Intensive Care Medicine

, Volume 45, Issue 10, pp 1347–1359 | Cite as

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

  • Anders Granholm
  • Linan Zeng
  • Joanna Colleen Dionne
  • Anders Perner
  • Søren Marker
  • Mette Krag
  • Robert MacLaren
  • Zhikang Ye
  • Morten Hylander MøllerEmail author
  • Waleed Alhazzani
  • the GUIDE Group
Systematic Review



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


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.


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).


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.


Stress ulcer prophylaxis Gastrointestinal bleeding Meta-analysis Predictors Critical care Prognosis 



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.


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

Compliance with ethical standards

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.

Supplementary material

134_2019_5751_MOESM1_ESM.pdf (9.3 mb)
Supplementary material 1 (PDF 9563 kb)


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Anders Granholm
    • 1
  • Linan Zeng
    • 2
    • 3
  • Joanna Colleen Dionne
    • 3
    • 4
  • Anders Perner
    • 1
    • 5
  • Søren Marker
    • 1
    • 5
  • Mette Krag
    • 1
    • 5
  • Robert MacLaren
    • 6
  • Zhikang Ye
    • 3
  • Morten Hylander Møller
    • 1
    • 5
    Email author
  • Waleed Alhazzani
    • 3
    • 4
  • the GUIDE Group
  1. 1.Department of Intensive Care 4131Copenhagen University Hospital-RigshospitaletCopenhagenDenmark
  2. 2.Pharmacy Department-Evidence-Based Pharmacy Center, West China Second University HospitalSichuan UniversityChengduChina
  3. 3.Department of Health Research Methods, Evidence, and ImpactMcMaster UniversityHamiltonCanada
  4. 4.Department of Medicine, Division of Critical CareMcMaster UniversityHamiltonCanada
  5. 5.Centre for Research in Intensive CareCopenhagenDenmark
  6. 6.Department of Clinical Pharmacy, Skaggs School of Pharmacy and Pharmaceutical SciencesUniversity of ColoradoAuroraUSA

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