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 < 0.05).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.

Mortality rate and risk factors for gastrointestinal bleeding in elderly patients

Domenico Prisco
Membro del Collaboration Group
;
Elmo Mannarino
Membro del Collaboration Group
;
Graziana Lupattelli
Membro del Collaboration Group
;
Vanessa Bianconi
Membro del Collaboration Group
;
Francesco Paciullo
Membro del Collaboration Group
;
Oliviero Olivieri
Membro del Collaboration Group
;
Maria Domenica Cappellini
Membro del Collaboration Group
;
Federica Conti
Membro del Collaboration Group
;
Lucia Sofia
Membro del Collaboration Group
;
Maria Carbone
Membro del Collaboration Group
;
Paolo Mazzola
Membro del Collaboration Group
;
Marco Bertolotti
Membro del Collaboration Group
;
Elisa Pellegrini
Membro del Collaboration Group
;
Roberto Leonardi
Membro del Collaboration Group
;
Massimo Mattioli
Membro del Collaboration Group
;
Lorenzo Biondi
Membro del Collaboration Group
;
Maria Pasquale
Membro del Collaboration Group
;
Giuseppe Montalto
Membro del Collaboration Group
;
Patrizia Mecocci
Membro del Collaboration Group
;
Carmelinda Ruggiero
Membro del Collaboration Group
;
Virginia Boccardi
Membro del Collaboration Group
;
Roberto Tarquini
Membro del Collaboration Group
;
Riccardo Volpi
Membro del Collaboration Group
;
2019-01-01

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 < 0.05).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.
File in questo prodotto:
Non ci sono file associati a questo prodotto.

I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.

Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11391/1538494
Citazioni
  • ???jsp.display-item.citation.pmc??? 24
  • Scopus 42
  • ???jsp.display-item.citation.isi??? 43
social impact