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[Risk Factors for Adverse Outcomes in the Elderly Inpatients with Gastrointestinal Bleeding]
Xian Zhang1, Xue Xiao1, Liang Ma1
1Department of Gastroenterology, West China Hospital, Sichuan University, Chengdu 610041, China.
Insights
Elderly patients with gastrointestinal bleeding (GIB) face a higher risk of adverse outcomes, particularly those with upper GIB. Key predictors of poor prognosis include a high shock index, elevated INR, and fresh frozen plasma transfusion.
Area of Science:
- Gastroenterology
- Geriatrics
- Internal Medicine
Background:
- Gastrointestinal bleeding (GIB) poses a significant health risk to elderly inpatients.
- Identifying factors associated with adverse outcomes in this demographic is crucial for improving patient care.
Purpose of the Study:
- To investigate the independent risk factors for adverse outcomes in elderly inpatients diagnosed with GIB.
- To compare the prognosis of upper GIB (UGIB) versus lower GIB (LGIB) in this patient population.
Main Methods:
- Retrospective analysis of clinical data from 885 elderly patients (≥60 years) admitted with GIB.
- Logistic regression analyses (univariate and multivariate) were employed to identify risk factors for adverse outcomes, defined as ICU admission or in-hospital death.
Main Results:
- The overall adverse outcome rate was 13.22%, with significantly higher rates in UGIB patients compared to LGIB patients (P<0.001).
- Independent risk factors for adverse outcomes included UGIB, a shock index >1 on admission, a higher international normalized ratio (INR) on admission, and fresh frozen plasma (FFP) transfusion during hospitalization.
- An INR >1.5 on admission was strongly associated with increased risk of adverse outcomes (P<0.001).
Conclusions:
- Elderly patients with UGIB have a worse prognosis than those with LGIB.
- A shock index >1, INR >1.5 on admission, and FFP transfusion are independent risk factors for adverse outcomes in elderly GIB inpatients.
Objective:
To explore the factors affecting the adverse prognosis of elderly inpatients with gastrointestinal bleeding (GIB).
Methods:
We retrospectively analyzed the clinical data of elderly patients aged 60 and over admitted with GIB to the Department of Gastroenterology, West China Hospital, Sichuan University between January 2016 and January 2021. The adverse outcome was defined as admission to the intensive care unit and/or in-hospital death during the patient's stay at the hospital. Univariate and multivariate logistic regression analyses were done to identify the risk factors associated with the adverse outcome of the elderly.
Results:
A total of 885 elderly patients (median age: 72.00 years, 517 males and 368 females) with GIB were enrolled, including 436 cases of upper GIB (UGIB) and 449 cases of lower GIB (LGIB). The overall rate of adverse outcome was 13.22% (117/885), which was significantly higher in the UGIB patients than that in the LGIB patients ( P<0.001). Univariate logistic regression identified UGIB ( P<0.001), shock index>1 ( P<0.001), hemoglobin ( P<0.001), blood urea nitrogen ( P<0.001), creatinine ( P<0.001), and international normalized ratio (INR) ( P<0.001) on admission, as well as erythrocyte transfusion ( P<0.001), fresh frozen plasma (FFP) transfusion ( P<0.001), and platelet transfusion ( P<0.001) were associated with adverse outcome. Multivariate logistic analysis showed that UGIB ( P<0.001), shock index >1 on admission ( P=0.001), higher INR on admission ( P=0.015) and FFP transfusion during hospitalization ( P<0.001) were independent risk factors for adverse outcome of elderly patients with GIB. Further analysis showed that INR>1.5 on admission significantly increased the risks of adverse outcome ( P<0.001).
Conclusion:
Elderly patients with UGIB exhibited worse prognosis than those with LGIB. After adjusting for age and the location of bleeding, shock index>1, INR>1.5 on admission and FFP transfusion were considered independent risk factors for the adverse outcome of elderly inpatients with GIB.
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