Heterogeneous treatment effects of stress ulcer prophylaxis among ICU patients at risk for gastrointestinal bleeding

1. In patients admitted to the intensive care unit (ICU) with at least one risk factor for clinically significant gastrointestinal bleeding (GIB), the impact of stress ulcer prophylaxis (SUP) on 28-day mortality was greatest in those who were younger, had chronic liver disease, coagulopathy or malignancy. 

Evidence Rating Level: 2 (Good)

While GIB can contribute to critical illness or death, SUP may also increase the rate of adverse events such that it is difficult to delineate whether benefits of SUP justify its application in such patients. A previous clinical trial has shown benefits for SUP in ICU patients with risk factors for GIB. However, significant heterogeneity in treatment effect was observed depending on patient characteristics. This retrospective cohort study therefore sought to identify which patients would benefit most from SUP. Records of 25,475 patients (median[IQR] age, 66[55-77] years) with at least 1 risk factor for GIB were obtained from a comprehensive database from the Beth Israel Deaconess Medical Centre, Boston and analyzed for 28-day mortality after ICU entry. When analyzed based on subgroups, the impact of SUP on 28-day mortality was markedly different in patients older than 77 compared to other age groups (posterior probability of difference in OR, 99.3%), in patients with liver disease compared to those without (median OR, 0.87 vs 1.07; posterior probability of difference in OR, 99.9%), in patients with coagulopathy compared to those without (median OR, 0.95 vs 1.09; posterior probability of difference in OR, 92.1%) and in those with malignancy compared to those without (median OR 0.57 vs 1.20, posterior probability of difference in OR, 100%). Overall, this study found that among patients admitted to ICU with at least one risk factor for clinically significant GIB, the impact of SUB on 28-day mortality was greatest in younger patients and patients who had chronic liver disease, coagulopathy or malignancy.

Click to read the study in BMC Medicine

Image: PD

©2025 2 Minute Medicine, Inc. All rights reserved. No works may be reproduced without expressed written consent from 2 Minute Medicine, Inc. Inquire about licensing here. No article should be construed as medical advice and is not intended as such by the authors or by 2 Minute Medicine, Inc.