Identification of risk factors for upper gastrointestinal bleeding in intensive care unit patients (GIBICU study)

Abstract

Background and goals

Risk stratification for the need for therapeutic endoscopy and prediction of mortality in patients with upper gastrointestinal bleeding (UGIB) can be assessed by several scores. However, current scores are not validated for variceal bleeding and Intensive Care Unit (ICU) patients. The aim of this study was to evaluate potential parameters for the prediction of UGIB and patient outcomes.

Patients and study methods

In this monocenter retrospective observational study, data from all esophagogastroduodenoscopies (EGD) between November 2014 and February 2020 with suspected hemorrhage in our ICU were evaluated.

Results

Out of 345 included EGD, 42.3% of UGIB was diagnosed. 51.9% needed endoscopic intervention. Overall, 52.3% of included patients with UGIB died. Logistic regression showed that preceding variceal or non-variceal UGIB (p < .001), serum lactate (p = .001), heart rate (HR) (p = .005), and blood transfusions (p = .001) were significant predictors of UGIB. Previous UGIB (p < .001), male sex (p = .015), known varices (p < .001), serum albumin (p = .19) and use of catecholamines (p = .040) were significant predictors for the need of endoscopic intervention. Higher mortality was significantly associated with the usage of steroids (p < .001), malignant preconditions (p = .021), serum albumin (p = .020) and prolonged PTT (partial thromboplastin time) (p = .001).

Conclusions

We were able to identify additional parameters that had previously not been included in existing scores to predict the risk of UGIB, the need for therapeutic endoscopy and mortality in ICU patients. Therefore, an extension of these scores is necessary. Further validation of identified parameters in multicenter trials is needed to improve risk scores for ICU patients.

Keywords:

• Endoscopy
• gastrointestinal bleeding
• intensive care unit
• variceal bleeding
• risk scores

Acknowledgement

Professor Wolfgang Huber was the leading consultant physician of our intensive care unit and he was a very inspirational researcher and passionate physician who unfortunately died in the summer of 2020.

Ethics statement

The study conforms to the ethical guidelines of the 1975 Declaration of Helsinki. The study protocol was reviewed and approved by the local Ethics committee of the Technical University Munich (Register number 50/21 S-KK). Written consent was not obtained by the patients or their legal guardians as the study design was retrospective and the majority of the patients had already died when the data was acquired.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Data availability statement

The majority of the data generated or analyzed during this study are included in this article and the supplements tables. Further enquiries can be directed to the corresponding author.