Intensive Care Medicine

, Volume 41, Issue 5, pp 833–845 | Cite as

Prevalence and outcome of gastrointestinal bleeding and use of acid suppressants in acutely ill adult intensive care patients

  • Mette Krag
  • Anders Perner
  • Jørn Wetterslev
  • Matt P. Wise
  • Mark Borthwick
  • Stepani Bendel
  • Colin McArthur
  • Deborah Cook
  • Niklas Nielsen
  • Paolo Pelosi
  • Frederik Keus
  • Anne Berit Guttormsen
  • Alma D. Moller
  • Morten Hylander Møller
  • the SUP-ICU co-authors



To describe the prevalence of, risk factors for, and prognostic importance of gastrointestinal (GI) bleeding and use of acid suppressants in acutely ill adult intensive care patients.


We included adults without GI bleeding who were acutely admitted to the intensive care unit (ICU) during a 7-day period. The primary outcome was clinically important GI bleeding in ICU, and the analyses included estimations of baseline risk factors and potential associations with 90-day mortality.


A total of 1,034 patients in 97 ICUs in 11 countries were included. Clinically important GI bleeding occurred in 2.6 % (95 % confidence interval 1.6–3.6 %) of patients. The following variables at ICU admission were independently associated with clinically important GI bleeding: three or more co-existing diseases (odds ratio 8.9, 2.7–28.8), co-existing liver disease (7.6, 3.3–17.6), use of renal replacement therapy (6.9, 2.7–17.5), co-existing coagulopathy (5.2, 2.3–11.8), acute coagulopathy (4.2, 1.7–10.2), use of acid suppressants (3.6, 1.3–10.2) and higher organ failure score (1.4, 1.2–1.5). In ICU, 73 % (71–76 %) of patients received acid suppressants; most received proton pump inhibitors. In patients with clinically important GI bleeding, crude and adjusted odds for mortality were 3.7 (1.7–8.0) and 1.7 (0.7–4.3), respectively.


In ICU patients clinically important GI bleeding is rare, and acid suppressants are frequently used. Co-existing diseases, liver failure, coagulopathy and organ failures are the main risk factors for GI bleeding. Clinically important GI bleeding was not associated with increased adjusted 90-day mortality, which largely can be explained by severity of comorbidity, other organ failures and age.


Stress ulcer prophylaxis Gastrointestinal bleeding Proton pump inhibitors Histamine-2 receptor antagonists Critically ill patients Intensive care 


Financial support

We received support from Aase and Ejnar Danielsens Foundation, Ehrenreichs Foundation, Scandinavian Society of Anaesthesia and Intensive Care Medicine (SSAI), the Danish Society of Anaesthesiology and Intensive care Medicine (DASAIM) and the Danish Medical Association. The funding sources had no influence on design or execution of the study, data analyses or writing of the manuscript.

Conflicts of interest

All authors have completed the Unified Competing Interest form (available on request from the corresponding author) and declare the following interests: DC received donated study drugs in 1992 from a company that does not exist anymore while leading an RCT funded by the Canadian government. The ICU at Rigshospitalet receives support for other research projects from Fresenius Kabi and CSL Behring. MW reports personal fees from KaloBios Pharmaceuticals, personal fees from Wiley Publishing, personal fees from Fisher & Paykel, personal fees from Merck (MSD) and non-financial support from Qualitech Healthcare, outside the submitted work. On behalf of all other authors the corresponding author states that there are no conflicts of interest.

Supplementary material

134_2015_3725_MOESM1_ESM.doc (338 kb)
Supplementary material 1 (DOC 337 kb)
134_2015_3725_MOESM2_ESM.pdf (744 kb)
Supplementary material 2 (PDF 743 kb)
134_2015_3725_MOESM3_ESM.pdf (190 kb)
Supplementary material 3 (PDF 190 kb)


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Copyright information

© Springer-Verlag Berlin Heidelberg and ESICM 2015

Authors and Affiliations

  • Mette Krag
    • 1
  • Anders Perner
    • 1
  • Jørn Wetterslev
    • 2
  • Matt P. Wise
    • 3
  • Mark Borthwick
    • 4
  • Stepani Bendel
    • 5
  • Colin McArthur
    • 6
  • Deborah Cook
    • 7
  • Niklas Nielsen
    • 8
  • Paolo Pelosi
    • 9
  • Frederik Keus
    • 10
  • Anne Berit Guttormsen
    • 11
  • Alma D. Moller
    • 12
  • Morten Hylander Møller
    • 1
  • the SUP-ICU co-authors
  1. 1.Department of Intensive Care 4131Copenhagen University Hospital, RigshospitaletCopenhagenDenmark
  2. 2.Copenhagen Trial Unit, Centre for Clinical Intervention ResearchCopenhagen University Hospital RigshospitaletCopenhagenDenmark
  3. 3.Department of Adult Critical CareUniversity Hospital of WalesCardiffUK
  4. 4.Pharmacy DepartmentOxford University Hospitals NHS TrustOxfordUK
  5. 5.Department of Intensive Care MedicineKuopio University HospitalKuopioFinland
  6. 6.Department of Critical Care MedicineAuckland City HospitalAucklandNew Zealand
  7. 7.Department of MedicineMcMaster UniversityHamiltonCanada
  8. 8.Department of Anaesthesiology and Intensive Care, Helsingborg Hospital, Sweden and Department of Clinical SciencesLund UniversityLundSweden
  9. 9.Department of Surgical Sciences and Integrated Diagnostics, IRCCS San Martino ISTUniversity of GenoaGenoaItaly
  10. 10.University of Groningen, Department of Critical CareUniversity Medical Center GroningenGroningenThe Netherlands
  11. 11.Department of Anaesthesia and Intensive CareHaukeland University Hospital and Clinical Institute 1 UiBBergenNorway
  12. 12.Department of Anaesthesia and Intensive CareLandspitali University Hospital ReykjavikReykjavikIceland

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