Upper gastrointestinal tract bleeding in the ICU

Introduction

The aim of this study was to analyze the incidence, features and consequences of upper gastrointestinal tract bleeding (UGITB) in patients admitted to an ICU in a 6-year period.

Methods

A retrospective observational study in an ICU of a university hospital. We recorded the UGITB episodes of all admissions (6,245 patients) from January 2001 to December 2007 excluding those in whom the UGITB motivated the admission, or it occurred within the first 48 hours. UGITB was defined as: melena and or nasogastric tube bleed with or without anemia, or anemia with a concomitant lesion on G-scope. All patients were on UGITB prophylaxis. Demographic data, APACHE II score, previous medical history and risk factors for the development of UGITB were recorded. Also the information regarding G-scope findings, type of treatment received and consequences of the episode were recorded.

Results

We included a total of 73 patients (1.17%), 46 male (63%). The average APACHE II score was 22 – global mortality of 49%. The relative incidence distributed for age groups shows more incidence in the 41 to 50 years group. Six patients were on oral anticoagulation (8.2%), 14 on platelet anti-aggregation (19.1%), and one patient on low molecular weight heparin (1.4%). There were 11 patients with chronic liver disease (15% and 3.3% of total admissions (TA), three with previous history of UGITB (4.1% and 1.93% TA), four with peptic ulcer disease (5.5% and 1.16% TA) and two patients with inflammatory bowel disease (2.8%). We analyzed: organ failure, sepsis, coagulopathy and nutrition, and we found an important association of UGITB with sepsis, shock, organ failure and mechanical ventilation nutrition [1]. Presentation of UGITB: hematemesis/bleeding nasogastric tube 52(71.2%), melenas 10 (13.7%) and acute anemia 11 (15%). Endoscopic findings: ulcers 43%, erosions 37%, esophagitis and gastritis 10%. G-scope was performed in 54 patients (74%): 12 of them (16.4%) required sclerosis, one patient (1.4%) a Sengs-taken-Blakemore tube, and two patients (2.8%) arteriography with embolization. Most of the episodes resolved spontaneously. The overall mortality was 49.3% (36 patients); 1.1% of deaths were directly related to the UGITB.

Conclusion

In our series UGITB is not a common entity, and the most frequent findings were ulcers and erosions. UGITB must be considered a new severity criterion because although it is neither related with the typical predisposing factors nor age, in these patients we observed higher mortality than the expected for their APACHE II score.