Risk Under Pressure: Gastrointestinal Bleeding in Critically Injured Trauma Patients

Gastrointestinal bleeding (GiB) is associated with hypoperfusion, cytokine release, and alterations to the mucosal barrier, which are frequently seen in the critical care population. Risk factors in the population at large have been well studied, but few have specifically addressed the unique circumstances surrounding critically ill trauma patients. We aimed to evaluate the incidence and risk factors for GiB in the trauma critical care population.

We retrospectively analyzed patients admitted to the trauma ICU at a level 1 trauma center from March 2019 to July 2023. We included patients who were mechanically ventilated for more than 48 hours. Patients with GiB were matched (1:3) by age to control patients for case-control analysis. We compared demographics, management, and outcomes between cohorts. We conducted a conditional logistic regression analysis to identify GiB predictors.

We reviewed 2,289 patients and identified 64 with a GiB. After matching, 256 patients met the inclusion criteria. The overall population consisted of men (77%) and had a median age of 41, an Injury Severity Score of 22, and a mortality rate of 21%. Of 64 patients with GiB, 48 (75%) were clinically significant. Male sex (adjusted odds ratio [AOR] 3.12, 95% CI 1.10 to 9.11, p = 0.04), vasopressor use (AOR 3.16, 95% CI 1.25 to 8.02, p = 0.02), corticosteroid use (AOR 2.45, 95% CI 1.06 to 5.67, p = 0.04), need for renal replacement therapy (AOR 3.54, 95% CI 1.22 to 10.28, p = 0.02), and enteral nutrition intolerance (AOR 3.86, 95% CI 1.49 to 9.99, p = 0.01) were all identified as independent predictors for GiB.

GiB remains a significant problem in critically ill populations. Identifying risk factors unique to the critically ill trauma patient may lead to earlier identification of susceptible patients and allow for more robust preventive measures to reduce the incidence.