Digestive Diseases and Sciences

, Volume 64, Issue 1, pp 283–284 | Cite as

Preventive Effects of Epinephrine for Critically Ill Patients? More Questions Waiting to Be Answered

  • Shanlan Shi
  • Yi Lin
  • Ru Ding
  • Yihong Chen
  • Feng Wu
  • Zhiqing He
  • Zonggui WuEmail author
  • Chun LiangEmail author

To the Editors,

We read with great interest the paper about the preventive effects of epinephrine on the occurrence of stress ulcer-induced gastrointestinal bleeding in critically ill patients published recently by Becq et al. [1]. In contrary to previous findings, increase usage of epinephrine per day was shown to delay the stress ulcer occurrence among intensive care unit (ICU) patients.

However, we still have some concerns about the study. First, in addition to epinephrine, other vasopressors, such as norepinephrine and dopamine, are also widely used in such populations [2, 3], which might lead to potential bias in assessing epinephrine’s preventive effects, but no data about the associated drug usage were revealed.

Second, stress ulcer-induced gastrointestinal bleeding could be one of the remote organ consequences of acute kidney injury (AKI) or failure among ICU patients [4]. Considering that 60% of enrolled participants received renal replacement therapy, it is natural to...



This work was supported by NSFC Grants (91539118, 81611130092) to C.L., NSFC Grant (81770352) to R.D., NSFC Grant (81473445) to ZG. W., CSC (201703170134) to Y.C., Program of Shanghai Academic Research Leader (17XD1405000), Program for Outstanding Medical Academic Leader (LJRC2015-21), and Shanghai Pilot project for clinical collaboration between TCM and Western Medicine (ZY 2018-2020-FWTX-1102) to C.L.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.


  1. 1.
    Becq A, Urien S, Barret M, et al. Epinephrine dose has a preventive effect on the occurrence of stress ulcer-induced gastrointestinal bleeding in critically ill patients. Dig Dis Sci. 2018;63:2687–2694.CrossRefGoogle Scholar
  2. 2.
    Levy B, Clere-Jehl R, Legras A, et al. Epinephrine versus norepinephrine for cardiogenic shock after acute myocardial infarction. J Am Coll Cardiol. 2018;72:173–182.CrossRefGoogle Scholar
  3. 3.
    Joannidis M, Druml W, Forni LG, et al. Prevention of acute kidney injury and protection of renal function in the intensive care unit: update 2017: expert opinion of the Working Group on Prevention, AKI section, European Society of Intensive Care Medicine. Intensive Care Med. 2017;43:730–749.CrossRefGoogle Scholar
  4. 4.
    Shiao CC, Wu PC, Huang TM, et al. Long-term remote organ consequences following acute kidney injury. Crit Care. 2015;19:438.CrossRefGoogle Scholar
  5. 5.
    Perkins GD, Ji C, Deakin CD, et al. A randomized trial of epinephrine in out-of-hospital cardiac arrest. N Engl J Med. 2018;379:711–721.CrossRefGoogle Scholar
  6. 6.
    Lafont E, Urien S, Salem JE, Heming N, Faisy C. Modeling for critically ill patients: an introduction for beginners. J Crit Care. 2015;30(6):1287–1294. Scholar
  7. 7.
    Cook DJ, Fuller HD, Guyatt GH, et al. Risk factors for gastrointestinal bleeding in critically ill patients. Canadian Critical Care Trials Group. N Engl J Med. 1994;330:377–381.CrossRefGoogle Scholar
  8. 8.
    Spirt MJ. Stress-related mucosal disease: risk factors and prophylactic therapy. Clin Ther. 2004;26:197–213.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of CardiologyShanghai Baoshan Traditional Chinese Medicine-Integrated HospitalShanghaiChina
  2. 2.Department of CardiologyFuzhou General Hospital of Nanjing Military CommandFuzhouChina
  3. 3.Department of Cardiology, Shanghai Changzheng HospitalSecond Military Medical UniversityShanghaiChina
  4. 4.Department of Clinical Sciences MalmöLund UniversityMalmöSweden

Personalised recommendations