Incidence and Predictors of GI Bleeding Among Septic Shock Patients of United States: A 10-Year Analysis of Nationwide Inpatient Population

Siddiqui, Abdul Hasan; Siddiqui, Faraz; Abbasi, Saqib; Khan, Tahir; Ahmed, Moiz; Alhajri, Sana; Wiesel, Shimshon; Narula, Naureen; Memon, Asma; Chalhoub, Michel

doi:10.1016/j.chest.2017.08.424

Cited by 3 publications

(8 citation statements)

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“…46 Siddiqui et al showed patients with septic shock who developed UGI bleeding had significantly higher in-hospital mortality than patients without bleeding (54% vs 45%, P < .001). 14 In line with their findings, we showed that the negative impact may extend to patients with BSI with or without septic shock. We showed that patients with BSI and UGI bleeding had increased mortality than patients without UGI bleeding independent of underlying demographics or comorbidities.…”

Section: Discussionsupporting

confidence: 89%

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Survival Impact and Clinical Predictors of Acute Gastrointestinal Bleeding in Patients With Bloodstream Infection

Huang

Liu

Hsien

et al. 2019

J Intensive Care Med

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Purpose: The impact of gastrointestinal bleeding (GIB) on outcomes of patients with bloodstream infection (BSI) has not been studied. We aim to evaluate the risk factors and survival impact of GIB on the outcome of BSI. Materials and Methods: This study was conducted prospectively at National Taiwan University Hospital Yunlin Branch between January 1, 2015, and December 31, 2016. Patients aged ≥18 years for who BSI was confirmed by blood cultures were enrolled and followed for 90 days. Risk factors of GIB were identified by univariable and multivariable logistic regression models. The survival impact of GIB on BSI was evaluated with the Cox proportional hazards model with inverse probability of treatment weighting. Results: Of the 1034 patients with BSI, 79 (7.64%) developed acute GIB. We identified 5 independent predictors of GIB. Patients with BSI complicated with GIB had an increased 90-day mortality compared to patients without GIB (hazard ratio 1.74, 95% confidence interval: 1.14, 2.65). Conclusions: Gastrointestinal bleeding had an adverse impact on the short-term survival in patients with BSI. The clinical predictors may help identify patients who may benefit from active prevention and treatment of GIB.

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Section: Discussionsupporting

confidence: 89%

“…[10][11][12] The prevalence of overt UGI bleeding is 0.17% to 6% among critically ill patients. [13][14][15][16] In these patients, clinically significant upper GI bleeding is associated with a 7-fold increase in mortality. 17 Despite these findings, the impact of UGI bleeding on the outcomes of BSI has not been well evaluated.…”

Section: Introductionmentioning

confidence: 99%

Survival Impact and Clinical Predictors of Acute Gastrointestinal Bleeding in Patients With Bloodstream Infection

Huang

Liu

Hsien

et al. 2019

J Intensive Care Med

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“…A database analysis of patients with septic shock in the USA by Siddiqui et al reported that the incidence of GIB was 5.4% (6,571/119,684) in those hospitalized patients between 2003 and 2012. The occurrence of GIB was associated with a 9% increase in mortality from 45% to 54% [ 5 ]. In this study, the GIB occurred in 3.80% of the patients, and the occurrence of GIB increased mortality to 46% compared with 39% in uncomplicated sepsis.…”

Section: Discussionmentioning

confidence: 99%

“…GIB is not an infrequent complication of sepsis patients, and it increases the complexity of care. Siddiqui et al found that GIB increased the length of hospital stay from 15.76 to 20.56 days [ 5 ]. Consequently, effective GIB prophylaxis is important, and PPIs may be of use.…”

Section: Discussionmentioning

confidence: 99%

“…An analysis of over 119,000 patients hospitalized with sepsis between 2003 and 2012 and included in a nationwide database in the USA estimated that the incidence of GIB was 5.4% (6,571/119,684 patients). Concurrent GIB was found to increase sepsis mortality by 9% [ 5 ]. Sepsis-associated atrial fibrillation, coagulopathy, hemodynamic instability, and prolonged systemic inflammation act to trigger acute ischemic stroke.…”

