{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,31]],"date-time":"2026-10-31T01:31:51Z","timestamp":1793410311909,"version":"4.5.0"},"reference-count":45,"publisher":"Oxford University Press (OUP)","issue":"9","license":[{"start":{"date-parts":[[2026,1,18]],"date-time":"2026-01-18T00:00:00Z","timestamp":1768694400000},"content-version":"vor","delay-in-days":139,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000024","name":"Canadian Institutes of Health Research","doi-asserted-by":"publisher","award":["201610PJT-378226-PJT-CEBA-18373"],"award-info":[{"award-number":["201610PJT-378226-PJT-CEBA-18373"]}],"id":[{"id":"10.13039\/501100000024","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000024","name":"Canadian Institutes of Health Research","doi-asserted-by":"publisher","award":["202207CL3-492565-CTP-CEBA-19215"],"award-info":[{"award-number":["202207CL3-492565-CTP-CEBA-19215"]}],"id":[{"id":"10.13039\/501100000024","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000925","name":"National Health and Medical Research Council of Australia","doi-asserted-by":"publisher","award":["GNT1124675"],"award-info":[{"award-number":["GNT1124675"]}],"id":[{"id":"10.13039\/501100000925","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000024","name":"Canadian Institutes of Health Research","doi-asserted-by":"crossref","award":["201610PJT-378226-PJT-CEBA-18373"],"award-info":[{"award-number":["201610PJT-378226-PJT-CEBA-18373"]}],"id":[{"id":"10.13039\/501100000024","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/501100000024","name":"Canadian Institutes of Health Research","doi-asserted-by":"crossref","award":["202207CL3-492565-CTP-CEBA-19215"],"award-info":[{"award-number":["202207CL3-492565-CTP-CEBA-19215"]}],"id":[{"id":"10.13039\/501100000024","id-type":"DOI","asserted-by":"crossref"}]},{"name":"National Health and Medical Research Council of Australia","award":["GNT1124675"],"award-info":[{"award-number":["GNT1124675"]}]}],"content-domain":{"domain":["www.atsjournals.org"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2025,9,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Rationale<\/jats:title>\n                    <jats:p>Patient-important gastrointestinal bleeding is an endpoint developed by patients and family members; however, risk factors for this outcome are unknown.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>We sought to identify risk factors for patient-important upper gastrointestinal bleeding among invasively ventilated adults.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This preplanned regression analysis of an international trial database evaluated baseline and time-varying risk factors in the preceding 3 days for patient-important upper gastrointestinal bleeding, accounting for illness severity and the competing risk of death.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Measurements and Main Results<\/jats:title>\n                    <jats:p>Patient-important upper gastrointestinal bleeding occurred in the ICU among 131 of 4,821 (2.7%) patients. Baseline APACHE II score\u2014hazard ratio (HR), 1.24 (95% confidence interval [CI]\u2009=\u20091.12, 1.37) per 5-point increase\u2014and the following were associated with greater risk of patient-important bleeding: inotropes or vasopressors (HR, 2.05 [95% CI\u2009=\u20091.35, 3.12]), severe thrombocytopenia (platelet count, &amp;lt;50\u2009\u00d7\u2009109\/L) (HR, 2.21 [95% CI\u2009=\u20091.24, 3.94]) and platelet inhibitor drugs (HR, 1.69 [95% CI\u2009=\u20091.11, 2.56]). A lower bleeding risk was associated with pantoprazole (HR, 0.36 [95% CI\u2009=\u20090.25, 0.54]) and enteral nutrition (HR, 0.81 [95% CI\u2009=\u20090.68, 0.97]) for every increase of 500 ml\/d. There was no interaction between enteral nutrition and pantoprazole (interaction P\u2009=\u20090.94). Allocation to pantoprazole was associated with a lower risk of patient-important upper gastrointestinal bleeding regardless of the volume of enteral nutrition (for 500 ml\/d: HR, 0.36 [95% CI\u2009=\u20090.22, 0.58]; for no enteral nutrition: HR, 0.36 [95% CI\u2009=\u20090.18, 0.72]). The association of enteral nutrition and bleeding was similar with pantoprazole (HR, 0.82 [95% CI\u2009=\u20090.63, 1.07]) or without pantoprazole (HR, 0.81 [95% CI\u2009=\u20090.66, 1.00]).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Several factors are associated with the risk of patient-important upper gastrointestinal bleeding during invasive ventilation.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1164\/rccm.202411-2245oc","type":"journal-article","created":{"date-parts":[[2025,4,18]],"date-time":"2025-04-18T18:27:01Z","timestamp":1745000821000},"page":"1671-1680","update-policy":"https:\/\/doi.org\/10.1164\/crossmarkpolicies","source":"Crossref","is-referenced-by-count":13,"title":["Risk Factors for Patient-Important Upper Gastrointestinal Bleeding"],"prefix":"10.1093","volume":"211","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7620-5577","authenticated-orcid":false,"given":"Adam M.","family":"Deane","sequence":"first","affiliation":[{"name":"Department of Critical Care, Melbourne Medical School, University of Melbourne, Melbourne, Victoria, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6530-5513","authenticated-orcid":false,"given":"Fran\u00e7ois","family":"Lauzier","sequence":"additional","affiliation":[{"name":"D\u00e9partement de m\u00e9decine et D\u00e9partement d\u2019anesth\u00e9siologie et de soins intensifs, Universit\u00e9 Laval, Qu\u00e9bec, Qu\u00e9bec, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4038-5382","authenticated-orcid":false,"given":"Neill K. J.","family":"Adhikari","sequence":"additional","affiliation":[{"name":"Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0360-3427","authenticated-orcid":false,"given":"Fran\u00e7ois","family":"Lamontagne","sequence":"additional","affiliation":[{"name":"D\u00e9partement de soins intensifs, Universit\u00e9 de Sherbrooke, Sherbrooke, Qu\u00e9bec, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4362-801X","authenticated-orcid":false,"given":"Diane","family":"Heels-Ansdell","sequence":"additional","affiliation":[{"name":"Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, 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