Clinical management and patient outcomes of acute lower gastrointestinal bleeding. A multicenter, prospective, cohort study. Issue 9 (September 2021)

• Record Type: Journal Article
• Authors: Radaelli, Franco; Frazzoni, Leonardo; Repici, Alessandro; Rondonotti, Emanuele; Mussetto, Alessandro; Feletti, Valentina; Spada, Cristiano; Manes, Gianpiero; Segato, Sergio; Grassi, Eleonora; Musso, Alessandro; Di Giulio, Emilio; Coluccio, Chiara; Manno, Mauro; De Nucci, Germana; Festa, Virginia; Di Leo, Alfredo; Marini, Mario; Ferraris, Luca; Feliziani, Marcella; Amato, Arnaldo; Soriani, Paola; Del Bono, Chiara; Paggi, Silvia; Hassan, Cesare; Fuccio, Lorenzo
• Is Part Of: Digestive and liver disease. Volume 53:Issue 9(2021)
• Page Start: 1141
• Page End: 1147
• Publication Date: 2021-09
• Subjects: Colonoscopy -- Endoscopic hemostasis -- Lower GI bleeding; 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; Digestive organs -- Diseases -- Periodicals; Liver -- Diseases -- Periodicals; 616.33005
• DOI: 10.1016/j.dld.2021.01.002
• Languages: English
• ISSNs: 1590-8658

Abstract

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].