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Risk factors for severity and recurrence of colonic diverticular bleeding
Natércia Joaquim1, Paulo Caldeira2, Artur G Antunes3
1Departamento de Ciências Biomédicas e de Medicina, Universidade do Algarve , Portugal.
Insights
Colonic diverticular bleeding is common, with nearly half of hospitalized patients experiencing severe bleeding. Key risk factors for severe bleeding include low hemoglobin, older age, bilateral diverticular location, and chronic kidney disease.
Area of Science:
- Gastroenterology
- Internal Medicine
- Clinical Research
Background:
- Colonic diverticular bleeding is a leading cause of lower gastrointestinal bleeding.
- Predictors for bleeding severity and recurrence remain incompletely understood.
Purpose of the Study:
- To characterize Portuguese patients hospitalized for colonic diverticular bleeding.
- To identify clinical predictors of bleeding severity and rebleeding.
Main Methods:
- Retrospective analysis of hospitalized patients diagnosed with colonic diverticular bleeding (2008-2013).
- Outcomes assessed: bleeding severity (transfusion/hemodynamic shock) and 1-year recurrence rate.
Main Results:
- 74 patients analyzed; mean age 75.7 years, 62.2% male.
- 48.6% experienced severe bleeding.
- Independent risk factors for severe bleeding: low hemoglobin (≤11 g/dL), age (≥75 years), bilateral diverticular location, and chronic kidney disease.
- 1-year recurrence rate was 12.9%; no independent risk factors for recurrence identified.
Conclusions:
- Nearly half of hospitalized patients with diverticular bleeding present with severe bleeding.
- Low hemoglobin, advanced age, bilateral diverticular location, and chronic kidney disease increase the risk of severe bleeding.
- While a small proportion rebled within a year, no independent risk factors for recurrence were found.
Background:
Colonic diverticular bleeding is the most common cause of lower gastrointestinal bleeding. Risk factors related to severity and repeated bleeding episodes are not completely clearly defined.
Objective:
To characterize a Portuguese population hospitalized due to colonic diverticular bleeding and to identify the clinical predictors related to bleeding severity and rebleeding.
Methods:
Retrospective analysis of all hospitalized patients diagnosed with colonic diverticular bleeding from January 2008 to December 2013 at our institution. The main outcomes evaluated were bleeding severity, defined as any transfusion support requirements and/or signs of hemodynamic shock, and 1-year recurrence rate.
Results:
Seventy-four patients were included, with a mean age of 75.7 ± 9.5 years; the majority were male (62.2%). Thirty-six patients (48.6%) met the criteria for severe bleeding; four independent risk factors for severe diverticular bleeding were identified: low hemoglobin level at admission (≤ 11 g/dL; OR 18.8), older age (≥ 75 years; OR 4.7), bilateral diverticular location (OR 14.2) and chronic kidney disease (OR 5.6). The 1-year recurrence rate was 12.9%. We did not identify any independent risk factor for bleeding recurrence in this population.
Conclusion:
In this series, nearly half of the patients hospitalized with diverticular bleeding presented with severe bleeding. Patients with low hemoglobin levels, older age, bilateral diverticular location and chronic kidney disease had a significantly increased risk for severe diverticular bleeding. In addition, a small number of patients rebled within the first year after the index episode, although we could not identify independent risk factors associated with the recurrence of diverticular bleeding.
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