Risk Factors for Upper Gastrointestinal Rebleeding in Critically Ill Patients

Koh, Seong Joon; Cheon, Jae Hee; Kim, Joo Sung; Ye, Byong Duk; Kang, Hae Yeon; Kim, Bo Hyun; Lee, Jeong Hoon; Yang, Ki Young; Kim, Sang Gyun; Jung, Hyun Chae; Song, In Sung

Abstract

BACKGROUND/AIMS: To determine the incidence and risk factors associated with rebleeding after upper gastrointestinal bleeding (UGIB) in critically ill patients.
METHODS
This study retrospectively reviewed the medical records of 60 patients undergoing bedside esophagogastroduodenoscopy between April 2000 and February 2004 for UGIB that developed whilst in the intensive care unit (ICU).
RESULTS
Eight out of 60 patients died within 7 days, and an additional 7 patients died within 30 days after the initial bleeding. Two of these 15 patients (13.3%), died from GI bleeding. The 7-day and 30-day rebleeding rates were 34.6% (18/52 patients), and 51.1% (23/45 patients), respectively. Multiple logistic regression using the significant variables revealed, anemia (Hb<9.0 g/dL) and hypoalbuminemia (<3.0 g/dL) to be significant factor for 7-day rebleeding, and hypoxia (<80 mmHg), anemia (Hb<9.0 g/dL), blood transfusion (> or =3 units) to be significant independent risk factor for 30-day rebleeding.
CONCLUSIONS
The rebleeding rates in the ICU setting were as high as 34.6% at 7 days and 51.1% at 30 days. This suggests that the underlying conditions of the critically ill patients affect the rebleeding rate more than the endoscopic features. Therefore, adequate general ICU care including the prevention and correction of hypoxia, anemia, and hypoalbuminemia, and minimizing blood loss can reduce the risk of rebleeding after UGIB in an ICU setting.