💊 Stress Ulcer Prophylaxis Indication (SUP)
Stress-ulcer prophylaxis decision aid, weighing GI-bleeding risk factors against the risks of acid suppression in the ICU.
Clinical takeaway
The strongest indications are mechanical ventilation > 48 h and coagulopathy; without these, routine prophylaxis is often unnecessary (original synthesis · not guideline verbatim).
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When to use
Use to decide whether to give pharmacologic stress-ulcer prophylaxis based on the presence of major risk factors.
How it works
Prophylaxis indicated with a major risk factor (mechanical ventilation > 48 h, coagulopathy) or multiple minor factors; otherwise withhold given the risk of pneumonia/C. difficile from acid suppression. Prefer PPI or H2RA.
Key points
- The strongest indications are mechanical ventilation > 48 h and coagulopathy; without these, routine prophylaxis is often unnecessary (original synthesis · not guideline verbatim).
- Acid suppression is not benign — it associates with nosocomial pneumonia and C. difficile, so apply it selectively.
- Enteral nutrition itself confers some protection and may reduce the need for pharmacologic prophylaxis.
References
- ASHP therapeutic guidelines on stress-ulcer prophylaxis.
- Krag M, et al. SUP-ICU trial. N Engl J Med 2018.
Decision support for licensed clinicians only; not a substitute for clinical judgement, diagnosis or local protocols.
Worked calculation
The values below come from this tool's own example placeholders and are computed server-side with the formula shown on this page, so the arithmetic can be checked quickly. It demonstrates how to substitute values only — it is not clinical advice and not a real case.
| Mechanical ventilation > 48 hours | No |
|---|---|
| Coagulopathy (platelets < 50 / INR > 1.5 / PTT > 2× normal) | No |
| Chronic liver disease (cirrhosis/portal hypertension/history of variceal bleed) | No |
| GI ulcer/bleed in the past year | No |
| Shock (vasopressors / SBP < 90 / MAP < 70 / lactate > 4) | No |
| Sepsis | No |
| AKI or need for renal replacement therapy | No |
| Other high-risk (TBI/SCI/polytrauma ISS > 16/burn > 35%/high-dose steroids) | No |
→SUPNot advised
- Determination：Does not meet (no major factor and < 2 minor): clinically important bleeding risk < 4%, prophylaxis generally not needed
- Management direction：No drug prophylaxis needed; start enteral nutrition early; reassess dynamically and re-evaluate if new risk factors arise
- Note：Any major risk factor triggers prophylaxis: mechanical ventilation > 48 h, coagulopathy, chronic liver disease, GI ulcer/bleed history; ≥ 2 minor factors trigger prophylaxis: shock, sepsis, AKI/RRT, TBI/SCI/polytrauma/burn/high-dose steroids, etc. The 2024 SCCM/ASHP guidance emphasizes coagulopathy, shock and chronic liver disease as major risks; enteral nutrition lowers bleeding
| Mechanical ventilation > 48 hours | Yes (major) |
|---|---|
| Coagulopathy (platelets < 50 / INR > 1.5 / PTT > 2× normal) | Yes (major) |
| Chronic liver disease (cirrhosis/portal hypertension/history of variceal bleed) | Yes (major) |
| GI ulcer/bleed in the past year | Yes (major) |
| Shock (vasopressors / SBP < 90 / MAP < 70 / lactate > 4) | Yes (minor) |
| Sepsis | Yes (minor) |
| AKI or need for renal replacement therapy | Yes (minor) |
| Other high-risk (TBI/SCI/polytrauma ISS > 16/burn > 35%/high-dose steroids) | Yes (minor) |
→SUPProphylaxis advised
- Determination：Meets indication (major: mechanical ventilation > 48 h, coagulopathy, chronic liver disease, GI ulcer/bleed history; ≥ 2 minor: shock, sepsis, AKI/RRT, other high-risk)
- Management direction：Give a PPI or H2RA (low dose, oral or IV, PPI slightly preferred); start enteral nutrition early (can lower bleeding risk); stop once risk factors resolve or the patient leaves the ICU (avoid inappropriate continuation after transfer)
- Note：Any major risk factor triggers prophylaxis: mechanical ventilation > 48 h, coagulopathy, chronic liver disease, GI ulcer/bleed history; ≥ 2 minor factors trigger prophylaxis: shock, sepsis, AKI/RRT, TBI/SCI/polytrauma/burn/high-dose steroids, etc. The 2024 SCCM/ASHP guidance emphasizes coagulopathy, shock and chronic liver disease as major risks; enteral nutrition lowers bleeding
Frequently asked questions
- What is Stress Ulcer Prophylaxis Indication (SUP)?