Section: Introductionmentioning

confidence: 99%

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Occurrence and Impact of Gastrointestinal Bleeding and Major Adverse Cardiovascular Events during Sepsis: A 15-Year Observational Study

Hsieh

Liao

Hsieh

et al. 2020

Emergency Medicine International

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Objective. Sepsis patients are at risk of gastrointestinal bleeding (GIB) and major adverse cardiovascular events (MACEs), but few data are available on the occurrence of GIB and MACEs and their impact on sepsis outcomes. Methods. The medical claims records of 220,082 patients admitted for sepsis between 1999 and 2013 were retrieved from the nationwide database. The adjusted odds ratios (aORs) of composite outcomes including the hospital mortality, intensive care unit (ICU) admission, and mechanical ventilation (MV) in patients with a MACE or GIB were estimated by multivariate logistic regression and joint effect analyses. Results. The enrollees were 70.15 ± 15.17 years of age with a hospital mortality rate of 38.91%. GIB developed in 3.80% of the patients; MACEs included ischemic stroke in 1.54%, intracranial hemorrhage (ICH) in 0.92%, and acute myocardial infarction (AMI) in 1.59%. Both ICH and AMI significantly increased the risk of (1) ICU admission (aOR = 8.02, 95% confidence interval (CI): 6.84–9.42 for ICH and aOR = 4.78, 95% CI: 4.21–5.42 for AMI, respectively), (2) receiving MV (aOR = 3.92, 95% CI: 3.52–4.40 and aOR = 1.99, 95% CI: 1.84–2.16, respectively), and (3) the hospital mortality (aOR = 1.08, 95% CI: 0.98–1.19 and aOR = 1.11, 95% CI: 1.03–1.19, respectively). However, sepsis with GIB or ischemic stroke increased only the risk of ICU admission and MV but not the hospital mortality (aOR = 0.98, 95% CI: 0.93–1.03 for GIB and aOR = 0.84, 95% CI: 0.78–0.91 for ischemic stroke, respectively). Conclusions. GIB and MACEs significantly increased the risk of ICU admission and receiving MV but not the hospital mortality, which was independently associated with both AMI and ICH. Early prevention can at least reduce the complexity of clinical course and even the hospital mortality.

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Hemostasis without clot formation: how platelets guard the vasculature in inflammation, infection, and malignancy

Kaiser,

Escaig,

Nicolai

2023

Blood

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Platelets are key vascular effectors in hemostasis, with activation signals leading to fast recruitment, aggregation, and clot formation. The canonical process of hemostasis is well characterized and shares many similarities with pathological thrombus formation. However, platelets are also crucially involved in the maintenance of vascular integrity under both steady state and inflammatory conditions by ensuring blood vessel homeostasis and preventing microbleeds. In these settings, platelets use distinct receptors, signaling pathways and ensuing effector functions to carry out their deeds: Instead of simply forming clots, they mainly act as individual sentinels that swiftly adapt their behavior to the local microenvironment. In this Review, we summarize previously recognized and more recent studies that have elucidated how anucleate, small platelets manage to maintain vascular integrity when faced with challenges of infection, sterile inflammation and even malignancy. We dissect how platelets are recruited to the vascular wall, how they identify sites of injury, and how they prevent hemorrhage as single cells. Further, we discuss mechanisms and consequences of platelets interacting with leukocytes and endothelial cells, the relevance of adhesion as well as signaling receptors, in particular ITAM receptors, and crosstalk with the coagulation system. Finally, we outline how recent insights into inflammatory hemostasis and vascular integrity may aid in the development of novel therapeutic strategies to prevent hemorrhagic events and vascular dysfunction in critically ill patients.

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Incidence and Predictors of GI Bleeding Among Septic Shock Patients of United States: A 10-Year Analysis of Nationwide Inpatient Population

Cited by 3 publications

References 0 publications

Survival Impact and Clinical Predictors of Acute Gastrointestinal Bleeding in Patients With Bloodstream Infection

Survival Impact and Clinical Predictors of Acute Gastrointestinal Bleeding in Patients With Bloodstream Infection

Occurrence and Impact of Gastrointestinal Bleeding and Major Adverse Cardiovascular Events during Sepsis: A 15-Year Observational Study

Hemostasis without clot formation: how platelets guard the vasculature in inflammation, infection, and malignancy

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