Treatment with proton pump inhibitors (PPIs) is not associated with an increased risk for upper gastrointestinal bleeding (UGIB) in ICU-admitted stroke patients, and UGIB is not associated with all-cause mortality, according to study results published in Journal of Clinical Gastroenterology.

Ischemic and hemorrhagic strokes are among the top causes of disability and mortality worldwide, and relatively common in ICU admissions. UGIB is a common complication in ICU patients and is associated with a worse prognosis in stroke patients. As PPI use can lead to UGIB, researchers aimed to investigate their relationship to mortality, as well as UGIB and mortality in critically ill stroke patients.

A retrospective study was conducted based on the MIMIC-IV database, which contains information on patients admitted to ICUs at Beth Israel Deaconess Medical Center (BIDMC) between 2008 and 2019. Individuals with ischemic or hemorrhagic stroke or subarachnoid hemorrhage, diagnosed by International Classification of Diseases-9 (ICD-9), were included in the study. Those who had an ICU stay of less than 24 hours or had a nonfirst ICU admission were excluded from the study.

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A UGIB diagnosis was based on symptoms after ICU admission, such as melena or hematemesis, or a positive fecal occult test. In-hospital mortality and 30-day mortality were the primary outcomes of the study.

A total of 5716 patients diagnosed with stroke were included in the study, of which 1019 died in the hospital, accounting for an in-hospital mortality rate of 17.8%. The mean [SD] age of admitted patients was 68.5[15.7] years, with an average length of ICU stay of 12.3[13.7] days. PPI use was accounted for up to 60.6% of patients, with UGIB occurring in only 109 patients (1.9%).

Multivariable logistic analysis found several independent risk factors for the occurrence of gastrointestinal bleeding in severe stroke patents, including chronic liver disease (OR, 1.039, P <.001), sepsis (OR, 2.455, P =.002), shock (OR, 2.041, P =.004), hemoglobin (OR,.850, P =.001), and BUN (OR, 1.012, P =.004).

Comparably, several risk factors for in-hospital mortality were identified by logistic analysis, with the most prominent being mechanical ventilation (OR, 3.313, P <.001), continuous renal replacement therapy (CRRT; OR, 2.208, P =.001), heart failure (OR, 1.418, P =.004), and shock (OR, 1.406, P =.013).

Of note, PPI use was not associated with the occurrence of UGIB, and UGIB itself was not associated with all-cause mortality.

Study limitations include the single-center design, so selection bias is possible. Additionally, functional outcomes of poststroke patients are unknown, as there was no long-term follow-up provided in the database.

PPI was not the risk factor for the occurrence of UGIB,” study authors wrote. “UGIB was also not associated with all-cause mortality. Definitive recommendations need further clinical trials to evaluate benefits of using PPI in critically ill stroke patients with low incidence of UGIB.”


Chen Z, Lin W, Zhang F, Cao W. Risk factors and prognosis analysis of upper gastrointestinal bleeding in patients with acute severe cerebral strokeJ Clin Gastroenterol. Published online June 22, 2023. doi:10.1097/MCG.0000000000001877

This article originally appeared on Gastroenterology Advisor