The clinical and economic consequences of clinically important gastro-intestinal bleeding in critically ill patients

Objective: To evaluate the clinical and economic consequences of clinically important gastro-intestinal bleeding (CIB) in patients admitted to the intensive care unit (ICU). Design: Prospective, cohort study. Setting: Four university-affiliated hospitals in Canada. Patients and methods: Consecutive patients over 16 years of age admitted to the ICU were followed to document CIB events (defined as overt bleeding in association with haemodynamic compromise or the need for blood transfusion) and hospital resources consumed secondary to CIB. To determine the prolongation of ICU stay and excess mortality attributable to CIB, we matched patients who bled with control patients. Cost estimates for resources consumed per CIB patient were derived from hospital costing data. Measurements and results: Of the 2,252 patients in the study, 33 developed CIB (1.5% [95% confidence interval, 1.0-2.1%]). On average, each bleeding episode resulted in an excess of 6.6 haematology tests, 10.8 Units of transfusion products and 23.6 days of anti-ulcer medication. Twenty-one patients had 25 endoscopies and 10 patients had 11 gastro-intestinal operations. Prolongation of ICU stay due to CIB was 11.4 days in those patients who lived. There was a trend towards increased risk of death in patients with CIB (relative risk increase of 12.5% [95% confidence interval, -38.0 to 63.0%]). The total cost of a CIB per patient was $12,215.60 ($Canadian). Conclusions: CIB results in significant morbidity and increased health care costs, and may marginally increase mortality.