- Stress-ulcer prophylaxis decision aid, weighing GI-bleeding risk factors against the risks of acid suppression in the ICU.
- How is Stress Ulcer Prophylaxis Indication (SUP) calculated? What is the core formula?
- Prophylaxis indicated with a major risk factor (mechanical ventilation > 48 h, coagulopathy) or multiple minor factors; otherwise withhold given the risk of pneumonia/C. difficile from acid suppression. Prefer PPI or H2RA.
- When is Stress Ulcer Prophylaxis Indication (SUP) used?
- Use to decide whether to give pharmacologic stress-ulcer prophylaxis based on the presence of major risk factors.
- What are the key clinical points for Stress Ulcer Prophylaxis Indication (SUP)?
- The strongest indications are mechanical ventilation > 48 h and coagulopathy; without these, routine prophylaxis is often unnecessary (original synthesis · not guideline verbatim). Acid suppression is not benign — it associates with nosocomial pneumonia and C. difficile, so apply it selectively. Enteral nutrition itself confers some protection and may reduce the need for pharmacologic prophylaxis.
- What are the limits and cautions when using Stress Ulcer Prophylaxis Indication (SUP)?
- For licensed clinicians and clinical researchers. Interpret results with history, investigations and local protocols; not a diagnosis or prescription, and not a substitute for multidisciplinary decision-making or local guidelines.
- How is Stress Ulcer Prophylaxis Indication (SUP) calculated in practice? Can you show a worked example?
- Inputs: Mechanical ventilation > 48 hours No, Coagulopathy (platelets < 50 / INR > 1.5 / PTT > 2× normal) No, Chronic liver disease (cirrhosis/portal hypertension/history of variceal bleed) No, GI ulcer/bleed in the past year No, Shock (vasopressors / SBP < 90 / MAP < 70 / lactate > 4) No, Sepsis No, AKI or need for renal replacement therapy No, Other high-risk (TBI/SCI/polytrauma ISS > 16/burn > 35%/high-dose steroids) No → Result: SUP Not advised（Determination: Does not meet (no major factor and < 2 minor): clinically important bleeding risk < 4%, prophylaxis generally not needed, Management direction: No drug prophylaxis needed; start enteral nutrition early; reassess dynamically and re-evaluate if new risk factors arise, Note: Any major risk factor triggers prophylaxis: mechanical ventilation > 48 h, coagulopathy, chronic liver disease, GI ulcer/bleed history; ≥ 2 minor factors trigger prophylaxis: shock, sepsis, AKI/RRT, TBI/SCI/polytrauma/burn/high-dose steroids, etc. The 2024 SCCM/ASHP guidance emphasizes coagulopathy, shock and chronic liver disease as major risks; enteral nutrition lowers bleeding） Inputs: Mechanical ventilation > 48 hours Yes (major), Coagulopathy (platelets < 50 / INR > 1.5 / PTT > 2× normal) Yes (major), Chronic liver disease (cirrhosis/portal hypertension/history of variceal bleed) Yes (major), GI ulcer/bleed in the past year Yes (major), Shock (vasopressors / SBP < 90 / MAP < 70 / lactate > 4) Yes (minor), Sepsis Yes (minor), AKI or need for renal replacement therapy Yes (minor), Other high-risk (TBI/SCI/polytrauma ISS > 16/burn > 35%/high-dose steroids) Yes (minor) → Result: SUP Prophylaxis advised（Determination: Meets indication (major: mechanical ventilation > 48 h, coagulopathy, chronic liver disease, GI ulcer/bleed history; ≥ 2 minor: shock, sepsis, AKI/RRT, other high-risk), Management direction: Give a PPI or H2RA (low dose, oral or IV, PPI slightly preferred); start enteral nutrition early (can lower bleeding risk); stop once risk factors resolve or the patient leaves the ICU (avoid inappropriate continuation after transfer), Note: Any major risk factor triggers prophylaxis: mechanical ventilation > 48 h, coagulopathy, chronic liver disease, GI ulcer/bleed history; ≥ 2 minor factors trigger prophylaxis: shock, sepsis, AKI/RRT, TBI/SCI/polytrauma/burn/high-dose steroids, etc. The 2024 SCCM/ASHP guidance emphasizes coagulopathy, shock and chronic liver disease as major risks; enteral nutrition lowers bleeding）