Helicobacter pylori infection is not associated with an increased hemorrhagic risk in patients in the intensive care unit
1 Réanimation Médicale, CHU Poitiers, 2 rue de la milèterie, BP 577 86021 Poitiers cedex France
2 Réanimation Polyvalente, Hopital Girac 16140 Saint Michel France
3 Réanimation Médicale, CHU Angers 4 rue Larrey 49100 Angers France
4 Réanimation Chirurgicale, CHU Poitiers, 2 rue de la milèterie, BP 577, 86021 Poitiers cedex France
5 Réanimation Médicale, CHU Bretonneau, 2 Boulevard Tonnelé 37044 Tours, France
6 Réanimation Médicale, CHU de la Cavale Blanche rue Tanguy Pringent 29200 Brest, France
7 Réanimation Médicale, CHU Nantes, 1 place Alexis Ricordeau 44093 Nantes cedex, France
8 Réanimation Polyvalente, Centre hospitalier de Saintes, 9 place du 11 novembre BP 326, 17108 Saintes cedex, France
9 Réanimation Polyvalente Chateauroux, Centre hospitalier de Chateauroux 216 avenue de verdun 36000 Chateauroux, France
10 Réanimation Polyvalente Limoges, CHU Dupuytren 2 avenue Martin Luther King 87042 Limoges cedex, France
11 Réanimation Polyvalente Niort, 40 avenue du général de Gaulle 79000 Niort, France
12 Laboratoire de Microbiologie A EA 3807, CHU Poitiers, 2 rue de la milèterie, BP 577, 86021 Poitiers cedex France
Critical Care 2006, 10:R77 doi:10.1186/cc4920Published: 16 May 2006
The potential role of Helicobacter pylori in acute stress ulcer in patients in an intensive care unit (ICU) is controversial. The aim of this study was to determine the frequency of H. pylori infection in ICU patients by antigen detection on rectal swabs, and to analyze the potential relationship between the presence of H. pylori and the risk of digestive gastrointestinal bleeding.
In this prospective, multicenter, epidemiological study, the inclusion criteria were as follows: patients admitted to the 12 participating ICU for at least two days, who were free of hemorrhagic shock and did not receive more than four units of red blood cells during the day before or the first 48 hours after admission to the ICU. Rectal swabs were obtained within the first 24 hours of admission to the ICU and were tested for H. pylori antigens with the ImmunoCard STAT! HpSA kit. The following events were analyzed according to H. pylori status: gastrointestinal bleeding, unexplained decline in hematocrit, and the number of red cell transfusions.
The study involved 1,776 patients. Forty-nine patients (2.8%) had clinical evidence of upper digestive bleeding. Esophagogastroduodenoscopy was performed in 7.6% of patients. Five hundred patients (28.2%) required blood transfusion. H. pylori antigen was detected in 6.3% of patients (95% confidence interval 5.2 to 7.5). H. pylori antigen positivity was associated with female sex (p < 0.05) and with a higher Simplified Acute Physiology Score II (SAPS II; p < 0.05). H. pylori antigen status was not associated with the use of fiber-optic gastroscopy, the need for red cell transfusions, or the number of red cell units infused.
This large study reported a small percentage of H. pylori infection detected with rectal swab sampling in ICU patients and showed that the patients infected with H. pylori had no additional risk of gastrointestinal bleeding. Thus H. pylori does not seem to have a major role in the pathogenesis of acute stress ulcer in ICU patients.