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.

Lenti, M., Pasina, L., Cococcia, S., Cortesi, L., Miceli, E., Dominioni, C., et al. (2019). Mortality rate and risk factors for gastrointestinal bleeding in elderly patients. EUROPEAN JOURNAL OF INTERNAL MEDICINE, 61, 54-61 [10.1016/j.ejim.2018.11.003].

Mortality rate and risk factors for gastrointestinal bleeding in elderly patients

Santi L.;Seghezzi S.;Annoni G.;Bellelli G.;Zazzetta S.;Mazzola P.;Szabo H.;Brucato A.;Sirico D.;Porta M.;Harari S.;
2019

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.
No
Articolo in rivista - Articolo scientifico
Scientifica
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
English
Lenti, M., Pasina, L., Cococcia, S., Cortesi, L., Miceli, E., Dominioni, C., et al. (2019). Mortality rate and risk factors for gastrointestinal bleeding in elderly patients. EUROPEAN JOURNAL OF INTERNAL MEDICINE, 61, 54-61 [10.1016/j.ejim.2018.11.003].
Lenti, M; Pasina, L; Cococcia, S; Cortesi, L; Miceli, E; Dominioni, C; Pisati, M; Mengoli, C; Perticone, F; Nobili, A; Di Sabatino, A; Corazza, G; Mannucci, P; Tettamanti, M; Franchi, C; Corrao, S; Marengoni, A; Salerno, F; Cesari, M; Licata, G; Violi, F; Ardoino, I; Prisco, D; Silvestri, E; Cenci, C; Emmi, G; Biolo, G; Zanetti, M; Guadagni, M; Zaccari, M; Vanoli, M; Grignani, G; Pulixi, E; Bernardi, M; Bassi, S; Santi, L; Zaccherini, G; Mannarino, E; Lupattelli, G; Bianconi, V; Paciullo, F; Nuti, R; Valenti, R; Ruvio, M; Cappelli, S; Palazzuoli, A; Olivieri, O; Girelli, D; Matteazzi, T; Barbagallo, M; Dominguez, L; Cocita, F; Beneduce, V; Plances, L; Zoli, M; Lazzari, I; Brunori, M; Pasini, F; Capecchi, P; Palasciano, G; Modeo, M; Di Gennaro, C; Cappellini, M; Maira, D; Di Stefano, V; Fabio, G; Seghezzi, S; Mancarella, M; Rossi, P; Damanti, S; Clerici, M; Conti, F; Murialdo, G; Marra, A; Cattaneo, F; Pontremoli, R; Secchi, M; Ghelfi, D; Anastasio, L; Sofia, L; Carbone, M; Cipollone, F; Guagnano, M; Angelucci, E; Valeriani, E; Mancuso, G; Calipari, D; Bartone, M; Delitala, G; Berria, M; Muscaritoli, M; Molfino, A; Petrillo, E; Zuccala, G; D'Aurizio, G; Romanelli, G; Zucchelli, A; Picardi, A; Gentilucci, U; Gallo, P; Dell'Unto, C; Annoni, G; Corsi, M; Bellelli, G; Zazzetta, S; Mazzola, P; Szabo, H; Bonfanti, A; Arturi, F; Succurro, E; Rubino, M; Serra, M; Bleve, M; Gasbarrone, L; Sajeva, M; Brucato, A; Ghidoni, S; Fabris, F; Bertozzi, I; Bogoni, G; Rabuini, M; Cosi, E; Manfredini, R; Fabbian, F; Boari, B; De Giorgi, A; Tiseo, R; Paolisso, G; Rizzo, M; Borghi, C; Strocchi, E; De Sando, V; Pareo, I; Sabba, C; Vella, F; Suppressa, P; Agosti, P; Schilardi, A; Loparco, F; Fenoglio, L; Bracco, C; Giraudo, A; Fargion, S; Periti, G; Porzio, M; Tiraboschi, S; Peyvandi, F; Rossio, R; Ferrari, B; Colombo, G; Monzani, V; Savojardo, V; Folli, C; Ceriani, G; Pallini, G; Dallegri, F; Ottonello, L; Liberale, L; Caserza, L; Salam, K; Liberato, N; Tognin, T; Bianchi, G; Giaquinto, S; Purrello, F; Di Pino, A; Piro, S; Rozzini, R; Falanga, L; Spazzini, E; Ferrandina, C; Montrucchio, G; Petitti, P; Salmi, R; Gaudenzi, P; Perri, L; Landolfi, R; Montalto, M; Mirijello, A; Guasti, L; Castiglioni, L; Maresca, A; Squizzato, A; Molaro, M; Grossi, A; Bertolotti, M; Mussi, C; Libbra, M; Dondi, G; Pellegrini, E; Carulli, L; Colangelo, L; Falbo, T; Stanghellini, V; Giorgio, R; Ruggeri, E; Vecchio, S; Salvi, A; Leonardi, R; Damiani, G; Gabrielli, A; Capeci, W; Mattioli, M; Martino, G; Biondi, L; Pettinari, P; Ghio, R; Col, A; Minisola, S; Colangelo, L; Afeltra, A; Marigliano, B; Pipita, M; Castellino, P; Blanco, J; Zanoli, L; Pignataro, S; Saracco, V; Fogliati, M; Bussolino, C; Mete, F; Gino, M; Cittadini, A; Vigorito, C; Arcopinto, M; Salzano, A; Bobbio, E; Marra, A; Sirico, D; Moreo, G; Gasparini, F; Prolo, S; Pina, G; Ballestrero, A; Ferrando, F; Berra, S; Dassi, S; Nava, M; Graziella, B; Baldassarre, S; Fragapani, S; Gruden, G; Galanti, G; Mascherini, G; Petri, C; Stefani, L; Girino, M; Piccinelli, V; Nasso, F; Gioffra, V; Pasquale, M; Scattolin, G; Martinelli, S; Turrin, M; Sechi, L; Catena, C; Colussi, G; Passariello, N; Rinaldi, L; Berti, F; Famularo, G; Patrizia, T; Castello, R; Pasino, M; Ceda, G; Maggio, M; Morganti, S; Artoni, A; Giacco, S; Firinu, D; Losa, F; Paoletti, G; Montalto, G; Licata, A; Malerba, V; Antonino, L; Basile, G; Antonino, C; Malatino, L; Stancanelli, B; Terranova, V; Di Marca, S; Mecocci, P; Ruggiero, C; Boccardi, V; Meschi, T; Lauretani, F; Ticinesi, A; Minuz, P; Fondrieschi, L; Pirisi, M; Fra, G; Sola, D; Porta, M; Riva, P; Quadri, R; Scanzi, G; Provini, S; Ricevuti, L; Simeone, E; Scurti, R; Tolloso, F; Tarquini, R; Valoriani, A; Dolenti, S; Vannini, G; Tedeschi, A; Trotta, L; Volpi, R; Bocchi, P; Vignali, A; Harari, S; Lonati, C; Cattaneo, M
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Utilizza questo identificativo per citare o creare un link a questo documento: http://hdl.handle.net/10281/280153
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