the multivariate study, acute kidney injury (OR 13.8, CI [2.9-67], p=0.001), fluid intake <2 ml/kg/%TBSA over the first 24h (OR 10, IC [1.5-68.5], p=0.019), and length of ICU stay >10 days (OR 48.2, IC [4.4-530], p=0.002) were independent risk factors for the occurrence of gastrointestinal bleeding. Mortality in the UGIB group was higher (55.8% vs 25%, p=0.001). Upper gastrointestinal bleeding is a serious complication of a burn patient's ICU stay. Acute renal failure, low fluid intake in the first 24h, and a long duration of ICU stay were independent risk factors for its occurrence.