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Construction of a Model for Predicting the Severity of Diverticular Bleeding in an Elderly Population
Tomoyuki Okada1, Tsuyoshi Mikamo1, Ayana Nakashima1
1Tottori Prefectural Central Hospital, Japan.
Insights
Changes in vital signs, hypoalbuminemia, bilateral diverticula, and rebleeding are key predictors of severe diverticular bleeding in elderly patients. Early identification of these risk factors can aid in managing this condition.
Area of Science:
- Gastroenterology
- Geriatric Medicine
- Clinical Epidemiology
Background:
- Diverticular bleeding is a common cause of lower gastrointestinal bleeding, particularly in the elderly.
- Identifying risk factors for severe diverticular bleeding is crucial for timely intervention and improved patient outcomes.
Purpose of the Study:
- To identify independent risk factors associated with severe diverticular bleeding in patients aged 65 and older.
- To develop a predictive model for severe diverticular bleeding in an elderly population.
Main Methods:
- A retrospective study analyzing data from 120 elderly patients (≥65 years) diagnosed with diverticular bleeding.
- Comparison of 19 potential risk factors between severe and non-severe bleeding cases using logistic regression analysis.
Main Results:
- Severe diverticular bleeding occurred in 43% of the study cohort.
- Independent predictors of severe bleeding included changes in vital signs (OR 5.23), hypoalbuminemia (OR 12.3), bilateral diverticula (OR 3.47), and rebleeding (OR 5.92).
- The predictive model demonstrated good performance with an area under the receiver operating characteristic curve of 0.79.
Conclusions:
- Changes in vital signs, hypoalbuminemia, bilateral diverticula, and a history of rebleeding are significant predictors of severe diverticular bleeding in the elderly.
- These factors can aid clinicians in assessing the risk of severe bleeding and guiding management strategies.
Abstract:
Objective To identify the risk factors for severe diverticular bleeding in an elderly population. Methods Using a comprehensive computerized hospital database, severe and non-severe diverticular bleeding cases were compared for 19 factors: the age, sex, body mass index, comorbid conditions (hypertension, cardiovascular disease, cerebrovascular disease, and chronic renal failure, including those undergoing dialysis), history of diverticular bleeding, use of low-dose aspirin, use of antiplatelet agent besides aspirin, use of anticoagulant agent, use of prednisolone, use of non-steroidal anti-inflammatory drugs, use of cyclooxygenase-2 selective inhibitors, changes in vital signs, hypoalbuminemia, bilateral diverticula, identification of bleeding lesion, and rebleeding. Severe bleeding was defined as the need for blood transfusion, emergency surgery, or vascular embolization. Patients A total of 258 patients were admitted for lower gastrointestinal bleeding between August 2010 and July 2020, among whom 120 patients over 65 years old diagnosed with diverticular bleeding were included in this study. Results Fifty-one patients (43%) had severe diverticular bleeding. Independent risk factors for severe diverticular bleeding were as follows: change in vital signs [odds ratio (OR), 5.23; 95% confidence interval (CI), 1.9-14.4; p=0.0014], hypoalbuminemia (OR, 12.3; 95% CI, 1.97-77.3; p=0.0073), bilateral diverticula (OR, 3.47; 95% CI, 1.33-9.02; p=0.011), and rebleeding (OR, 5.92; 95% CI, 2.21-15.8; p<0.001). The area under the receiver operating characteristic curve was 0.79 after cross validation. Conclusion Severe diverticular bleeding in elderly population may be predicted by changes in their vital signs, hypoalbuminemia, bilateral diverticula, and rebleeding.
