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Mortality rate and risk factors for gastrointestinal bleeding in elderly patients

Published:December 03, 2018DOI:https://doi.org/10.1016/j.ejim.2018.11.003

      Highlights

      • Gastrointestinal bleeding (GIB) was present in 120/3872 elderly patients (3.1%).
      • Patients with GIB had a 3.3% in-hospital and a 9.4% 3-month mortality rate.
      • An index of comorbidity >3 was significantly associated with GIB (OR 2.41).
      • Antiplatelet therapy should be carefully discussed in patients with multimorbidity.

      Abstract

      Background

      Gastrointestinal bleeding (GIB) is burdened by high mortality rate that increases with aging. Elderly patients may be exposed to multiple risk factors for GIB. We aimed at defining the impact of GIB in elderly patients.

      Methods

      Since 2008, samples of elderly patients (age ≥ 65 years) with multimorbidity admitted to 101 internal medicine wards across Italy have been prospectively enrolled and followed-up (REPOSI registry). Diagnoses of GIB, length of stay (LOS), mortality rate, and possible risk factors, including drugs, index of comorbidity (Cumulative Illness Rating Scale [CIRS]), polypharmacy, and chronic diseases were assessed. Adjusted multivariate logistic regression models were computed.

      Results

      3872 patients were included (mean age 79 ± 7.5 years, F:M ratio 1.1:1). GIB was reported in 120 patients (mean age 79.6 ± 7.3 years, F:M 0.9:1), with a crude prevalence of 3.1%. Upper GIB occurred in 72 patients (mean age 79.3 ± 7.6 years, F:M 0.8:1), lower GIB in 51 patients (mean age 79.4 ± 7.1 years, F:M 0.9:1), and both upper/lower GIB in 3 patients. Hemorrhagic gastritis/duodenitis and colonic diverticular disease were the most common causes. The LOS of patients with GIB was 11.7 ± 8.1 days, with a 3.3% in-hospital and a 9.4% 3-month mortality rates. Liver cirrhosis (OR 5.64; CI 2.51–12.65), non-ASA antiplatelet agents (OR 2.70; CI 1.23–5.90), and CIRS index of comorbidity >3 (OR 2.41; CI 1.16–4.98) were associated with GIB (p < 0.05).

      Conclusions

      A high index of comorbidity is associated with high odds of GIB in elderly patients. The use of non-ASA antiplatelet agents should be discussed in patients with multimorbidity.

      Abbreviations:

      ASA (acetylsalicylic acid), BMI (body mass index), CIRS (Cumulative Illness Rating Scale), COPD (chronic obstructive pulmonary disease), DOAC (direct oral anticoagulant), GIB (gastrointestinal bleeding), ICD (International Classification of Diseases), LOS (length of stay), NSAID (nonsteroidal anti-inflammatory drugs), PPI (proton pump inhibitor), SBT (Short Blessed Test), SIMI (Italian Society of Internal Medicine), SSRI (selective serotonin reuptake inhibitor.)

      Keywords

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