Risk Factors for Patient-Important Upper Gastrointestinal Bleeding.

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.