Tlili B, Fredj H, Mokline A, Galai H, Zarouk S, Gasri B, Jemi I, Messadi A A
Major Burns ICU, Center for Traumatology and Major Burns, Ben Arous, Tunisia.
Ann Burns Fire Disasters. 2025 Mar 31;38(1):38-45. eCollection 2025 Mar.
Upper gastrointestinal bleeding (UGIB) is a rare complication of the ICU stay. Our objective was to study the epidemiological, clinical manifestations, and evolutionary characteristics of UGIB, and identify its risk factors in severely burned patients. This is a retrospective case-control study of burned patients in the ICU in Tunisia over a period of 6 years, including all adult patients with severe burns who presented at least one episode of gastrointestinal bleeding. The control group consisted of severely burned patients with no gastrointestinal bleeding during their ICU stay. The two groups were matched according to age, gender and extent of burns. The incidence of gastrointestinal bleeding was 2.3% with an average time of onset of 19±17 days. Esophagogastroduodenoscopy was performed in 45 patients showing bulbar ulcer, gastric ulcer, and oesophageal ulcerations in respectively 28, 8 and 3 patients. In the multivariate study, acute kidney injury (OR 13.8, CI [2.9-67], p=0.001), fluid intake <2 ml/kg/%TBSA over the first 24h (OR 10, IC [1.5-68.5], p=0.019), and length of ICU stay >10 days (OR 48.2, IC [4.4-530], p=0.002) were independent risk factors for the occurrence of gastrointestinal bleeding. Mortality in the UGIB group was higher (55.8% vs 25%, p=0.001). Upper gastrointestinal bleeding is a serious complication of a burn patient's ICU stay. Acute renal failure, low fluid intake in the first 24h, and a long duration of ICU stay were independent risk factors for its occurrence.
上消化道出血（UGIB）是重症监护病房（ICU）住院期间的一种罕见并发症。我们的目的是研究UGIB的流行病学、临床表现及演变特征，并确定重度烧伤患者发生UGIB的危险因素。这是一项对突尼斯ICU内烧伤患者进行的为期6年的回顾性病例对照研究，纳入了所有出现至少一次胃肠道出血的重度成年烧伤患者。对照组由在ICU住院期间未发生胃肠道出血的重度烧伤患者组成。两组根据年龄、性别和烧伤程度进行匹配。胃肠道出血的发生率为2.3%，平均发病时间为19±17天。45例患者接受了食管胃十二指肠镜检查，分别有28例、8例和3例显示球部溃疡、胃溃疡和食管溃疡。在多因素研究中，急性肾损伤（OR 13.8，CI[2.9 - 67]，p = 0.001）、伤后24小时内液体摄入量<2 ml/kg/%TBSA（OR 10，IC[1.5 - 68.5]，p = 0.019）以及ICU住院时间>10天（OR 48.2，IC[4.4 - 530]，p = 0.002）是发生胃肠道出血的独立危险因素。UGIB组的死亡率更高（55.8%对25%，p = 0.001）。上消化道出血是烧伤患者ICU住院期间的一种严重并发症。急性肾衰竭、伤后24小时内低液体摄入量以及长时间的ICU住院是其发生的独立危险因素。
