Prevalence and outcome of gastrointestinal bleeding and use of acid suppressants in acutely ill adult intensive care patients

Corresponding author:

Mette Krag, MD

Department of Intensive Care, 4131

Copenhagen University Hospital Rigshospitalet

Blegdamsvej 9

2100 Copenhagen, Denmark

+45 42405714

www.sup-icu.com

Electronic Supplementary Material


Online resource 1: Baseline variables

Online resource 2: Daily registered variables

Online resource 3: Table 1 Characteristics of participating intensive care units

Online resource 4: Table 2 Selected baseline variables in patients with early and late clinically important gastrointestinal bleeding


Online Resource 1

Baseline variables

At baseline, the following data were registered: elective or emergency surgery during current hospital stay (y/n), the variables for Simplified Acute Physiology Score (SAPS) II and Sequential Organ Failure Assessment (SOFA) scoring in the first 24 hours of ICU admission, coagulopathy (platelets < 50 x 109/l and/or INR > 1.5) during current hospital stay (y/n), use of acid suppressants at or prior to ICU admission (y/n), treatment with non-steroidal anti-inflammatory (incl. acetylsalicylic acid), anticoagulant or thrombolytic drugs upon ICU admission (y/n), co-existing diseases (y/n): chronic pulmonary disease (chronic obstructive pulmonary disease (COPD), asthma or other chronic lung disease or treatment with any relevant drug indicating this at hospital admission), previous acute myocardial infarction, severe chronic heart failure (New York Heart Association class 3-4), chronic renal failure (need of any form of renal replacement therapy (RRT) or serum creatinine > 3.6 g/dl (300 µmol/l) within the last year), chronic liver failure (liver cirrhosis or other proven structural damage and/or bilirubin > 33 µmol/l at hospital admission, metastatic carcinoma (previous or present metastatic carcinoma proven by surgery, C.T. scan or any other method), active hematologic cancer (diagnosis of lymphoma, leukaemia, multiple myeloma or myelodysplastic syndrome), immunosuppression (treatment with at least 0.3 mg/kg/day of prednisolone equivalent for at least 1 month in the 6 months prior to ICU admission); and acquired immunodeficiency syndrome (AIDS) (HIV positive with AIDS defining disease).

Baseline data were obtained from the medical records.


Online Resource 2

Daily registered variables

The following data were registered daily during ICU stay to a maximum of 90 days: circulatory support (continuous infusion of vasopressors or inotropes (norepinephrine, epinephrine, dobutamine, dopamine, vasopressin, levosimendan, phenylephrine or milrinone)) (y/n), invasive mechanical ventilation (y/n), continuous or intermittent RRT (y/n), coagulopathy (platelets < 50 x 109/l and/or INR > 1.5) (y/n), administration of acid suppressing agents (PPI, H2RA, sucralfate, antacids and prostanoids) (y/n), presence of overt GI bleeding (see definition below) (y/n), and presence of clinically significant GI bleeding (see definition below) (y/n). If GI bleeding was reported, the following additional data were registered: diagnostic or therapeutic endoscopy performed (y/n), ulcer verified (y/n), gastritis verified (y/n), oesophageal varices verified (y/n), open surgical intervention (y/n), and treatment with endovascular coiling (y/n).

Daily data and data on GI bleeding were obtained from the medical files and from the monitoring equipment used.

Days were 24 hours except from day 1 which was a partial day from inclusion until 6 AM.


Online Resource 3

Table 1. Characteristics of participating intensive care units (ICUs)

Variable / No. of units (n = 97)
Country
United Kingdom / 38 (39)
Denmark / 24 (25)
Sweden / 10 (10)
Finland / 6 (6)
Canada / 5 (5)
New Zealand / 4 (4)
Australia / 4 (4)
Norway / 2 (2)
The Netherlands / 2 (2)
Iceland / 1 (1)
Italy / 1 (1)
Type of hospital
University / 48 (49)
Teaching / 26 (27)
District or general / 23 (24)
Type of ICU
Mixed / 90 (93)
Neurosurgical / 3 (3)
Cardiothoracic / 2 (2)
Medical / 1 (1)
Cardiac / 1 (1)
Size of ICU / < 10 beds / 31 (32)
10-20 beds / 43 (44)
> 20 beds / 23 (24)

Numbers are frequencies (%)


Online Resource 4

Table 2. Selected baseline variables in patients with early and late clinically important gastrointestinal (GI) bleeding

Clinically important GI bleeding < 48 hours (n=13) / Clinically important GI bleeding > 48 hours (n=14)
At least 1 condition* / 9 / 10
Treatment with NSAID / 3 / 2
Treatment with anticoagulants / 2 / 4
Platelets < 50 x 109/L / 4 / 5
Liver cirrhosis / 1 / 4

*Conditions: treatment with NSAID, treatment with anticoagulants, platelets < 50 x 109/l and liver cirrhosis

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