Journal of Medical and Surgical Intensive Care Medicine 2010 , Vol 1, Issue 3
Comparison Between the Patients Admitted to the Intensive Care Unit with Gastrointestinal Bleeding and the Patients who Had Gastrointestinal Bleeding in the Intensive Care Unit Due to Stress Ulcer
Melda Türkoğlu 1 , Neriman Defne Altıntaş 2 , Arzu Topeli İskit 3
1Gazi Üniversitesi Tıp Fakültesi, İç Hastalıkları Yoğun Bakım Bilim Dalı, Ankara, Türkiye
2Ankara Atatürk Eğitim ve Araştırma Hastanesi, İç Hastalıkları Yoğun Bakım Ünitesi, Ankara, Türkiye
3Hacettepe Üniversitesi Tıp Fakültesi, İç Hastalıkları Yoğun Bakım Ünitesi, Ankara, Turkey

Aim: To compare the clinical characteristics,  morbidity and mortality of patients admitted to intensive care unit (ICU) with gastrointestinal (GI) bleeding and patients who had new onset GI bleeding in the ICU.

Material and Methods: Between 01.02.2004 and 31.01.2006, patients admitted to the medical ICU in a university hospital due to GI bleeding and patients who had new onset GI bleeding in the ICU were examined retrospectively. The data on admission and the data concerning the ICU stay, the length of ICU stay and the outcome were assessed. Chi-square and Mann Whitney U test were used to compare two groups and to compare patients who lived and died in the ICU. Multivariate analysis was used to find  the factors affecting mortality in the ICU.

Results: During the study period, 550 patients were admitted to the ICU. Twenty patients (4%) were admitted with GI bleeding and 27 (5%) patients had a new onset GI bleeding in the ICU. The groups were similar regarding to age, gender, APACHE II (acute physiology and chronic health score) and and Glasgow coma scores. Patients with a new onset GI bleeding in the ICU had more pulmonary problems on admission (p=0.000). Invasive blood pressure 22 (82%) and 7 (35%), p=0.001 and central venous pressure monitorization 24 (89%) and 8(40%), p=0.000 were more frequently performed in these patients and they received more red blood cell transfusion 24(89%) and 12(60%), p=0.02. In patients with a new onset GI bleeding in the ICU, mechanical ventilation was applied more frequently 25 (93%) and 10 (50%), p=0.001 and new onset sepsis occurred more frequently 14 (52%) and 3(15%), p=0.009 compared to patients admitted with GI bleeding. ICU (13 6-20 days and 3 2-7 days, p=0.001) and hospital stay (33 17-60 days and 12 6-30 days, p=0.012) were longer, and ICU mortality 17 (63%) and 4 (20%), p=0.003 was higher in patients with new onset GI bleeding in the ICU than for patients admitted with GI bleeding. In the multivariate analysis, it was found that a new onset sepsis in the ICU was the only independent risk factor for mortality (OR:12.50 2.08-74.80, p=0.006). 

Conclusion: The morbidity and mortality rate were higher in patients who had stress ulcer bleeding in the ICU compared to patients admitted with GI bleeding. In these patients, the length of ICU and hospital stay were also longer. This may be due to the nature of bleeding or due to the critical illness per se. Further studies must be conducted to explain this relationship.

Keywords : Gastrointestinal hemorrhage, mortality, length of stay, morbidity, critical care, stress ulcer bleeding