Predictors of gastrointestinal bleeding in adult ICU patients: a systematic review and meta-analysis
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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After excluding high risk of bias studies, shock is a risk factor for clinically important GI bleeding (RE 2.60; 95% CI 1.25-5.42).
“shock (RE 2.60; 95% CI 1.25–5.42)”
From Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021 (2021) · cites this paper as [496]
After excluding high risk of bias studies, coagulopathy is a risk factor for clinically important GI bleeding (RE 4.76; 95% CI 2.62-8.63).
“After excluding high risk of bias studies, risk factors included: coagulopathy (relative effect (RE) 4.76; 95% CI 2.62–8.63)”
From Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021 (2021) · cites this paper as [496]
After excluding high risk of bias studies, chronic liver disease is a risk factor for clinically important GI bleeding (RE 7.64; 95% CI 3.32-17.58).
“and chronic liver disease (RE 7.64; 95% CI 3.32–17.58).”
From Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021 (2021) · cites this paper as [496]
The effect of mechanical ventilation on clinically important bleeding was unclear (RE 1.93, 0.57-6.50, very low certainty).
“The effect of mechanical ventilation on clinically important bleeding was unclear (RE 1.93, 0.57–6.50, very low certainty).”
From Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021 (2021) · cites this paper as [496]
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Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2021.
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Self-citationSurviving Sepsis campaign: international guidelines for Management of Sepsis and Septic Shock 2026
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- Authors
- the GUIDE Group, Granholm, A., Zeng, L., Dionne, J. C., Perner, A., Marker, S., Krag, M., MacLaren, R., Ye, Z., Møller, M. H., & Alhazzani, W.
- Affiliations
- Copenhagen University Hospital (DK)
- Sichuan University (CN)
- University of Colorado Anschutz (US)
- Centre for Research in Intensive Care (DK)
- McMaster University (CA)
- Corresponding author
- Møller, Morten Hylander
- ORCID
- Venue
- Intensive Care Medicine
- Published
- 2019-09-05
- Volume
- 45
- Issue
- 10
- Pages
- 1347-1359
- ISSN
- 0342-4642 (ISSN-L)
- 1432-1238
- OpenAlex
- W2971511686
- Cited by
- 83
- References
- 33
- Citations by year
- 2026: 10 · 2025: 13 · 2024: 11 · 2023: 12 · 2022: 5 · 2021: 19 · 2020: 11 · 2019: 2
- FWCI
- 1.68
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Intensive Care Medicine (publishedVersion)
- PubMed (publishedVersion)
- Research at the University of Copenhagen (University of Copenhagen) (submittedVersion)
- Funders
- The Guidelines in Intensive Care, Development and Evaluation (GUIDE) Group
- Topics
- Health Sciences › Medicine › Gastroenterology › Gastrointestinal Bleeding Diagnosis and Treatment
- Health Sciences › Medicine › Surgery › Abdominal vascular conditions and treatments
- Health Sciences › Medicine › Critical Care and Intensive Care Medicine › Nosocomial Infections in ICU
- Keywords
- gastrointestinal bleeding, intensive care unit patients, risk factors, acute kidney injury, coagulopathy, shock, chronic liver disease, mechanical ventilation, stress ulcer prophylaxis, critically ill adults
- MeSH terms
- Adult, Gastrointestinal Hemorrhage, Humans, Intensive Care Units, Stomach Ulcer, Causality, Pre-Exposure Prophylaxis
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