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Gastrointestinal bleeding in critically ill immunocompromised patients.

Jennifer Catano1, Sophie Caroline Sacleux2, Jean-Marc Gornet3

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Annals of Intensive Care
|August 22, 2021
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Summary

Gastrointestinal bleeding (GIB) in immunocompromised patients admitted to the ICU is severe, with male gender, upper GIB, and malignancy increasing risk. Prophylactic proton pump inhibitors may reduce GIB severity in this population.

Keywords:
Gastrointestinal bleedingImmunocompromised hostIntensive care unitLymphoma

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Area of Science:

  • Critical care medicine
  • Gastroenterology
  • Immunology

Background:

  • Acute gastrointestinal bleeding (GIB) poses a severe risk to immunocompromised patients, often necessitating intensive care unit (ICU) admission.
  • Understanding the clinical characteristics and risk factors for severe GIB and mortality in this vulnerable population is crucial for improving outcomes.

Purpose of the Study:

  • To describe the clinical spectrum of critically ill immunocompromised patients with GIB.
  • To identify risk factors associated with mortality and severe GIB.
  • To compare this cohort with non-immunocompromised patients admitted to the ICU for GIB.

Main Methods:

  • Retrospective study across 3 centers from January 2010 to December 2019.
  • Inclusion of immunocompromised patients with GIB admitted to the ICU.
  • Logistic regression analysis to assess risk factors for mortality and severe GIB, with matching to a control group.

Main Results:

  • Upper GIB (73%) was more frequent than lower GIB (27%) in immunocompromised patients.
  • Severe GIB was associated with male gender, upper GIB, and digestive malignant infiltration.
  • Long-term corticosteroid therapy and hemorrhagic shock increased mortality, while albuminemia was protective. Severity of bleeding was higher in immunocompromised patients, but 90-day mortality was similar to non-immunocompromised patients.

Conclusions:

  • Mortality in immunocompromised patients with GIB in the ICU is high, particularly with long-term corticosteroid use.
  • Despite increased bleeding severity, overall mortality in the ICU for GIB is comparable between immunocompromised and non-immunocompromised patients.
  • Prophylactic proton pump inhibitor administration should be considered for immunocompromised patients experiencing GIB.