Risk Factors

Major Risk Factors for Stress Ulcers

These are factors that significantly increase the likelihood of stress ulcer development and associated bleeding:

1. Mechanical Ventilation: Patients who require mechanical ventilation for more than 48 hours are at a substantially increased risk.
2. Coagulopathy: Conditions like thrombocytopenia (low platelet count) or disseminated intravascular coagulation (DIC) increase the risk of bleeding from stress ulcers.
   1. One of the following:
      1. Platelet count < 50,000 mm3
      2.  INR > 1.5 – not anticoagulant induced
      3.  aPTT > 2x normal value – not anticoagulant induced
3. Traumatic Brain Injury (TBI): The physiological stress response following TBI can lead to increased gastric acid production.
4. Severe Burns: Extensive burn injuries can lead to systemic inflammatory responses and reduced perfusion, increasing the risk of stress ulcers.
5. Multiple Organ Failure: Patients with multiple organ dysfunction syndrome (MODS) are at a higher risk due to compromised perfusion and increased systemic inflammation.

Minor Risk Factors for Stress Ulcers

While these factors alone may not significantly increase the risk, their presence, especially in combination with other factors, can contribute to stress ulcer development:

1. Major Surgery: Especially surgeries involving the gastrointestinal tract or those lasting more than 4 hours.
2. Sepsis: The systemic inflammatory response can compromise the gastric mucosal barrier.
3. Prolonged ICU Stay: The longer a patient stays in the ICU, the higher the cumulative exposure to multiple risk factors.
4. Acute Kidney Injury: Reduced renal function can lead to acid-base imbalances affecting the stomach.
5. History of Peptic Ulcer Disease: Patients with a history of ulcers might be at a higher risk of developing stress ulcers.
6. High-Dose Corticosteroids: These can increase gastric acid production and reduce mucosal defense.
7. Non-Steroidal Anti-Inflammatory Drugs (NSAIDs): Chronic use can compromise the gastric mucosal barrier.
8. Spinal Cord Injury: Can trigger a physiological stress response similar to TBI.

In clinical practice, the presence of one or more major risk factors often prompts consideration for stress ulcer prophylaxis. Minor risk factors, especially when present in combination, can also influence the decision to initiate prophylaxis. It’s essential to evaluate each patient’s individual risk profile to determine the best course of action.