Recurrence and Mortality Among Patients Hospitalized for Acute Lower Gastrointestinal Bleeding.

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Recurrence and Mortality Among Patients Hospitalized for Acute Lower Gastrointestinal Bleeding.

Clin Gastroenterol Hepatol. 2014 Jul 2;

Authors: Aoki T, Nagata N, Niikura R, Shimbo T, Tanaka S, Sekine K, Kishida Y, Watanabe K, Sakurai T, Yokoi C, Akiyama J, Yanase M, Mizokami M, Uemura N

BACKGROUND & AIMS: The long-term recurrence of lower gastrointestinal bleeding (LGIB) and associated mortality have not been extensively studied. We investigated rates of recurrence of LGIB, mortality, and associated risk factors.
METHODS: In a retrospective study, we analyzed data from 342 patients hospitalized for overt LGIB at the National Center for Global Health and Medicine in Japan from December 2004 through June 2013. All patients underwent colonoscopy. We assessed Charlson comorbidity index scores and the use of non-steroidal anti-inflammatory drugs (NSAIDs), low-dose aspirin, other antiplatelet drugs, or warfarin. Re-bleeding, the total number of re-bleeding episodes, and mortality were measured. The Cox proportional hazards model was used to estimate hazard ratios (HR).
RESULTS: Re-bleeding occurred in 84 patients, at mean follow-up time of 19 months. The cumulative percentages of patients with re-bleeding at 1 and 5 years were 19% and 46%, respectively. During the follow-up period, 29 patients (39%) had secondary re-bleeding and 18 (62%) had subsequent re-bleeding. Multivariate analysis revealed age ≥65 years (HR, 1.7; P=.04) and the use of NSAIDs (HR, 2.0; P<.01) and non-aspirin antiplatelet drugs (HR, 1.8; P<.05) as independent risk factors for rebleeding. Dual therapy carried a higher risk than single therapy (adjusted HR, 1.8; P<.05). During the mean follow-up period of 28 months, 21 patients died (2 from bleeding). Cumulative mortalities at 1 and 5 years were 4.2% and 13%, respectively. Mortality was significantly associated with age ≥65 year (P<.05), Charlson comorbidity index score, and warfarin use.
CONCLUSION: Based on a retrospective analysis of patients with LGIB, 46% of all patients have rebleeding and overall mortality is 13% within 5 years after hospitalization. Besides age ≥65 years, use of antithrombotic drugs increases the risk of bleeding recurrence and mortality among patients with LGIB.

PMID: 24997327 [PubMed - as supplied by publisher]

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