Postoperative acute gastrointestinal tract hemorrhage and multiple-organ failure

E. Bumaschny, G. Doglio, J. Pusajo, L. Vetere, C. Parra, R. M. Grosso and E. Schieppati
Intensive Care Service, Hospital Israelita Ezrah, Buenos Aires.

Acute upper gastrointestinal tract hemorrhage (AUGH) was evaluated postoperatively in 720 critically ill patients and correlated with multiple-organ failure (MOF). The AUGH incidence was 20.1%. Patients were divided into three groups. Group 1 (n = 77) patients were admitted without AUGH, but developed MOF and later AUGH, with renal failure as the most common previous failure. Group 2 (n = 36) patients were admitted with AUGH and other failures. Group 3 (n = 32) patients were admitted without AUGH, which appeared as the first or only failure. Means +/- SDs for MOF and mortality for groups 1, 2, and 3, respectively, were as follows: 3.2 +/- 0.8, 75.3%; 3.2 +/- 1.1, 63.9%; and 1.8 +/- 0.8, 28.1%. A control group (n = 90) with MOF but without AUGH presented 1.8 +/- 0.9 for MOF and 41.1% mortality. Mortality, sepsis, and mean MOF were higher in AUGH cases and lower in group 3 vs groups 1 and 2. Acute upper gastrointestinal tract hemorrhage is a component of MOF (Baue's syndrome) that is closely related to sepsis particularly after abdominal surgery.