Recurrence and Mortality Among Patients Hospitalized for Acute Lower Gastrointestinal Bleeding

• Published in: Clinical gastroenterology and hepatology Vol. 13; no. 3; pp. 488 - 494.e1
• Main Authors: Aoki, Tomonori, Nagata, Naoyoshi, Niikura, Ryota, Shimbo, Takuro, Tanaka, Shohei, Sekine, Katsunori, Kishida, Yoshihiro, Watanabe, Kazuhiro, Sakurai, Toshiyuki, Yokoi, Chizu, Akiyama, Junichi, Yanase, Mikio, Mizokami, Masashi, Uemura, Naomi
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.03.2015
• Subjects: Adult; Age Factors; Aged; Aged, 80 and over; Anti-Inflammatory Agents - therapeutic use; Anticoagulants; Anticoagulants - therapeutic use; Antithrombotic Agents; Aspirin - therapeutic use; Female; Gastroenterology and Hepatology; Gastrointestinal Hemorrhage - epidemiology; Gastrointestinal Hemorrhage - mortality; Hospitalization; Humans; Japan; LGIB; Lower Gastrointestinal Hemorrhage; Male; Middle Aged; Mortality; Platelet Aggregation Inhibitors - therapeutic use; Poor Clinical Outcomes; Recurrence; Retrospective Studies; Risk Factors; Survival Analysis; Warfarin - therapeutic use; Japan; Anticoagulants; Recurrence; Mortality; CI; NSAID; National Center for Global Health and Medicine; HR; Lower Gastrointestinal Hemorrhage; UGIB; Poor Clinical Outcomes; upper gastrointestinal bleeding; lower gastrointestinal bleeding; Antithrombotic Agents; subdistribution hazard ratio; LGIB; hazard ratio; confidence interval; SHR; NCGM; nonsteroidal anti-inflammatory drug
• ISSN: 1542-3565; 1542-7714
• DOI: 10.1016/j.cgh.2014.06.023

Background & Aims The long-term recurrence of lower gastrointestinal bleeding (LGIB) and associated mortality have not been studied extensively. We investigated rates of recurrence of LGIB, mortality, and associated risk factors. Methods In a retrospective study, we analyzed data from 342 patients hospitalized for overt LGIB at the National Center for Global Health and Medicine in Japan from December 2004 through June 2013. All patients underwent colonoscopy. We assessed Charlson comorbidity index scores and the use of nonsteroidal anti-inflammatory drugs, low-dose aspirin, other antiplatelet drugs, or warfarin. Rebleeding, the total number of rebleeding episodes, and mortality were measured. The Cox proportional hazards model was used to estimate hazard ratios (HRs). Results Rebleeding occurred in 84 patients, at a mean follow-up time of 19 months. The cumulative percentages of patients with rebleeding at 1 and 5 years were 19% and 46%, respectively. During the follow-up period, 29 patients (39%) had secondary rebleeding and 18 patients (62%) had subsequent rebleeding. Multivariate analysis showed age 65 years and older (HR, 1.7; P  = .04) and the use of nonsteroidal anti-inflammatory drugs (HR, 2.0; P < .01) and nonaspirin antiplatelet drugs (HR, 1.8; P < .05) as independent risk factors for rebleeding. Dual therapy had a higher risk than single therapy (adjusted HR, 1.8; P < .05). During the mean follow-up period of 28 months, 21 patients died (2 from bleeding). Cumulative mortality rates at 1 and 5 years were 4.2% and 13%, respectively. Mortality was associated significantly with age ≥65 years ( P < .05), Charlson comorbidity index score, and warfarin use. Conclusions Based on a retrospective analysis of patients with LGIB, 46% of all patients have rebleeding, and the overall mortality rate is 13% within 5 years after hospitalization. Besides age ≥65 years, use of antithrombotic drugs increases the risk of bleeding recurrence and mortality among patients with LGIB.