Czempik Piotr F, Buś Karolina, Dzięcioł Karina, Gołda Mikołaj, Osicki Jan, Wosiewicz Piotr
Department of Anesthesiology and Intensive Care, Faculty of Medical Sciences in Katowice, Medical University of Silesia, Medyków 14, Katowice, 40-752, Poland.
Transfusion Committee, University Clinical Center of Medical University of Silesia in Katowice, Medyków 14, Katowice, 40-752, Poland.
BMC Gastroenterol. 2024 Dec 18;24(1):464. doi: 10.1186/s12876-024-03567-3.
Pharmacologic prophylaxis for gastric ulcer is commonly prescribed in patients hospitalized in the intensive care unit (ICU). The aim of the study was to assess the current prevalence and risk factors for gastric mucosa lesion in ICU patients receiving standard pharmacologic prophylaxis undergoing endoscopy for percutaneous gastrostomy implantation.
Patients hospitalized in the mixed medical-surgical ICU undergoing percutaneous endoscopic gastrostomy (PEG) were analyzed. We excluded patients receiving either no or high doses of intravenous proton pump inhibitor (PPI), only patients receiving standard doses of PPI were included. Data retrieved from the electronic medical records included: demographics, risk factors for gastric mucosa lesion (use of stimulants, comorbidities, medications, treatment methods in the ICU, laboratory derangements) and endoscopic findings. The study compared a group of patients with gastric mucosa lesions (cases) vs. patients without gastric mucosa lesions (controls). Inter-group comparisons between cases and controls were performed. Depending on the type of distribution continuous variables were assessed using two-sample t-test or Mann-Whitney test, whereas categorical variables with Chi-squared or Fisher exact test. Odds ratio (OR) with 95% confidence interval (95% CI) were calculated. Statistical significance was assumed at p < 0.05.
Patients with no prophylaxis (n = 8) or receiving high doses (> 40 mg per day) of proton pump inhibitor (n = 2) were excluded. There were 182 patients receiving standard intravenous dose of PPI, 63 (34.6%) women and 119 (65.4%) men, with median age 61.5 (interquartile range IQR 46.0-70.0) years. Majority of patients (n = 169, 92.9%) were receiving pharmacological prophylaxis for venous thromboembolism. There were 53 (29.1%) patients with gastric mucosa lesion. The only risk factor that was significantly different between cases and controls was history of gastric ulcer (p = 0.04) with OR 3.8 (95% CI 1.1-12.5; p = 0.03).
Majority of various risk factors for gastric ulceration may not predict gastric mucosa lesion in ICU patients receiving standard pharmacological prophylaxis undergoing endoscopy for PEG implantation. We found that history of gastric ulcer may be a risk factor for gastric ulceration in the ICU patients. Patients with history of gastric ulcer might benefit from higher than standard doses of anti-ulcer medication when hospitalized in the ICU.
在重症监护病房（ICU）住院的患者中，通常会开具胃溃疡的药物预防处方。本研究的目的是评估在接受标准药物预防并因经皮胃造口术植入而接受内镜检查的ICU患者中，胃黏膜病变的当前患病率和危险因素。
对在综合内科-外科ICU住院并接受经皮内镜下胃造口术（PEG）的患者进行分析。我们排除了未接受或接受高剂量静脉质子泵抑制剂（PPI）的患者，仅纳入接受标准剂量PPI的患者。从电子病历中检索的数据包括：人口统计学资料、胃黏膜病变的危险因素（使用兴奋剂、合并症、药物、ICU治疗方法、实验室检查异常）和内镜检查结果。该研究将一组有胃黏膜病变的患者（病例组）与无胃黏膜病变的患者（对照组）进行比较。对病例组和对照组进行组间比较。根据分布类型，连续变量使用两样本t检验或曼-惠特尼检验进行评估，分类变量使用卡方检验或费舍尔精确检验进行评估。计算比值比（OR）及其95%置信区间（95%CI）。p < 0.05被认为具有统计学意义。
排除未接受预防（n = 8）或接受高剂量（> 40毫克/天）质子泵抑制剂（n = 2）的患者。有182例接受标准静脉剂量PPI的患者，其中63例（34.6%）为女性，119例（65.4%）为男性，中位年龄61.5岁（四分位间距IQR 46.0 - 70.0）。大多数患者（n = 169，92.9%）正在接受静脉血栓栓塞的药物预防。有53例（29.1%）患者有胃黏膜病变。病例组和对照组之间唯一有显著差异的危险因素是胃溃疡病史（p = 0.04），OR为3.8（95%CI 1.1 - 12.5；p = 0.03）。
在接受标准药物预防并因PEG植入而接受内镜检查的ICU患者中，大多数胃溃疡的各种危险因素可能无法预测胃黏膜病变。我们发现胃溃疡病史可能是ICU患者胃溃疡的一个危险因素。有胃溃疡病史的患者在ICU住院时可能从高于标准剂量的抗溃疡药物中获益。
