Endoscopy 2020; 52(S 01): S21
DOI: 10.1055/s-0040-1704070
ESGE Days 2020 oral presentations
Friday, April 24, 2020 08:30 – 10:30 Blood on the tracks Wicklow Meeting Room 3
© Georg Thieme Verlag KG Stuttgart · New York

MORTALITY OF ACUTE LOWER GASTROINTESTINAL BLEEDING: A PROSPECTIVE, MULTICENTRE, COHORT STUDY

A Andrealli
1   Ospedale Valduce, Como, Italy
,
F Radaelli
1   Ospedale Valduce, Como, Italy
,
L Frazzoni
2   University of Bologna, Department of Medical and Surgical Sciences, Bologna, Italy
,
A Repici
3   Istituto Clinico Humanitas, Humanitas Research Hospital, Rozzano, , Milano, Italy
,
A Mussetto
4   Gastroenterology Unit, S. Maria delle Croci Hospital, Ravenna, Italy
,
C Spada
5   Digestive Endoscopy Unit, Fondazione Poliambulanza, Brescia, Italy
,
G Manes
6   ASST Rhodense, Rho and Garbagnate Milanese Hospital, Department of Gastroenterology, Milano, Italy
,
S Segato
7   Ospedale di Circolo e Fondazione Macchi, Varese, Italy
,
A Musso
8   Città della Salute e della Scienza di Torino, Presidio Le Molinette, Torino, Italy
,
ED Giulio
9   Azienda Ospedaliera Sant’Andrea, Roma, Italy
,
M Manno
10   UOSD Gastroenterologia ed Endoscopia Digestiva, Azienda USL di Modena, Carpi, Italy
,
GD Nucci
6   ASST Rhodense, Rho and Garbagnate Milanese Hospital, Department of Gastroenterology, Milano, Italy
,
V Festa
11   ASL Roma 1, Ospedale San Filippo Neri, Roma, Italy
,
AD Leo
12   UO Gastroenterologia Policlinico di Bari, Bari, Italy
,
M Marini
13   Azienda Ospedaliera Universitaria Senese, Siena, Italy,
,
L Ferraris
14   ASST Valle Olona, Presidio Ospedaliero di Gallarate, Varese, Italy
,
C Hassan
15   Endoscopy Unit, Nuovo Regina Margherita Hospital, Roma, Italy
,
L Fuccio
2   University of Bologna, Department of Medical and Surgical Sciences, Bologna, Italy
,
S Paggi
1   Ospedale Valduce, Como, Italy
› Author Affiliations
Further Information

Publication History

Publication Date:
23 April 2020 (online)

Also available at
 

Aims Acute lower GI bleeding (LGIB) is a common reason for hospitalization and death. This study was aimed to identify predictors of mortality in a large cohort of patients with acute LGIB.

Methods A multicentre, prospective, observational study on acute LGIB was conducted from October 1st 2018 to October 28th 2019 in 15 Italian hospitals. Consecutive, unselected adult outpatients acutely admitted for LGIB or developing LGIB during hospital stay were prospectively enrolled; those witch upper GI bleeding diagnosis were excluded. Demographic data, comorbidities, medications, interventions, and main clinical outcomes were recorded. Those significant related to in-hospital mortality at univariate analysis were included in a logistic regression model.

Results Data on 1198 cases (1060 new admissions; 138 inpatients) were analysed. Most patients were elderly (mean age 74+15 years) and 76% had at least one major comorbidity (Charlson Comorbidity Index > 1). A total of 117 (9.8%) patients received no inpatient investigation. In-hospital mortality was 3.4% (41 patients), and resulted significantly higher for inpatients than outpatients (6% vs. 2.7%, p< 0.001). At univariate analysis, increasing age, Charlson comorbidity Index, bleeding presentation (haemodynamic instability, melena, inpatient bleeding) and ICU admission were associated with higher mortality. Mortality was lower in patients admitted in GI or surgical units (vs. internal medicine) or taking antithrombotic drugs. No association was found between mortality and early colonoscopy. At multivariate analysis, independent predictors of mortality were age (OR 1.08; 95%CI, 1.04-1.13), Charlson comorbidity Index (OR 1.16; 95%CI, 1.01-1.34), in-hospital bleeding (OR; 3.57; 95%CI 1.38-9.29), haemodynamic instability at presentation (OR 2.60; 95%CI, 1.01-6.72), and ICU admission (OR 7.30; 95%CI, 1.43-37.13)

Conclusions Patient age, comorbidities, and severity of haemorrhage were the main determinants of in-patient mortality. These variables should be considered when triaging LGIB patients for immediate resuscitation, close observation and early treatment.