Stress-related upper gastrointestinal bleeding in adult neurocritical care patients: a Chinese multicenter, retrospective study

Abstract

Objective: China has limited data on stress-related gastrointestinal ulcers in patients admitted for neurosurgical care. This study evaluated the incidence of upper gastrointestinal bleeding (UGIB) and use of stress ulcer prophylaxis (SUP) in Chinese neurocritical care patients (Glasgow Coma Scale [GCS] score ≤10).

Methods: This multicenter, retrospective study was performed from January 2015 to July 2015. Medical records of 1468 patients hospitalized during 2014 were reviewed. An estimated UGIB incidence rate of 4.4% was considered for precision of 1.3% for estimation of UGIB. The primary endpoint was evaluation of overall incidence of any overt UGIB in ≤14 days after cerebral lesion. Secondary endpoints included incidence of UGIB with or and without clinically significant complications, time to UGIB, associated risk factors and SUP used.

Results: We analyzed 1416 patients (mean age: 53.7 ± 14.00 years; males: 62.4%) with cerebral lesions. Overall incidence rate of UGIB ≤14 days was 12.9% (95% CI: 11.2%–14.7%), 0.76% with and 12.1% without significant clinical complications. Average time and duration of bleeding were 2.9 ± 3.37 days and 4.2 ± 8.4 days, respectively. The most significant risk factors for UGIB were mechanical ventilation for >48 hours (p < .0001), UGIB history (p = .0026) and use of anticoagulants (p < .0001). Acid-suppression drugs were administered for SUP in 79.0% of the patients, whereas 40.5% received hemostatic drugs.

Conclusions: The rate of UGIB incidence was higher than the estimated rate in neurocritical care patients in China, suggesting the need for better management and treatment for stress-related mucosal disease in China. History of UGIB, mechanical ventilation and/or anticoagulants significantly affected UGIB.

ClinicalTrials registry number: NCT02316990.

Keywords:

• Stress ulcer bleeding
• upper gastrointestinal bleeding
• neurocritical care
• Glasgow coma scale
• H2-receptor antagonists
• proton pump inhibitors

Transparency

Declaration of funding

This study was funded by AstraZeneca. The funder of the study had no role in study design, data collection, data analysis, data interpretation or writing of the manuscript.

Author contributions: All the authors planned this study and contributed to interpretation of the data, revisions and inputs at all stages of the study. All the authors have approved the final version of the manuscript. We are also thankful for the support provided by the China Neurosurgical Critical Care Specialist Council (CNCCSC).

Declaration of financial/other relationships

J.W., R.J., L.L., D.K., G.G., C.Y., J.Z., L.G., Q.H., D.L., G.Z., H.Z., S.W. and R.W. have disclosed that they have no significant relationships with or financial interests in any commercial companies related to this study or article.

CMRO peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Acknowledgements

The authors thank Karan Sharma and Dr. Amit Bhat (Indegene, Bangalore, India) for providing medical writing support in the development of this manuscript, as funded by AstraZeneca China.