RISK-FACTORS FOR UPPER GASTROINTESTINAL-BLEEDING IN INTENSIVE-CARE UNIT PATIENTS - ROLE OF HELICOBACTER-PYLORI

Objective: To determine the role of preexisting Helicobacter pylori in fection in the development of acute upper gastrointestinal (GI) hemorr hage in intensive care unit (ICU) patients in relation to other potent ial predisposing risk factors, Design: Prospective, multicenter, cohor t study, Setting: Medical and surgical ICUs in six tertiary care Depar tment of Veterans Affairs Medical Centers, Patients: Eight hundred sev enty-four patients without previous GI bleeding or peptic ulcer diseas e who were enrolled in a multicenter, randomized, controlled trial of prophylactic intravenous immunoglobulin to prevent ICU-associated infe ctions, Interventions: This substudy of the larger intravenous immunog lobulin study only involved data analysis and had no intervention, All patients were enrolled in the larger study where they received intrav enous immunoglobulin or placebo as intervention, Measurements and Main Results: Patients were prospectively evaluated for the development of acute upper GI hemorrhage while in an ICU, Anti-H. pylori immunoglobu lin G and immunoglobulin A concentrations were determined by enzyme im munoassay on preintervention serum samples, Seventy-six (9%) patients had overt upper GI bleeding and a mortality rate of 49%, as compared w ith a 15% mortality rate in patients who did not bleed (p < .001), By logistic regression analysis, the following factors were associated wi th an increased risk of bleeding: acute hepatic failure, prolonged dur ation of nasogastric tube placement, alcoholism and an increased serum concentration of anti-H. pylori immunoglobulin A. Conclusions: Increa sed anti-H. pylori immunoglobulin A concentrations, prolonged nasogast ric intubation, alcoholism, and acute hepatic failure were found to be independently correlated with the development of acute GI bleeding in an ICU setting, These observations should be prospectively confirmed in an Independent population before being used for treatment guideline s.