Patel Parth, Siraw Bekure B, Mehadi Abdulrahim Yusuf, Zaher Eli Adrian, Ebrahim Mohamed Ayman, Tafesse Yordanos T
Department of Internal Medicine, Ascension Saint Joseph Hospital, Chicago (Parth Patel, Bekure B. Siraw, Eli Adrian Zaher, Mohamed Ayman Ebrahim).
Department of Internal Medicine, John H. Stroger Jr. Hospital of Cook County (Abdulrahim Yusuf Mehadi).
Ann Gastroenterol. 2024 Jul-Aug;37(4):449-457. doi: 10.20524/aog.2024.0896. Epub 2024 Jun 14.
Diverticular bleeding is the leading cause of lower gastrointestinal bleeding, affecting 3-5% of patients with diverticulosis. Current management protocols include resuscitation, diagnosis via direct visualization, computed tomography imaging, endoscopic interventions, angioembolization, and surgery when needed. However, predictive factors for outcomes and optimal interventions remain ambiguous.
This retrospective cohort study analyzed data from the National Inpatient Sample (NIS) database (2016-2020) to determine predictors of adverse in-hospital outcomes in diverticular bleeding patients without perforation or abscess. Demographic and clinical data were extracted, and multivariate regression models were applied. Analysis was conducted using R statistical software (version 4.1.3), with significance set at P<0.05.
A total of 28,269 patients hospitalized for diverticular bleeding were identified. Age >85 years, moderate to severe Charlson Comorbidity Index, hypovolemic shock, blood transfusion requirement, and requirement for colectomy were significantly associated with greater in-hospital mortality. Factors such as late colonoscopy timing and colon resection led to longer hospital stays, while arterial embolization was predicted by older age, Black race, hypovolemic shock, and blood transfusion. Predictors of colon resection included advanced age, presence of colon cancer, and hypovolemic shock.
Our retrospective study identified significant predictors of in-hospital outcomes among patients with diverticular bleeding, informing risk stratification and management strategies. Further research is warranted to validate these findings and refine management algorithms for improved patient care. Integrating these insights into clinical practice may enhance outcomes and guide personalized interventions in diverticular bleeding management.
憩室出血是下消化道出血的主要原因，影响3%至5%的憩室病患者。目前的管理方案包括复苏、通过直接可视化诊断、计算机断层扫描成像、内镜干预、血管栓塞以及必要时的手术。然而，结局的预测因素和最佳干预措施仍不明确。
这项回顾性队列研究分析了国家住院患者样本（NIS）数据库（2016 - 2020年）中的数据，以确定无穿孔或脓肿的憩室出血患者院内不良结局的预测因素。提取了人口统计学和临床数据，并应用了多变量回归模型。使用R统计软件（版本4.1.3）进行分析，显著性设定为P<0.05。
共识别出28269例因憩室出血住院的患者。年龄>85岁、中度至重度查尔森合并症指数、低血容量性休克、输血需求以及结肠切除术需求与更高的院内死亡率显著相关。结肠镜检查时间较晚和结肠切除等因素导致住院时间延长，而动脉栓塞的预测因素包括年龄较大、黑人种族、低血容量性休克和输血。结肠切除的预测因素包括高龄、结肠癌的存在以及低血容量性休克。
我们的回顾性研究确定了憩室出血患者院内结局的重要预测因素，为风险分层和管理策略提供了依据。有必要进行进一步研究以验证这些发现并完善管理算法，以改善患者护理。将这些见解整合到临床实践中可能会改善结局，并指导憩室出血管理中的个性化干预。
