Gastroenterology Unit, Ospedale Valduce, Como, Italy.
Policlinico Sant'Orsola Malpighi, Università di Bologna, Italy.
Dig Liver Dis. 2021 Sep;53(9):1141-1147. doi: 10.1016/j.dld.2021.01.002. Epub 2021 Jan 25.
BACKGROUND & AIM: Although acute lower GI bleeding (LGIB) represents a significant healthcare burden, prospective real-life data on management and outcomes are scanty. Present multicentre, prospective cohort study was aimed at evaluating mortality and associated risk factors and at describing patient management.
Adult outpatients acutely admitted for or developing LGIB during hospitalization were consecutively enrolled in 15 high-volume referral centers. Demographics, comorbidities, medications, interventions and outcomes were recorded.
Overall 1,198 patients (1060 new admissions;138 inpatients) were included. Most patients were elderly (mean-age 74±15 years), 31% had a Charlson-Comorbidity-Index ≥3, 58% were on antithrombotic therapy. In-hospital mortality (primary outcome) was 3.4% (95%CI 2.5-4.6). At logistic regression analysis, independent predictors of mortality were increasing age, comorbidity, inpatient status, hemodynamic instability at presentation, and ICU-admission. Colonoscopy had a 78.8% diagnostic yield, with significantly higher hemostasis rate when performed within 24-hours than later (21.3% vs.10.8%, p = 0.027). Endoscopic hemostasis was associated with neither in-hospital mortality nor rebleeding. A definite or presumptive source of bleeding was disclosed in 90.4% of investigated patients.
Mortality in LGIB patients is mainly related to age and comorbidities. Although early colonoscopy has a relevant diagnostic yield and is associated with higher therapeutic intervention rate, endoscopic hemostasis is not associated with improved clinical outcomes [ClinicalTrial.gov number: NCT04364412].
尽管急性下胃肠道出血（LGIB）对医疗保健造成了重大负担，但前瞻性的真实世界数据在管理和结局方面仍然很少。本多中心前瞻性队列研究旨在评估死亡率和相关的危险因素，并描述患者的管理情况。
连续纳入在 15 家高容量转诊中心住院期间或因 LGIB 急性入院或发展的成年门诊患者。记录人口统计学、合并症、药物治疗、干预措施和结局。
共纳入 1198 例患者（1060 例新入院；138 例住院患者）。大多数患者年龄较大（平均年龄 74±15 岁），31%的患者 Charlson 合并症指数≥3，58%的患者正在接受抗血栓治疗。住院期间死亡率（主要结局）为 3.4%（95%CI 2.5-4.6）。在逻辑回归分析中，死亡率的独立预测因素是年龄增加、合并症、住院状态、就诊时血流动力学不稳定以及入住 ICU。结肠镜检查的诊断率为 78.8%，在 24 小时内进行的止血率明显高于以后进行的止血率（21.3%比 10.8%，p=0.027）。内镜止血与住院期间死亡率或再出血均无关。90.4%的调查患者明确或疑似发现出血源。
LGIB 患者的死亡率主要与年龄和合并症有关。尽管早期结肠镜检查具有较高的诊断率，并且与较高的治疗干预率相关，但内镜止血与改善临床结局无关。[临床试验注册号：NCT04364412]。
