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Peer-reviewedCC BYPLOS One

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

  • Jin Wang1
  • Xingwei Zhu2
  • Linhui Jin1
  • Yafei Liu1
  • Man Tao1
  • Zhijuan He3
  • Xiaoxia Tang4
  • Guilan Zhang5
  • Hailin Zhu2
5 affiliations
  1. 1School of Nursing, Yunnan University of Traditional Chinese Medicine, Kunming, Yunnan, China.
  2. 2Department of Neurology, Chongqing Hospital of The Affiliated Hospital of Guangzhou University of Chinese Medicine, Chongqing, China.
  3. 3Department of Rehabilitation Medicine, Kunming Municipal Hospital of Traditional Chinese Medicine, Kunming, Yunnan, China.
  4. 4Department of Critical Care Medicine, Kunming Municipal Hospital of Traditional Chinese Medicine, Kunming, Yunnan, China.
  5. 5Department of Nursing, Kunming Municipal Hospital of Traditional Chinese Medicine, Kunming, Yunnan, China.
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Abstract

Background: Sepsis continues to be a major contributor to death among critically ill individuals and places a heavy strain on healthcare resources. In addition to causing systemic inflammation and affecting hemodynamics, sepsis has a significant effect on the gastrointestinal system, leading to complications like stress ulcers and notable gastrointestinal bleeding (GIB), which worsen patient outcomes. While stress ulcer prophylaxis (SUP) has traditionally been included in sepsis treatment protocols, the concept of applying it universally is being increasingly scrutinized due to the absence of definitive mortality advantages and the risk of adverse effects, such as hospital-acquired pneumonia. Nevertheless, there is a notable gap in synthesized research that specifically addresses the independent risk factors for stress ulcers in sepsis patients. Methods: We carried out a systematic review in accordance with PRISMA standards, exploring eight databases (CNKI, Wanfang, VIP, Sinomed, PubMed, Web of Science, Embase, and Cochrane Library) from their inception until September 1, 2026. We included observational analytical studies (either cohort or case-control) that examined factors linked to stress ulcers or significant gastrointestinal bleeding in adult patients with sepsis. Two researchers independently handled the selection of studies, extraction of data, and evaluation of quality using the Newcastle-Ottawa Scale. Due to the limited number of studies for each association between associated factors and outcomes, a narrative synthesis was utilized. Results: A total of six studies encompassing 131,568 individuals suffering from sepsis or septic shock were analyzed. The incidence rates of stress ulcers or gastrointestinal bleeding (GIB) varied between 2.0% and 32.3%. The identified associated factors were divided into three categories: patient-related (older age, history of GIB, cirrhosis, HIV, cancer/immunosuppression), disease-related (coagulopathy, kidney impairment, high BUN levels, severity of illness scores, source of infection), and treatment-related (mechanical ventilation, use of anticoagulants, corticosteroid therapy, duration of ICU stay). Specifically for stress ulcer, factors such as respiratory failure, high BUN levels, shock, and increased HMGB1/TLR2/TLR4 levels were found to be independently linked to a higher odds. Conclusions: In summary, the likelihood of developing stress ulcers and gastrointestinal bleeding in patients with sepsis is shaped by a variety of factors related to the patient, their illness, and the treatments they receive. Key indicators that consistently emerge include issues with blood coagulation, the presence of shock, the need for mechanical ventilation, liver and kidney dysfunction, the severity of the disease, and any previous occurrences of gastrointestinal bleeding. These results advocate for tailored strategies for stress ulcer prophylaxis based on individual risk rather than a one-size-fits-all approach, offering crucial insights for precise clinical decision-making. Additional high-quality research is essential to confirm and enhance the understanding of these associated factors. Registration: PROSPERO (CRD420251242849)

