Mortality rate and risk factors for gastrointestinal bleeding in elderly patients

• DOI: 10.1016/j.ejim.2018.11.003
• Publication Date: 2018-12-04T01:41:02Z
• Authors: Marco Vincenzo Lenti; Luca Pasina; Sara Cococcia; Laura Cortesi; Emanuela Miceli; Costanza Caccia D...; Martina Pisati; Caterina Mengoli; Francesco Perticone; Alessandro Nobili; Antonio Di Sabatino; Gino Roberto Corazza
• Keywords: Registrie; Male; Logistic Model; Anemia; Anticoagulant; Antiplatelet drug; Diverticulosis; Gastric ulcer; Multimorbidity;; 610; Severity of Illness Index; Anemia, Anticoagulant, Antiplatelet drug, Diverticulosis, Gastric ulcer, Multimorbidity; 03 medical and health sciences; 0302 clinical medicine; Risk Factors; 616; 80 and over; Humans; Anemia; Anticoagulant; Antiplatelet drug; Diverticulosis; Gastric ulcer; Multimorbidity; Aged; Aged, 80 and over; Female; Gastrointestinal Hemorrhage; Hospital Mortality; Humans; Italy; Length of Stay; Logistic Models; Male; Multivariate Analysis; Platelet Aggregation Inhibitors; Prospective Studies; Registries; Risk Factors; Severity of Illness Index; Multimorbidity; Hospital Mortality; Prospective Studies; Registries; Multivariate Analysi; anemia; anticoagulant; antiplatelet drug; diverticulosis; gastric ulcer; multimorbidity; aged; aged, 80 and over; female; gastrointestinal hemorrhage; hospital mortality; humans; italy; length of stay; logistic models; male; multivariate analysis; platelet aggregation inhibitors; prospective studies; registries; risk factors; severity of illness index; multimorbidity; Aged; Diverticulosis; Aged, 80 and over; Diverticulosi; Platelet Aggregation Inhibitor; Risk Factor; Gastric ulcer; Anemia; Anticoagulant; Antiplatelet drug; Diverticulosis; Gastric ulcer; Multimorbidity; Anticoagulant; Multimorbidity; Anemia; Anemia, Anticoagulant, Antiplatelet drug, Diverticulosis, Gastric ulcer, Multimorbidity, Aged, Aged, 80 and over, Female, Gastrointestinal Hemorrhage, Hospital Mortality, Humans, Italy, Length of Stay, Logistic Models, Male, Multivariate Analysis, Platelet Aggregation Inhibitors, Prospective Studies, Registries, Risk Factors, Severity of Illness Index, Multimorbidity; anemia; anticoagulant; antiplatelet drug; diverticulosis; gastric ulcer; multimorbidity; aged; aged 80 and over; female; gastrointestinal hemorrhage; hospital mortality; humans; italy; length of stay; logistic models; male; multivariate analysis; platelet aggregation inhibitors; prospective studies; registries; risk factors; severity of illness index; multimorbidity; Length of Stay; Anemia; Anticoagulant; Antiplatelet drug; Diverticulosis; Gastric ulcer; Multimorbidity; Internal Medicine; 3. Good health; Prospective Studie; Logistic Models; Italy; Multivariate Analysis; Anemia; Anticoagulant; Antiplatelet drug; Diverticulosis; Gastric ulcer; Multimorbidity; Aged; Aged; 80 and over; Female; Gastrointestinal Hemorrhage; Hospital Mortality; Humans; Italy; Length of Stay; Logistic Models; Male; Multivariate Analysis; Platelet Aggregation Inhibitors; Prospective Studies; Registries; Risk Factors; Severity of Illness Index; Multimorbidity; Female; Gastrointestinal Hemorrhage; Antiplatelet drug; Platelet Aggregation Inhibitors; Human

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.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.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).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.