Associated factors for stress ulcers and gastrointestinal bleeding in patients with sepsis or septic shock: A systematic review.

In 30 seconds

This systematic review synthesized observational cohort and case-control studies of factors associated with stress ulcers or significant gastrointestinal bleeding in adults with sepsis or septic shock. Six studies involving 131,568 patients were included; reported incidence ranged from 2.0% to 32.3%. Associated factors spanned patient characteristics, illness severity and treatments. For stress ulcers, respiratory failure, elevated BUN, shock, and increased HMGB1/TLR2/TLR4 levels were independently associated with higher odds. Because few studies addressed each association, the authors used narrative synthesis and call for further high-quality research.

Key findings

• Across six studies and 131,568 patients, stress ulcer or gastrointestinal bleeding incidence ranged from 2.0% to 32.3%.
• Stress ulcers were independently associated with respiratory failure, high BUN, shock, and increased HMGB1/TLR2/TLR4 levels.
• Reported associated factors included coagulopathy, kidney impairment, illness severity, mechanical ventilation, anticoagulants, corticosteroids, and prior gastrointestinal bleeding.

Why it matters

Sepsis-associated gastrointestinal complications occur across a broad reported incidence range, and the review identifies potential risk markers across patient, disease, and treatment domains. These findings help frame risk assessment while underscoring that the evidence is observational and does not establish that any associated factor causes bleeding or that prophylaxis improves outcomes.

What to keep in mind

Only six observational studies were included, and the limited number of studies for individual associations required narrative rather than quantitative synthesis.