Int J Clin Pract. 2021 Sep 6:e14806. doi: 10.1111/ijcp.14806. Online ahead of print.
ABSTRACT
INTRODUCTION: Outcomes in old patients with upper gastrointestinal bleeding (UGIB) have been scarcely studied. Our aim was to compare very old individuals (>80 years old) with younger patients with UGIB, and to identify risk factors for the main outcomes.
METHODS: A single-center prospectively collected database was analysed. Descriptive, inferential, and multivariate logistic regression models were performed. Main clinical outcomes were in-hospital and delayed 6-months mortality.
RESULTS: 698 patients were included, 143 very old and 555 aged<80. Old patients differed from younger ones in comorbidities (85.9% vs. 62%, p<0,0001), oral anticoagulants (32.3% vs 12.7%; p<0.0001), and antiplatelets intake (32.3% vs. 21.2 %; p<0.007). No differences were found in the need for endoscopic interventions, blood unit transfusions, hospital stay, in-hospital rebleeding and mortality. Among very old patients, creatinine levels were higher in those who died compared to the ones who survived (1.92±1.46 vs. 1.25±0.59 mg/dl; p=0,002), they had lower hemoglobin levels (8.1±1.4 vs. 9.1±2.4 g/dl; p=0.04) and longer hospital stays (17.75±15.5 vs. 8.1±8.4 days; p<0.0001). Logistic regression showed creatinine levels (OR: 2.42; 95%CI: 1.24-4.74; p=0.01), cirrhosis (OR: 2.88, 95%CI: 1.88-17.34; p=0.04) and being an impatient (OR: 3.90; 95%CI: 1.11-20; p=0.035) were independent risk factors for mortality in older patients. They had an increased delayed 6-month mortality compared to younger patients (17.5% vs 8%, p=0.001).
CONCLUSIONS: Creatinine levels, cirrhosis or the onset of UGIB while being an inpatient were independent risk factors for mortality in very old patients. Delayed mortality was higher among them, mostly caused by cardiovascular events and neoplasms, but not in-hospital mortality.
PMID:34487386 | DOI:10.1111/ijcp.14806