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Published on: July 12, 2018
Risk factors for adverse in-hospital outcomes in acute colonic diverticular hemorrhage
Naoyoshi Nagata1, Ryota Niikura1, Tomonori Aoki1
1Naoyoshi 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.
Insights
Female sex, warfarin use, and chronic kidney disease (CKD) increase transfusion risk in diverticular bleeding. Advanced age and non-steroidal anti-inflammatory drug (NSAID) use are linked to prolonged hospitalization.
Area of Science:
- Gastroenterology
- Internal Medicine
- Clinical Research
Background:
- Colonic diverticular bleeding is a common cause of lower gastrointestinal hemorrhage.
- Identifying risk factors for adverse outcomes is crucial for patient management.
Purpose of the Study:
- To investigate factors associated with transfusion, further bleeding, and prolonged hospital stay in patients with diverticular bleeding.
- To identify independent risk factors for adverse outcomes in this patient population.
Main Methods:
- Prospective enrollment of 153 patients hospitalized for diverticular bleeding.
- Assessment of patient demographics, medications (including NSAIDs, warfarin), and comorbidities (including CKD).
- Logistic regression analysis to determine odds ratios for transfusion, re-bleeding, and prolonged length of stay.
Main Results:
- Female sex, warfarin use, and chronic kidney disease (CKD) were independent risk factors for transfusion.
- Non-steroidal anti-inflammatory drug (NSAID) use and stigmata of bleeding were significant risk factors for further bleeding.
- Advanced age (>70 years) and NSAID use were independent risk factors for prolonged hospitalization (≥ 8 days).
Conclusions:
- Female sex, warfarin, and CKD are associated with an increased need for blood transfusions in colonic diverticular bleeding.
- Advanced age and NSAID use are associated with a longer hospital stay in patients with diverticular bleeding.
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.
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