Clinical management and patient outcomes of acute lower gastrointestinal bleeding. A multicenter, prospective, cohort study
Autor: | Germana de Nucci, Mauro Manno, Paola Soriani, Mario Marini, Cesare Hassan, Emanuele Rondonotti, Gianpiero Manes, Emilio Di Giulio, Chiara Del Bono, Alessandro Musso, Alessandro Mussetto, Sergio Segato, V. Festa, Luca Ferraris, Alfredo Di Leo, Chiara Coluccio, Leonardo Frazzoni, Franco Radaelli, Marcella Feliziani, Arnaldo Amato, E. Grassi, Alessandro Repici, Silvia Paggi, V. Feletti, Lorenzo Fuccio, Cristiano Spada |
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Přispěvatelé: | 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 |
Jazyk: | angličtina |
Rok vydání: | 2021 |
Předmět: |
Male
medicine.medical_specialty Referral Psychological intervention Colonoscopy Comorbidity Logistic regression 03 medical and health sciences 0302 clinical medicine Internal medicine Antithrombotic Medicine Humans Age Factor Hospital Mortality Prospective Studies Prospective cohort study Aged Aged 80 and over Hepatology medicine.diagnostic_test business.industry Gastroenterology Age Factors Middle Aged medicine.disease Hospitalization Endoscopic hemostasi 030220 oncology & carcinogenesis Hemostasis 030211 gastroenterology & hepatology Female business Gastrointestinal Hemorrhage Lower GI bleeding Human |
Popis: | 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]. |
Databáze: | OpenAIRE |
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