TY - JOUR
T1 - Clinical management and patient outcomes of acute lower gastrointestinal bleeding. A multicenter, prospective, cohort study
AU - Radaelli, Franco
AU - Frazzoni, Leonardo
AU - Repici, Alessandro
AU - Rondonotti, Emanuele
AU - Mussetto, Alessandro
AU - Feletti, Valentina
AU - Spada, Cristiano
AU - Manes, Gianpiero
AU - Segato, Sergio
AU - Grassi, Eleonora
AU - Grassi, Elisa Maria
AU - Musso, Alessandro
AU - Di Giulio, Emilio
AU - Coluccio, Chiara
AU - Manno, Mauro
AU - De Nucci, Germana
AU - Festa, Virginia
AU - Di Leo, Alfredo
AU - Marini, Mario
AU - Marini, Martina
AU - Ferraris, Luca
AU - Feliziani, Marcella
AU - Amato, Arnaldo
AU - Soriani, Paola
AU - Del Bono, Chiara
AU - Paggi, Silvia
AU - Hassan, Cesare
AU - Fuccio, Lorenzo
PY - 2021
Y1 - 2021
N2 - 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].
AB - 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].
KW - Colonoscopy
KW - Endoscopic hemostasis
KW - Lower GI bleeding
KW - Colonoscopy
KW - Endoscopic hemostasis
KW - Lower GI bleeding
UR - http://hdl.handle.net/10807/250778
U2 - 10.1016/j.dld.2021.01.002
DO - 10.1016/j.dld.2021.01.002
M3 - Article
SN - 1590-8658
VL - 53
SP - 1141
EP - 1147
JO - Digestive and Liver Disease
JF - Digestive and Liver Disease
ER -