Risk Factors for Nosocomial Gastrointestinal Bleeding and Use of Acid-Suppressive Medication in Non-Critically Ill Patients

ABSTRACT

BACKGROUND

It is unknown whether there exist certain subsets of patients outside of the intensive care unit in whom the risk of nosocomial gastrointestinal bleeding is high enough that prophylactic use of acid-suppressive medication may be warranted.

OBJECTIVE

To identify risk factors for nosocomial gastrointestinal bleeding in a cohort of non-critically ill hospitalized patients, develop a risk scoring system, and use this system to identify patients most likely to benefit from acid suppression.

DESIGN

Cohort study.

PATIENTS

Adult patients admitted to an academic medical center from 2004 through 2007. Admissions with a principal diagnosis of gastrointestinal bleeding or a principal procedure code for cardiac catheterization were excluded.

MAIN MEASURES

Medication, laboratory, and other clinical data were obtained through electronic data repositories maintained at the medical center. The main outcome measure—nosocomial gastrointestinal bleeding occurring outside of the intensive care unit—was ascertained via ICD-9-CM coding and confirmed by chart review.

KEY RESULTS

Of 75,723 admissions (median age = 56 years; 40 % men), nosocomial gastrointestinal bleeding occurred in 203 (0.27 %). Independent risk factors for bleeding included age > 60 years, male sex, liver disease, acute renal failure, sepsis, being on a medicine service, prophylactic anticoagulants, and coagulopathy. Risk of bleeding increased as clinical risk score derived from these factors increased. Acid-suppressive medication was utilized in > 50 % of patients in each risk stratum. Our risk scoring system identified a high risk group in whom the number-needed-to-treat with acid-suppressive medication to prevent one bleeding event was < 100.

CONCLUSIONS

In this large cohort of non-critically ill hospitalized patients, we identified several independent risk factors for nosocomial gastrointestinal bleeding. With further validation at other medical centers, the risk model derived from these factors may help clinicians to direct acid-suppressive medication to those most likely to benefit..

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Figure 1.

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Acknowledgements

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Funders

Dr. Ngo was funded by grant number 1 UL1 RR025758-01 from the National Center for Research Resources to support the Harvard Clinical and Translational Science Center. Dr. Marcantonio was funded by grant numbers P01AG031720, R01AG030618 and R03AG028189 from the National Institute on Aging. Dr. Marcantonio is also supported by a Midcareer Investigator Award in Patient-Oriented Research from the National Institute on Aging [K24 AG035075]. The study contents are solely the responsibility of the authors and do not necessarily represent the official views of the National Center for Research Resources or the National Institute on Aging. The funding organizations had no involvement in any aspect of the study, including design and conduct of the study; collection, management, analysis, and interpretation of the data; and preparation, review, or approval of the manuscript.

Prior Presentations

An earlier version of these results was presented as a poster at the Society of General Medicine National Meeting in Phoenix, Arizona, in May, 2011.

Conflict of Interest

None of the authors of this manuscript have any relevant disclosures or conflicts of interest to report.

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Correspondence to Shoshana J. Herzig MD, MPH.

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Herzig, S.J., Rothberg, M.B., Feinbloom, D.B. et al. Risk Factors for Nosocomial Gastrointestinal Bleeding and Use of Acid-Suppressive Medication in Non-Critically Ill Patients. J GEN INTERN MED 28, 683–690 (2013). https://doi.org/10.1007/s11606-012-2296-x

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KEY WORDS

  • gastrointestinal bleeding
  • acid suppression
  • antiulcer agents