Risk factors for stress ulcer bleeding in neurocritical patients : A multi-center study

Abstract

Objective To explore the incidence and related risk factors for stress ulcer (SU) bleeding in neurocritical patients at multiple centers. Methods We retrospectively analyzed the data of neurocritical patients at Department of Neurosurgery of 12 hospitals in China, which consisted of the patient’s age, diagnosis, past medical history and 17 potential associated risk factors including duration of mechanical ventilation, gastrointestinal (GI) ulcer or bleeding history, GCS (Glasgow coma scale), duration of neurosurgical operation, intracranial infection, stroke, traumatic brain injury, intracerebral hemorrhage, history of brain tumor operation, resuscitation of heart, lung and brain, shock, hepatic failure, renal failure, multiple organ failure, acid base imbalance, high dose of corticosteroids, administration of anticoagulant and antiplatelet drugs. Univariate analysis was conducted with Log-rank and multivariate analysis was performed using the Cox proportional hazard model. Results A total of 1 416 patients were enrolled into this study, among whom 182 cases (12.9%, 95% CI: 11.2-14.7) developed SU. The incidence of GI bleeding (10 cases) was 0.7% (95% CI: 0.3-1.3). Multivariate analysis showed that mechanical ventilation lasting over 48 hours (RR=0.526, 95% CI: 0.381-0.726, P<0.0001) and use of anticoagulants (RR=0.458, 95% CI: 0.327-0.643, P<0.0001) were independent risk factors for SU bleeding in neurocritical patients. The patients with history of GI ulcer or bleeding (RR=0.082, 95% CI: 0.016-0.411, P=0.0023) had higher chance of developing SU bleeding. Conclusion SU bleeding is not uncommon in neurocritical patients and cautions should be warranted particularly for those with risk factors. Key words: Intensive care; Neurosurgical procedures; Risk factors; Adult; Stress ulcer