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Risk factors for major gastrointestinal bleeding in septic patients: a multicenter retrospective study
Yi Zhang1, Haibo Zhang2, Yuanyuan Feng3
1Department of Emergency Medicine, Medical Center of Trauma and War Injury, Daping Hospital, Army Medical University, Chongqing, China.
Insights
Major gastrointestinal bleeding (MGB) in sepsis patients significantly increases mortality. Key risk factors include older age, renal dysfunction, and gastrointestinal infections, aiding in early risk stratification for better outcomes.
Area of Science:
- Critical Care Medicine
- Gastroenterology
- Infectious Diseases
Background:
- Major gastrointestinal bleeding (MGB) is a severe complication of sepsis, linked to poor patient prognosis.
- Identifying predictors of MGB is crucial for clinical risk stratification in septic patients.
Purpose of the Study:
- To identify independent predictors of MGB in a large multicenter cohort of septic patients.
- To facilitate clinical risk stratification for MGB in sepsis.
Main Methods:
- Retrospective analysis of 10,249 septic patients from four tertiary hospitals (2016-2023).
- Data included demographics, comorbidities, infection sources, lab parameters, and treatments.
- MGB defined as overt bleeding with hemoglobin drop >20 g/L or transfusion requirement within 28 days.
Main Results:
- 2.0% of patients developed MGB, with significantly higher in-hospital mortality (44.0% vs. 17.0%).
- Independent risk factors for MGB: renal dysfunction, malignancy/immunosuppression, gastrointestinal infection, elevated BUN, and older age.
- Protective factors: urinary tract infection and higher baseline hemoglobin levels. Predictive model AUC was 0.702.
Conclusions:
- MGB in sepsis, though infrequent, is associated with substantially increased mortality.
- Older age, renal dysfunction, elevated BUN, and GI sources are key MGB risk drivers.
- Early risk stratification and targeted prevention in high-risk patients are vital for improving survival.
Introduction:
Major gastrointestinal bleeding (MGB) is a critical complication of sepsis that is associated with a poor prognosis. We aimed to identify independent predictors of MGB in a large multicenter cohort of septic patients to facilitate clinical risk stratification.
Materials And Methods:
This retrospective study analyzed data collected from four tertiary hospitals in China between 2016 and 2023. Data on patient demographics, comorbidities, infection sources, admission laboratory parameters and treatments were collected. The primary outcome was MGB within 28 d, defined as overt bleeding with a hemoglobin drop >20 g/L or transfusion requirement.
Results:
Of 10,249 eligible patients, 205 (2.0%) developed MGB. In-hospital mortality was significantly higher in the MGB group compared to the non-MGB group (44.0% vs. 17.0%, p < 0.001). Multivariable analysis identified independent risk factors for MGB: renal dysfunction (aOR 1.61), malignancy or immunosuppression (aOR 1.55), gastrointestinal infection (aOR 1.50), elevated blood urea nitrogen (BUN; aOR 1.03) and older age (aOR 1.01). Conversely, urinary tract infection (aOR 0.29) and higher baseline hemoglobin (HGB) levels (aOR 0.99) were associated with a lower risk. The predictive model achieved an area under the curve (AUC) of 0.702.
Conclusions:
Although MGB occurred in only 2.0% of septic patients, it was associated with substantially higher mortality. Older age, renal dysfunction, elevated BUN and gastrointestinal sources were key drivers of risk, while urinary tract infection was associated with a lower risk. These findings underscore the importance of early risk stratification and targeted preventive strategies in high-risk patients to mitigate bleeding events and improve survival.
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