Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
J Gastroenterol. 2015 May;50(5):533-40. doi: 10.1007/s00535-014-0994-3. Epub 2014 Sep 3.
Bleeding of the lower gastrointestinal tract requires hospitalization and can cause in-hospital death in the most serious cases; however, only a few studies have evaluated in-hospital death from bleeding of the lower gastrointestinal tract. The aim of this study was to investigate the in-hospital mortality of patients with bleeding of the lower gastrointestinal tract and elucidate the factors associated with it using a large-scale database.
We analyzed a nationwide database in Japan retrospectively. From the Diagnosis Procedure Combination database, we extracted data on patients who were admitted with visible blood in stool between July 1, 2010 and March 31, 2012. We assessed age, sex, comorbidity, cause of bleeding, type of hospital, medications, body mass index (BMI), and need for blood transfusion and treatments. A multivariable logistic regression model was used to examine factors associated with blood transfusion and in-hospital death.
A total of 30,846 patients were identified. The median age was 74 years, and 52.0% of patients were male. A total of 782 patients died in hospital (2.5%), and 8,060 patients (26.1%) needed blood transfusion. In a multivariate analysis, in-hospital death was significantly associated with being older or male; comorbidities, including congestive heart failure, renal disease, and mild to severe liver disease; the cause of bleeding; a nonacademic hospital; nonsteroidal anti-inflammatory drug use; lower BMI; and requirements for blood transfusion, interventional radiology, and surgery. Most factors were similarly associated with blood transfusion.
In-hospital mortality was 2.5% and was associated with age, sex, comorbidities, cause of bleeding, type of hospital, nonsteroidal anti-inflammatory drug use, BMI, blood transfusion, and requirements for treatments.
下消化道出血需要住院治疗，在最严重的情况下可导致院内死亡；然而，仅有少数研究评估过下消化道出血的院内死亡情况。本研究旨在利用大规模数据库调查下消化道出血患者的院内死亡率，并阐明与之相关的因素。
我们回顾性地分析了日本的一个全国性数据库。从诊断程序组合数据库中，我们提取了 2010 年 7 月 1 日至 2012 年 3 月 31 日期间因大便带血而入院的患者的数据。我们评估了年龄、性别、合并症、出血原因、医院类型、药物使用、体重指数（BMI）以及输血和治疗的需求。使用多变量逻辑回归模型来检查与输血和院内死亡相关的因素。
共确定了 30846 例患者。中位年龄为 74 岁，52.0%的患者为男性。共有 782 例患者在院内死亡（2.5%），8060 例患者（26.1%）需要输血。多变量分析显示，院内死亡与年龄较大或男性、充血性心力衰竭、肾脏疾病和轻度至重度肝脏疾病等合并症、出血原因、非学术医院、非甾体抗炎药使用、较低的 BMI 以及输血、介入放射学和手术的需求显著相关。大多数因素与输血也存在类似的相关性。
院内死亡率为 2.5%，与年龄、性别、合并症、出血原因、医院类型、非甾体抗炎药使用、BMI、输血以及治疗需求相关。
