Mortality rate and risk factors for gastrointestinal bleeding in elderly patients

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RESEARCH PRODUCT

Mortality rate and risk factors for gastrointestinal bleeding in elderly patients

M. V. Lenti L. Pasina S. Cococcia L. Cortesi E. Miceli C. C. Dominioni M. Pisati C. Mengoli F. Perticone A. Nobili A. Di Sabatino G. R. Corazza P. M. Mannucci M. Tettamanti C. Franchi S. Corrao A. Marengoni F. Salerno M. Cesari G. Licata F. Violi I. Ardoino D. Prisco E. Silvestri C. Cenci G. Emmi G. Biolo M. Zanetti M. Guadagni M. Zaccari M. Vanoli G. Grignani E. A. Pulixi M. Bernardi S. L. Bassi L. Santi G. Zaccherini E. Mannarino G. Lupattelli V. Bianconi F. Paciullo R. Nuti R. Valenti M. Ruvio S. Cappelli A. Palazzuoli O. Olivieri D. Girelli T. Matteazzi M. Barbagallo L. Dominguez F. Cocita V. Beneduce L. Plances M. Zoli I. Lazzari M. Brunori F. L. Pasini P. L. Capecchi G. Palasciano M. E. Modeo C. Di Gennaro M. D. Cappellini D. Maira V. Di Stefano G. Fabio S. Seghezzi M. Mancarella P. D. Rossi S. Damanti M. Clerici F. Conti G. Murialdo A. Marra F. Cattaneo R. Pontremoli M. B. Secchi D. Ghelfi L. Anastasio L. Sofia M. Carbone F. Cipollone M. T. Guagnano E. Angelucci E. Valeriani G. Mancuso D. Calipari M. Bartone G. Delitala M. Berria M. Muscaritoli A. Molfino E. Petrillo G. Zuccala G. D'aurizio G. Romanelli A. Zucchelli A. Picardi U. V. Gentilucci P. Gallo C. Dell'unto G. Annoni M. Corsi G. Bellelli S. Zazzetta P. Mazzola H. Szabo A. Bonfanti F. Arturi E. Succurro M. Rubino M. G. Serra M. A. Bleve L. Gasbarrone M. R. Sajeva A. Brucato S. Ghidoni F. Fabris I. Bertozzi G. Bogoni M. V. Rabuini E. Cosi R. Manfredini F. Fabbian B. Boari A. De Giorgi R. Tiseo G. Paolisso M. R. Rizzo C. Borghi E. Strocchi V. De Sando I. Pareo C. Sabba F. S. Vella P. Suppressa P. Agosti A. Schilardi F. Loparco L. Fenoglio C. Bracco A. V. Giraudo S. Fargion G. Periti M. Porzio S. Tiraboschi F. Peyvandi R. Rossio B. Ferrari G. Colombo V. Monzani V. Savojardo C. Folli G. Ceriani G. Pallini F. Dallegri L. Ottonello L. Liberale L. Caserza K. Salam N. L. Liberato T. Tognin G. B. Bianchi S. Giaquinto F. Purrello A. Di Pino S. Piro R. Rozzini L. Falanga E. Spazzini C. Ferrandina G. Montrucchio P. Petitti R. Salmi P. Gaudenzi L. Perri R. Landolfi M. Montalto A. Mirijello L. Guasti L. Castiglioni A. Maresca A. Squizzato M. Molaro A. Grossi M. Bertolotti C. Mussi M. V. Libbra G. Dondi E. Pellegrini L. Carulli L. Colangelo T. Falbo V. Stanghellini R. D. Giorgio E. Ruggeri S. Vecchio A. Salvi R. Leonardi G. Damiani A. Gabrielli W. Capeci M. Mattioli G. P. Martino L. Biondi P. Pettinari R. Ghio A. D. Col S. Minisola L. Colangelo A. Afeltra B. Marigliano M. E. Pipita P. Castellino J. Blanco L. Zanoli S. Pignataro V. Saracco M. Fogliati C. Bussolino F. Mete M. Gino A. Cittadini C. Vigorito M. Arcopinto A. Salzano E. Bobbio A. M. Marra D. Sirico G. Moreo F. Gasparini S. Prolo G. Pina A. Ballestrero F. Ferrando S. Berra S. Dassi M. C. Nava B. Graziella S. Baldassarre S. Fragapani G. Gruden G. Galanti G. Mascherini C. Petri L. Stefani M. Girino V. Piccinelli F. Nasso V. Gioffra M. Pasquale G. Scattolin S. Martinelli M. Turrin L. Sechi C. Catena G. Colussi N. Passariello L. Rinaldi F. Berti G. Famularo T. Patrizia R. Castello M. Pasino G. P. Ceda M. G. Maggio S. Morganti A. Artoni S. D. Giacco D. Firinu F. Losa G. Paoletti G. Montalto A. Licata V. Malerba L. Antonino G. Basile C. Antonino L. Malatino B. Stancanelli V. Terranova S. Di Marca P. Mecocci C. Ruggiero V. Boccardi T. Meschi F. Lauretani A. Ticinesi P. Minuz L. Fondrieschi M. Pirisi G. P. Fra D. Sola M. Porta P. Riva R. Quadri G. Scanzi S. Provini L. Ricevuti E. Simeone R. Scurti F. Tolloso R. Tarquini A. Valoriani S. Dolenti G. Vannini A. Tedeschi L. Trotta R. Volpi P. Bocchi A. Vignali S. Harari C. Lonati M. Cattaneo

subject

Registrie Male Settore MED/09 - Medicina Interna 030204 cardiovascular system & hematology Severity of Illness Index 0302 clinical medicine Risk Factors 80 and over 030212 general & internal medicine Hospital Mortality Prospective Studies Registries Prospective cohort study Multivariate Analysi Aged 80 and over Diverticulosis Mortality rate Diverticulosi Gastric ulcer Anemia Anemia; Anticoagulant; Antiplatelet drug; Diverticulosis; Gastric ulcer; Multimorbidity; Internal Medicine Italy Platelet aggregation inhibitor Female Gastrointestinal Hemorrhage Antiplatelet drug Human Gastrointestinal bleeding medicine.medical_specialty Logistic Model Anemia Socio-culturale Anemia Anticoagulant Antiplatelet drug Diverticulosis Gastric ulcer Multimorbidity 03 medical and health sciences Internal medicine Severity of illness Internal Medicine medicine 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 Aged Polypharmacy business.industry Platelet Aggregation Inhibitor Risk Factor Anemia; Anticoagulant; Antiplatelet drug; Diverticulosis; Gastric ulcer; Multimorbidity Anticoagulant 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 medicine.disease Comorbidity Prospective Studie Logistic Models Multivariate Analysis business Platelet Aggregation Inhibitors

description

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  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.

year	journal	country	edition	language
2019-01-01

10.1016/j.ejim.2018.11.003 http://hdl.handle.net/11577/3340630