Risk Factors for Nosocomial Gastrointestinal Bleeding and Use of Acid-Suppressive Medication in Non-Critically Ill Patients
| Autor: | Michael B. Rothberg, Long Ngo, David Feinbloom, Kalon K.L. Ho, Edward R. Marcantonio, Michael D. Howell, Shoshana J. Herzig |
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| Rok vydání: | 2013 |
| Předmět: |
Adult
Male medicine.medical_specialty Gastrointestinal bleeding Adolescent Comorbidity Risk Assessment Decision Support Techniques law.invention Young Adult Risk Factors law Internal Medicine Humans Medicine Young adult Intensive care medicine Aged Antiulcer agents Aged 80 and over Academic Medical Centers business.industry Critically ill Middle Aged medicine.disease Intensive care unit Drug Utilization Hospitalization Massachusetts Acid suppression Capsule Commentaries Female Antacids Gastrointestinal Hemorrhage business Risk assessment |
| Zdroj: | Journal of General Internal Medicine. 28:683-690 |
| ISSN: | 1525-1497 0884-8734 |
| Popis: | It is unknown whether there exist certain subsets of patients outside of the intensive care unit in whom the risk of nosocomial gastrointestinal bleeding is high enough that prophylactic use of acid-suppressive medication may be warranted.To identify risk factors for nosocomial gastrointestinal bleeding in a cohort of non-critically ill hospitalized patients, develop a risk scoring system, and use this system to identify patients most likely to benefit from acid suppression.Cohort study.Adult patients admitted to an academic medical center from 2004 through 2007. Admissions with a principal diagnosis of gastrointestinal bleeding or a principal procedure code for cardiac catheterization were excluded.Medication, laboratory, and other clinical data were obtained through electronic data repositories maintained at the medical center. The main outcome measure-nosocomial gastrointestinal bleeding occurring outside of the intensive care unit-was ascertained via ICD-9-CM coding and confirmed by chart review.Of 75,723 admissions (median age = 56 years; 40 % men), nosocomial gastrointestinal bleeding occurred in 203 (0.27 %). Independent risk factors for bleeding included age60 years, male sex, liver disease, acute renal failure, sepsis, being on a medicine service, prophylactic anticoagulants, and coagulopathy. Risk of bleeding increased as clinical risk score derived from these factors increased. Acid-suppressive medication was utilized in50 % of patients in each risk stratum. Our risk scoring system identified a high risk group in whom the number-needed-to-treat with acid-suppressive medication to prevent one bleeding event was100.In this large cohort of non-critically ill hospitalized patients, we identified several independent risk factors for nosocomial gastrointestinal bleeding. With further validation at other medical centers, the risk model derived from these factors may help clinicians to direct acid-suppressive medication to those most likely to benefit. |
| Databáze: | OpenAIRE |
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