Abstract
Background & aim
Although acute lower GI bleeding (LGIB) represents a significant healthcare burden,
prospective real-life data on management and outcomes are scanty. Present multicentre,
prospective cohort study was aimed at evaluating mortality and associated risk factors
and at describing patient management.
Methods
Adult outpatients acutely admitted for or developing LGIB during hospitalization were
consecutively enrolled in 15 high-volume referral centers. Demographics, comorbidities,
medications, interventions and outcomes were recorded.
Results
Overall 1,198 patients (1060 new admissions;138 inpatients) were included. Most patients
were elderly (mean-age 74±15 years), 31% had a Charlson-Comorbidity-Index ≥3, 58%
were on antithrombotic therapy. In-hospital mortality (primary outcome) was 3.4% (95%CI
2.5–4.6). At logistic regression analysis, independent predictors of mortality were
increasing age, comorbidity, inpatient status, hemodynamic instability at presentation,
and ICU-admission. Colonoscopy had a 78.8% diagnostic yield, with significantly higher
hemostasis rate when performed within 24-hours than later (21.3% vs.10.8%, p = 0.027). Endoscopic hemostasis was associated with neither in-hospital mortality
nor rebleeding. A definite or presumptive source of bleeding was disclosed in 90.4%
of investigated patients.
Conclusion
Mortality in LGIB patients is mainly related to age and comorbidities. Although early
colonoscopy has a relevant diagnostic yield and is associated with higher therapeutic
intervention rate, endoscopic hemostasis is not associated with improved clinical
outcomes [ClinicalTrial.gov number: NCT 04364412].
Keywords
Abbreviations:
ASA (acetylsalicylic agent), DOAC (direct oral anticoagulant), DAPT (dual antiplatelet therapy GI, gastrointestinal), ICU (intensive care unit), IQR (inter-quartile range), LGIB (lower gastrointestinal bleeding), LMWH (low molecular weight heparin), CI (confidence interval), OR (odds ratio), SD (standard deviation), VKA (vitamin K antagonists)To read this article in full you will need to make a payment
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References
- The changing face of hospitalisation due to gastrointestinal bleeding and perforation.Aliment Pharmacol Ther. 2011; 33: 585-591
- Lower gastrointestinal bleeding: incidence, etiology and outcomes in a population-based setting.Eur J Gast Hepatol. 2013; 25: 37-43
- Risk factors for mortality in lower intestinal bleeding.Clin Gastroenterol Hepatol. 2008; 6: 1004-1010
- Time trends and impact of upper and lower gastrointestinal bleeding and perforation in clinical practice.Am J Gastroenterol. 2009; 104: 1633-1641
- Acute lower GI bleeding in UK: patient characteristics, interventions and outcomes in the first nationwide audit.Gut. 2018; 67: 654-662
- A new method of classifying prognostic comorbidity in longitudinal studies: development and validation.J Chronic Dis. 1987; 40: 373-383
- Efficacy and safety of early vs elective colonoscopy for acute lower gastrointestinal bleeding.Gastroenterology. 2020; 158: 168-175
- The in-hospital mortality rate for upper GI hemorrhage has decreased over 2 decades in the United States: a nationwide analysis.Gastrointest Endosc. 2015; (Issue): 882-888
- Predicting mortality in patients with in-hospital nonvariceal upper GI bleeding: a prospective, multicenter database study.Gastrointest Endosc. 2014; 79: 741-749
- ACG clinical guideline: management of patients with acute lower gastrointestinal bleeding.Am J Gastroenterol. 2016; 111: 459-474
- Diagnosis and management of acute lower gastrointestinal bleeding: guidelines from the British society of gastroenterology.Gut. 2019; 68: 776-789
- Overview of small bowel angioectasias: clinical presentation and treatment options.Expert Rev Gastroenterol Hepatol. 2018; 12: 125-139
- Urgent colonoscopy in patients with lower GI bleeding: a systematic review and meta-analysis.Gastrointest Endosc. 2017; 86: 107-117
- Outcomes of restrictive versus liberal transfusion strategies in older adults from nine randomised controlled trials: a systematic review and meta-analysis.Lancet Haematol. 2017; 4: e465-e474
- Outcomes following restrictive or liberal red blood cell transfusion in patients with lower gastrointestinal bleeding.Aliment Pharmacol Ther. 2019; 49: 919-925
Article info
Publication history
Published online: January 25, 2021
Accepted:
January 5,
2021
Received:
October 25,
2020
Identification
Copyright
© 2021 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.
