急性结肠憩室出血患者院内不良结局的危险因素
Risk factors for adverse in-hospital outcomes in acute colonic diverticular hemorrhage.
作者信息
Nagata Naoyoshi, Niikura Ryota, Aoki Tomonori, Moriyasu Shiori, Sakurai Toshiyuki, Shimbo Takuro, Sekine Katsunori, Okubo Hidetaka, Watanabe Kazuhiro, Yokoi Chizu, Akiyama Junichi, Yanase Mikio, Mizokami Masashi, Fujimoto Kazuma, Uemura Naomi
机构信息
Naoyoshi Nagata, Ryota Niikura, Tomonori Aoki, Shiori Moriyasu, Toshiyuki Sakurai, Katsunori Sekine, Hidetaka Okubo, Kazuhiro Watanabe, Chizu Yokoi, Junichi Akiyama, Mikio Yanase, Department of Gastroenterology and Hepatology, National Center for Global Health and Medicine, Shinjuku, Tokyo 162-8655, Japan.
出版信息
World J Gastroenterol. 2015 Oct 7;21(37):10697-703. doi: 10.3748/wjg.v21.i37.10697.
AIM
To investigate the factors associated with transfusion, further bleeding, and prolonged length of stay.
METHODS
In total, 153 patients emergently hospitalized for diverticular bleeding who were examined by colonoscopy were prospectively enrolled. Patients in whom the bleeding source was identified received endoscopic treatment such as clipping or endoscopic ligation. After spontaneous cessation of bleeding with conservative treatment or hemostasis with endoscopic treatment, all patients were started on a liquid food diet and gradually progressed to a solid diet over 3 d, and were discharged. At enrollment, we assessed smoking, alcohol, medications [non-steroidal anti-inflammatory drugs (NSAIDs)], low-dose aspirin, and other antiplatelets, warfarin, acetaminophen, and oral corticosteroids), and co-morbidities [hypertension, diabetes mellitus, dyslipidemia, cerebro-cardiovascular disease, chronic liver disease, and chronic kidney disease (CKD)]. The in-hospital outcomes were need for transfusion, further bleeding after spontaneous cessation of hemorrhage, and length of hospital stay. The odds ratio (OR) for transfusion need, further bleeding, and prolonged length of stay were estimated by logistic regression analysis.
RESULTS
No patients required angiographic embolization or surgery. Stigmata of bleeding occurred in 18% of patients (27/153) and was treated by endoscopic procedures. During hospitalization, 40 patients (26%) received a median of 6 units of packed red blood cells. Multivariate analysis revealed that female sex (OR = 2.5, P = 0.02), warfarin use (OR = 9.3, P < 0.01), and CKD (OR = 5.9, P < 0.01) were independent risk factors for transfusion need. During hospitalization, 6 patients (3.9%) experienced further bleeding, and NSAID use (OR = 5.9, P = 0.04) and stigmata of bleeding (OR = 11, P < 0.01) were significant risk factors. Median length of hospital stay was 8 d. Multivariate analysis revealed that age > 70 years (OR = 2.1, P = 0.04) and NSAID use (OR = 2.7, P = 0.03) were independent risk factors for prolonged hospitalization (≥ 8 d).
CONCLUSION
In colonic diverticular bleeding, female sex, warfarin, and CKD increased the risk of transfusion requirement, while advanced age and NSAID increased the risk of prolonged hospitalization.
目的
探讨与输血、再次出血及住院时间延长相关的因素。
方法
前瞻性纳入153例因憩室出血紧急住院并接受结肠镜检查的患者。确定出血源的患者接受了内镜治疗，如钳夹或内镜结扎。在保守治疗使出血自然停止或内镜治疗止血后，所有患者开始进食流食，并在3天内逐渐过渡到固体食物，然后出院。在入组时，我们评估了吸烟、饮酒、药物使用[非甾体抗炎药（NSAIDs）]、低剂量阿司匹林及其他抗血小板药物、华法林、对乙酰氨基酚和口服糖皮质激素）以及合并症[高血压、糖尿病、血脂异常、心脑血管疾病、慢性肝病和慢性肾病（CKD）]。住院结局包括输血需求、出血自然停止后的再次出血以及住院时间。通过逻辑回归分析估计输血需求、再次出血和住院时间延长的比值比（OR）。
结果
无患者需要血管造影栓塞或手术治疗。18%的患者（27/153）出现出血征象，并接受了内镜治疗。住院期间，40例患者（26%）接受了中位数为6单位的浓缩红细胞输注。多因素分析显示，女性（OR = 2.5，P = 0.02）、使用华法林（OR = 9.3，P < 0.01）和CKD（OR = 5.9，P < 0.01）是输血需求的独立危险因素。住院期间，6例患者（3.9%）再次出血，使用NSAIDs（OR = 5.9，P = 0.04）和出血征象（OR = 11，P < 0.01）是显著的危险因素。中位住院时间为8天。多因素分析显示，年龄>70岁（OR = 2.1，P = 0.04）和使用NSAIDs（OR = 2.7，P = 0.03）是住院时间延长（≥8天）的独立危险因素。
结论
在结肠憩室出血中，女性、华法林和CKD增加了输血需求的风险，而高龄和NSAIDs增加了住院时间延长的风险。
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