Risk Factors for Stress Ulceration in the ICU

 2006-2007, Institute for Algorithmic Medicine, Houston, TX, USA.

Certain risk factors may predispose a patient in the intensive care unit (ICU) for mucosal stress ulcerations that result in gastrointestinal hemorrhage. These patients may benefit from closer monitoring for bleeding and prophylaxis.

Risk factors for stress ulceration for a patient in the ICU:

1. mechanical ventilation

2. coagulopathy

3. head injury with Glasgow coma score <= 10 or inability to obey simple commands

4. thermal burn involving > 35% of body surface area

5. partial hepatectomy

6. transplantation patient perioperatively

7. multiple trauma with injury severity score >= 16

8. spinal cord injury

9. hepatic failure

10. past history of gastric ulceration or gastric bleeding during the year prior to admission

11. 2 or more of the following findings: ICU stay > 7 days, sepsis, use of high-dose corticosteroids (equivalent to > 250 mg per day of hydrocortisone), or occult or overt bleeding for >= 6 days

 References:

ASHP therapeutic guidelines on stress ulcer prophylaxis. pages 579-609 (page 585-586). IN: Deffenbaugh JH (editor) Best Practices for Health-System Pharmacy, 2002-2003 Edition. American Society for Health System Pharmacists. 2003.

Cook DJ. 17.1.26 Stress ulcer prophylaxis and antiulcer drugs. pages 1277-1280. IN: Webb AR, Shapiro MJ, et al (editors). Oxford Textbook of Critical Care. Oxford University Press. 1999.