The mortality rate in patients with acute lower gastrointestinal (GI) bleeding is substantial and mainly related to age and comorbidities, according to the results of a study published in Digestive and Liver Disease.
Researchers conducted a multicenter, prospective study of adult outpatients acutely admitted for or developing lower GI bleeding during hospitalization in 15 high-volume referral centers in Italy. A total of 1198 patients (1060 new admissions and 138 inpatients; median age, 78 years; 52.2% men) were included. Approximately 31% of participants had a Charlson Comorbidity Index of 3 or more, and about 58% were on an antithrombotic therapy regimen.
Overall, in-hospital mortality occurred in 41/1198 patients (3.4%; 95% CI, 2.5-4.6) and was significantly higher for inpatients (12/138, 8.7%; 95% CI, 5.0-14.0) compared with outpatients (29/1060, 2.7%; 95% CI, 1.9-3.9; P <.001).
According to multivariate analysis, independent predictors of mortality were age (OR, 1.10; 95% CI, 1.05-1.15), Charlson Comorbidity Index (OR 1.20; 95% CI, 1.04-1.38), in-hospital bleeding (OR, 3.08; 95% CI, 1.23-7.75), hemodynamic instability at presentation (OR, 3.42; 95% CI, 1.37-8.57), and admission to the intensive care unit. Conversely, the use of anticoagulants (OR 0.23; 95% CI, 0.09-0.63) and having bleeding in the colon (OR, 0.32; 95% CI, 0.14-0.72) were inversely associated with mortality.
The diagnostic yields for urgent, early, and elective colonoscopies were comparable (P =.564); however, endoscopic hemostasis was significantly more frequently performed in urgent (23/96, 23.9%) and early procedures (19/82, 18.8%) than elective procedures (40/396, 10.8%; P <.001 and P =.03, respectively). The definite or suspected source of bleeding was discovered in 1048 (87.4%) patients.
“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,” the investigators stated.
Among several study limitations, according to the study authors, the selection of participating centers may limit the generalizability of the results. Also, a systematic follow-up after discharge was not planned; therefore, outcome data are limited to the hospital time frame, and the researchers cannot exclude the possibility that fatality rate associated with lower GI bleeding rate could be underestimated.
“[The] present large multicenter prospective study showed that fatality rate for [lower GI bleeding] is substantial and mainly related to patient age and comorbidities,” the investigators commented. “The diagnostic yield of colonoscopy was high and its use as initial diagnostic test required fewer investigations to get the diagnosis, although the impact of urgent or early colonoscopy on both mortality and re-bleeding appears to be negligible. Present real-life results were partially inconsistent with practice guideline recommendations, suggesting that the quality of care for LGIB patient care has room for improvement and should be targeted by educational interventions from gastrointestinal societies.”
Radaelli F, Frazzoni L, Repici A, et al. Clinical management and patient outcomes of acute lower gastrointestinal bleeding. A multicenter, prospective, cohort study. Dig Liver Dis. Published online January 25, 2021. doi:10.1016/j.dld.2021.01.002