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The incidence of SCR ranged between 0.6 and 2, 8%, having been analyzed 12 potential predictors for thisevent. Acute kidney injury (relative risk [RR] 2.38; confidence interval [IC] 95% 1.07-5.28; certainty moderate) and male gender (RR 1.24; 95%CI 1.03-1.5; low certainty) were statistically associated with high risk for SCR. After excluding studies with high probability of bias, coagulopathy (RR 4.76; 95%CI 2.62-8 .63; moderate certainty), shock (RR 2.60; 95%CI 1.25-5.42; blow certainty) and chronic liver disease (RR 7.64; 95%CI 3.32-17.58, moderate certainty) were alsoconsidered risk factors for SCR. The influence of mechanical ventilation remained uncertain(RR 1.93; 95%CI 0.57-6.5; very low certainty).
N the evaluation of the secondary outcome, EDS, occurred in a greater proportion (1.3 to 12.8%). A meta-analysis of 21 potential predictors for this event was performed of which 8 were statistically associated with high risk for EDS: coagulopathy (RR 2.13; 95%CI 1.31-3.45; moderate certainty), shock (RR 1.34; 95%CI 1.03-1.74; low certainty), sepsis (RR 1.16; 95%CI 1.02-1.32; moderate certainty), acute liver failure (RR 1.76; 95%CI 1.13-2.74; moderate certainty), chronic liver disease (RR 2.16; 95%CI 1.25-3.71; moderate certainty), acute kidney injury (RR 1.90; 95%CI 1.20-3.02; moderate certainty), male sex (RR 1.18; 95%CI 1.07-1.31; low certainty) and acute infarction myocardium (RR 1.65; 95%CI 1.41-1.93; low certainty). Similarly, the influence of mechanical ventilation remained uncertain (RR 1.11; 95%CI 0.64-1.91; very low certainty). Afterexclusion of studies with a high chance of bias, only coagulopathy (RR 4.14; 95%CI 2.69-6.90; moderate certainty), shock (RR 2.56; 95%CI 1.44-4.54; low certainty) and chronic liver disease (RR4.51; 95%CI 2.30-8.85; moderate certainty) remained as risk factors for EDS.Know more: Find out how the management of the patient with upper gastrointestinal bleeding is
In summary, the present study reaffirmed risk factors such as coagulopathy, which have already been identified since the pfirst publications on the subject. On the other hand, previously flagged risk factors such as mechanical ventilation were not ratified in this study, being raised as a hypothesis for
j to use this fact to the current adoption of mechanical ventilation protective, in addition to heterogeneity in the characteristics of mechanical ventilation in the evaluated studies, such as different times of use. In addition to factors such as acute kidney injury, shock and chronic liver disease were identified as consistent HD predictors.
What to take home
Taking into account that the The systematic prescription of PPI as stress ulcer prophylaxis is a reality in the routine of several ICUs, the analysis based on current evidence on the[IC] is valid. risk-benefit of such a measure. In this context, the identification and stratification of patients with higher risk of HD, directing to this group the use of prophylactic PPI, has been considered as a means p to institute the rational and targeted use of this therapy. Author:
Resident in General Surgery at the Hospital de Clinicas da Federal University of Southern Frontier ⦁ Multiprofessional Specialization in Primary Health Care at the Federal University of Santa Catarina ⦁ Physician at the Federal University of Ceará ⦁ President of the Brazilian Department of Academic Leagues of Cardiovascular Surgery ⦁ Junior editor of the Brazilian Journal of Blog Cardiovascular Surgery ⦁ Served as Vice President member of the Brazilian Department of Academic Leagues of Cardiovascular Surgery and president of the Cardiovascular Surgery League of the Federal University of Ceará ⦁ Trainee in Cardiac Surgery at Cleveland Clinic (USA), Mount Sinai Hospital (USA), The Heart Hospital at Baylor Plano ( USA), Hôpital Européen Georges Pompidou (France), Herzzentrum Leipzig (Germany), Papworth Hospital (England), Harefield Hospital (England), St. Thomas Hospital (England), Manchester Royal Infirmary (England), Holy House of Mercy in Porto Alegre (Brazil) and Hospital São Raimundo (Brazil) ⦁ Research internship at William Harvey Heart Center (England) ⦁ Scholarship for Sandwich Graduation by the Science without Borders Program at University of Roehampton, London ⦁ Scholarship for scientific initiation CNPq, UFC and FUNCAP of the Laboratory of Inflammation and Cancer Physiology (LAFICA).
References:
Granholm A, Zeng L, Dionne J, Perner A, Marker S, Krag M, MacLaren R, Ye Z, MollerM, Alhazzani W. Predictors of gastrointestinal bleeding in adult ICU patients: a systematicreview and meta -analysis. Intensive Care Medicine. 2019;45(10):1347-1359. It hurts:
10.1007/s00134-019-05751-6
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