Gastrointestinal Bleeding in Patients With Acute Respiratory Distress Syndrome: A National Database Analysis

Abstract

BackgroundThe goal of our study was to determine the impact of gastrointestinal bleeding (GIB) on in-hospital outcomes among acute respiratory distress syndrome (ARDS) patients, and subsequently determine the potential risk factors for the development of GIB.MethodsARDS patients with and without GIB were identified using the National Inpatient Sample (2002 - 2012). Linear regression analysis was used to assess impact of GIB on in-hospital mortality, length of stay and total charges. Univariate logistic regression was used to determine associated odds ratios (OR) for causes of ARDS and common comorbid conditions.ResultsWe identified 149,190 ARDS patients. The incidence of GIB was the highest among patients > 60 years (P < 0.001). GIB was associated with longer hospitalization days (7.3 days versus 11.9 days, P < 0.001), higher mortality (11% versus 27%, P < 0.001) and greater economic burden ($82,812 versus $45,951, P < 0.001). GIB was common in cirrhosis (OR: 8.3), peptic ulcer disease (OR: 3.7), coagulopathy disorders (OR: 3.003), thrombocytopenia (OR: 2.6), anemia (OR: 2.5) and atrial fibrillation (OR: 1.5). ARDS secondary to aspiration pneumonia (OR: 2.0), pancreatitis (OR: 2.0), sepsis (OR: 1.6) and community acquired pneumonia (OR: 0.8) was more likely to have GIB.ConclusionOur study demonstrates that GIB in ARDS patients is associated with significant increased mortality, hospitalization and health care cost.

Trends and Outcomes of Gastrointestinal Bleeding Among Septic Shock Patients of the United States: A 10-Year Analysis of a Nationwide Inpatient Sample

“…Gastrointestinal bleeding (GIB) is one of the major diagnoses of critical care patients. The incidence of GIB has been shown to be approximately 1.5% to 8.5% in critically ill patients, where patients with critical illness in conjunction with GIB exhibit higher mortality in comparison to those without GIB [1][2][3][4]. Over the last few decades, although the incidence of GIB in critically ill patients has been declining, the majority of thes data are obtained from postoperative critical care units.…”

The Cost of ARDS

“…The 22 publications included cost analyses from a total of 49,483 patients with publication dates between 1984 and 2021. Thirteen were from the United States, 15,[26][27][28][29][30][31][32][33][34][35][36][37] three from the United Kingdom, [38][39][40] three were from Canada, 10,41,42 and one each was from Taiwan, 43 Brazil, 44 and Finland. 14 Ten studies looked exclusively at the inpatient costs associated with the index ARDS admission.…”

“…14 Ten studies looked exclusively at the inpatient costs associated with the index ARDS admission. 14,15,27,[34][35][36][37][42][43][44] Seven published the cost of the index ARDS admission along with costs after discharge for follow-up durations varying between 6 months and 2 years. 10,26,28,33,[38][39][40] Three studies looked at costs after discharge only with a range of follow-up of between 1 and 5 years.…”

Curling ulcer in the setting of severe sunburn: A case report

“…While the incidence of stress ulcers is not known, it typically occurs with severe acute illness, most commonly presenting as upper GI bleeding. Although stress ulcers can lead to perforation, it is very rare with less than 1% incidence[ 3 ]. An impaired mucosal barrier where the mucosal glycoprotein breaks down due to increased concentrations of refluxed bile salts or uremic toxins in the setting of critical illness may be the possible pathologic changes that lead to ulceration.…”