Predictors of gastrointestinal bleeding in adult ICU patients: a systematic review and meta-analysis (original) (raw)

Abstract

Purpose

To systematically identify predictors of gastrointestinal (GI) bleeding in adult intensive care unit (ICU) patients.

Methods

We conducted a systematic review and meta-analysis of cohort studies including trial cohorts. We searched MEDLINE, EMBASE, and trial registries up to March 2019. Eligible studies assessed potential predictors of clinically important GI bleeding (CIB; primary outcome) or overt GI bleeding (secondary outcome), had > 20 events, and presented adjusted effect estimates. Two reviewers assessed study eligibility, extracted data, and assessed risk of bias and certainty of evidence using GRADE. We meta-analysed adjusted effect estimates if data from ≥ 2 studies were available.

Results

We included 8 studies (116,497 patients). 4 studies (including 74,456 patients) assessed potential predictors of CIB, and we meta-analysed 12 potential predictors from these. Acute kidney injury (relative effect [RE] 2.38, 95% confidence interval [CI] 1.07–5.28, moderate certainty) and male gender (RE 1.24, 95% CI 1.03–1.50, low certainty) were associated with increased incidence of CIB. After excluding high risk of bias studies, coagulopathy (RE 4.76, 95% CI 2.62–8.63, moderate certainty), shock (RE 2.60, 95% CI 1.25–5.42, low certainty), and chronic liver disease (RE 7.64, 95% CI 3.32–17.58, moderate certainty) were associated with increased incidence of CIB. The effect of mechanical ventilation on CIB was unclear (RE 1.93, 0.57–6.50, very low certainty).

Conclusions

We identified predictors of CIB and overt GI bleeding in adult ICU patients. These findings may be used to identify ICU patients at higher risk of GI bleeding who are most likely to benefit from stress ulcer prophylaxis.

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Acknowledgements

The authors thank Ms. Sarah Culgin, research coordinator at the GUIDE Group and the Research Institute of St. Joseph’s Healthcare Hamilton, who coordinated practical aspects of this review; Ms. Karin Dearness, director of the Library Services at St. Joseph’s Healthcare Hamilton, who developed the electronic search strategy and conducted the searches; and Mr. Farid Foroutan, Department of Health Research Methods, Evidence, and Impact at McMaster University, who provided templates and materials used for the review.

Funding

The Guidelines in Intensive Care, Development and Evaluation (GUIDE) Group.

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Authors and Affiliations

  1. Department of Intensive Care 4131, Copenhagen University Hospital-Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark
    Anders Granholm, Anders Perner, Søren Marker, Mette Krag & Morten Hylander Møller
  2. Pharmacy Department-Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University, Chengdu, China
    Linan Zeng
  3. Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada
    Linan Zeng, Joanna Colleen Dionne, Zhikang Ye & Waleed Alhazzani
  4. Department of Medicine, Division of Critical Care, McMaster University, Hamilton, Canada
    Joanna Colleen Dionne & Waleed Alhazzani
  5. Centre for Research in Intensive Care, Copenhagen, Denmark
    Anders Perner, Søren Marker, Mette Krag & Morten Hylander Møller
  6. Department of Clinical Pharmacy, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado, Aurora, CO, USA
    Robert MacLaren

Authors

  1. Anders Granholm
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  2. Linan Zeng
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  3. Joanna Colleen Dionne
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  4. Anders Perner
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  5. Søren Marker
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  6. Mette Krag
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  7. Robert MacLaren
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  8. Zhikang Ye
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  9. Morten Hylander Møller
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  10. Waleed Alhazzani
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Consortia

the GUIDE Group

Corresponding author

Correspondence toMorten Hylander Møller.

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Conflicts of interest

The Department of Intensive Care at Rigshospitalet—Copenhagen University Hospital receives support for other research projects from Ferring Pharmaceuticals, Denmark, and the Novo Nordisk Foundation, Denmark. RM received support for other research projects from CSL Behring, USA. AG, AP, SM, MK, and MHM are involved in the SUP-ICU research programme, and AP, MK, and MHM were directly involved in one of the studies included [4]. RM was the lead author of one of the included studies [5]. Two of the included studies [2, 19] were led from McMaster University, Hamilton, Canada, where LZ, JCD, ZY, and WA are employed.

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Granholm, A., Zeng, L., Dionne, J.C. et al. Predictors of gastrointestinal bleeding in adult ICU patients: a systematic review and meta-analysis.Intensive Care Med 45, 1347–1359 (2019). https://doi.org/10.1007/s00134-019-05751-6

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