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Cite

BibTeXRIS
BibTeX
@article{wang2026associated,
  title = {{Associated factors for stress ulcers and gastrointestinal bleeding in patients with sepsis or septic shock: A systematic review}},
  author = {Jin Wang and Xingwei Zhu and Linhui Jin and Yafei Liu and Man Tao and Zhijuan He and Xiaoxia Tang and Guilan Zhang and Hailin Zhu},
  journal = {PLOS One},
  year = {2026},
  month = oct,
  doi = {10.1371/journal.pone.0361608},
  url = {https://doi.org/10.1371/journal.pone.0361608},
  note = {CC BY},
}
RIS
TY  - JOUR
TI  - Associated factors for stress ulcers and gastrointestinal bleeding in patients with sepsis or septic shock: A systematic review
AU  - Jin Wang
AU  - Xingwei Zhu
AU  - Linhui Jin
AU  - Yafei Liu
AU  - Man Tao
AU  - Zhijuan He
AU  - Xiaoxia Tang
AU  - Guilan Zhang
AU  - Hailin Zhu
PY  - 2026
DA  - 2026/10/30
JO  - PLOS One
DO  - 10.1371/journal.pone.0361608
UR  - https://doi.org/10.1371/journal.pone.0361608
AB  - Background: Sepsis continues to be a major contributor to death among critically ill individuals and places a heavy strain on healthcare resources. In addition to causing systemic inflammation and affecting hemodynamics, sepsis has a significant effect on the gastrointestinal system, leading to complications like stress ulcers and notable gastrointestinal bleeding (GIB), which worsen patient outcomes. While stress ulcer prophylaxis (SUP) has traditionally been included in sepsis treatment protocols, the concept of applying it universally is being increasingly scrutinized due to the absence of definitive mortality advantages and the risk of adverse effects, such as hospital-acquired pneumonia. Nevertheless, there is a notable gap in synthesized research that specifically addresses the independent risk factors for stress ulcers in sepsis patients. Methods: We carried out a systematic review in accordance with PRISMA standards, exploring eight databases (CNKI, Wanfang, VIP, Sinomed, PubMed, Web of Science, Embase, and Cochrane Library) from their inception until September 1, 2026. We included observational analytical studies (either cohort or case-control) that examined factors linked to stress ulcers or significant gastrointestinal bleeding in adult patients with sepsis. Two researchers independently handled the selection of studies, extraction of data, and evaluation of quality using the Newcastle-Ottawa Scale. Due to the limited number of studies for each association between associated factors and outcomes, a narrative synthesis was utilized. Results: A total of six studies encompassing 131,568 individuals suffering from sepsis or septic shock were analyzed. The incidence rates of stress ulcers or gastrointestinal bleeding (GIB) varied between 2.0% and 32.3%. The identified associated factors were divided into three categories: patient-related (older age, history of GIB, cirrhosis, HIV, cancer/immunosuppression), disease-related (coagulopathy, kidney impairment, high BUN levels, severity of illness scores, source of infection), and treatment-related (mechanical ventilation, use of anticoagulants, corticosteroid therapy, duration of ICU stay). Specifically for stress ulcer, factors such as respiratory failure, high BUN levels, shock, and increased HMGB1/TLR2/TLR4 levels were found to be independently linked to a higher odds. Conclusions: In summary, the likelihood of developing stress ulcers and gastrointestinal bleeding in patients with sepsis is shaped by a variety of factors related to the patient, their illness, and the treatments they receive. Key indicators that consistently emerge include issues with blood coagulation, the presence of shock, the need for mechanical ventilation, liver and kidney dysfunction, the severity of the disease, and any previous occurrences of gastrointestinal bleeding. These results advocate for tailored strategies for stress ulcer prophylaxis based on individual risk rather than a one-size-fits-all approach, offering crucial insights for precise clinical decision-making. Additional high-quality research is essential to confirm and enhance the understanding of these associated factors. Registration: PROSPERO (CRD420251242849)
SN  - 1932-6203
ER  -