Risk factors for major gastrointestinal bleeding in septic patients: a multicenter retrospective study.

INTRODUCTION

Major gastrointestinal bleeding (MGB) is a critical complication of sepsis that is associated with a poor prognosis. We aimed to identify independent predictors of MGB in a large multicenter cohort of septic patients to facilitate clinical risk stratification.

MATERIALS AND

METHODS

This retrospective study analyzed data collected from four tertiary hospitals in China between 2016 and 2023. Data on patient demographics, comorbidities, infection sources, admission laboratory parameters and treatments were collected. The primary outcome was MGB within 28 d, defined as overt bleeding with a hemoglobin drop >20 g/L or transfusion requirement.

RESULTS

Of 10,249 eligible patients, 205 (2.0%) developed MGB. In-hospital mortality was significantly higher in the MGB group compared to the non-MGB group (44.0% vs. 17.0%, p < 0.001). Multivariable analysis identified independent risk factors for MGB: renal dysfunction (aOR 1.61), malignancy or immunosuppression (aOR 1.55), gastrointestinal infection (aOR 1.50), elevated blood urea nitrogen (BUN; aOR 1.03) and older age (aOR 1.01). Conversely, urinary tract infection (aOR 0.29) and higher baseline hemoglobin (HGB) levels (aOR 0.99) were associated with a lower risk. The predictive model achieved an area under the curve (AUC) of 0.702.

CONCLUSIONS

Although MGB occurred in only 2.0% of septic patients, it was associated with substantially higher mortality. Older age, renal dysfunction, elevated BUN and gastrointestinal sources were key drivers of risk, while urinary tract infection was associated with a lower risk. These findings underscore the importance of early risk stratification and targeted preventive strategies in high-risk patients to mitigate bleeding events and improve survival.