Correlation of stress ulceration in the critically ill patients to APACHE score and role of Helicobacter pylori

Objective

Prevalence of Helicobacter pylori in critically ill patients, its relation to bleeding, the grade of stress ulcers and the APACHE score.

The study included 40 critically ill patients admitted to critical care department with different medical emergencies (21 males with mean age of 49 ± 17 years). Thirty patients had stress ulceration of different grades and 10 patients did not have stress ulcers (control group).

On admission all patients were subjected to full clinical assessment, routine laboratory investigations, occult blood in stool and upper GIT endoscopy (done in the 1st 24 hours) taking multiple biopsies from gastro-duodenal mucosa for culture of Helicobacter pylori (HP).

The APACHE II score for each patient was calculated. Endoscopical grading of stress ulceration was done using the grading system of Martin.

The patient group was classified into bleeders (73%) and non-bleeders (27%).

Results

Helicobacter pylori was +ve in 9 out of 40 patients (22.5%), 8 in the patient group (26%) and 1 in the control group (10%) P = NS. HP +ve cultures were uncountered in 7 bleeders, (32%) and 1 non-bleeders (12.5%).

The mean grade of stress ulcer in the HP +ve group was 3.3 ± 0.7 vs 2.5 ± 0.6 in HP –ve group (P = 0.026).

The stress ulcer grade was higher in bleeders than in non-bleeders (mean 2.9 ± 0.7, 2.3 ± 0.5, respectively P = 0.01) and higher in overt bleeders than in occult bleeders (mean 3.4 ± 0.5, 2.4 ± 0.5, respectively P = 0.000).

APACHE II score was higher in patient with grades 3 and 4 of stress ulceration than with grades 1 and 2 (mean 17.8 ± 5.6, 12.6 ± 4.8, respectively, P = 0.004), higher in bleeders than in non-bleeders (mean 17.0 ± 5.4, 12.9 ± 2.2, respectively P = 0.006).

Conclusions

The presence of HP was correlated with higher grades of stress ulceration and incidence of bleeding. As the APAPCE score was directly propertioned to the ulcer grading and to the incidence of bleeding, it can predict the occurrence of bleeding from stress ulceration and also its severity.