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Risk factors for patients hospitalized with recurrent colon diverticular bleeding: a single center experience
Hye-Su You1, Dong Hyun Kim1, Seo-Yeon Cho1
1Division of Gastroenterology and Hepatology, Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Republic of Korea.
Insights
Recurrent colonic diverticular bleeding (CDB) is common. High comorbidity scores and specific diverticula locations increase the risk of recurrent bleeding, guiding clinical management.
Area of Science:
- Gastroenterology
- Clinical Medicine
- Epidemiology
Background:
- Colonic diverticular bleeding (CDB) is a frequent cause of acute lower gastrointestinal bleeding.
- Patients experiencing CDB face a significant risk of bleeding recurrence.
- Understanding risk factors for recurrent CDB (rCDB) is crucial for patient management.
Purpose of the Study:
- To evaluate the clinical course of patients diagnosed with CDB.
- To identify independent risk factors associated with recurrent colonic diverticular bleeding (rCDB).
Main Methods:
- A retrospective cohort study included 219 patients hospitalized for CDB between 2005 and 2020.
- Cox proportional hazards regression analysis was employed to assess risk factors for rCDB.
- Models were adjusted for age, Charlson Comorbidity Index (CCI), and diverticula distribution (bilateral, left-sided, sigmoid).
Main Results:
- Over a median follow-up of 506 days, 28.3% of patients experienced rCDB.
- A high Charlson Comorbidity Index (CCI) score (≥4) was independently associated with rCDB.
- Advanced age (≥75 years) and the presence of bilateral or sigmoid colon diverticula were also identified as independent risk factors for rCDB.
Conclusions:
- Recurrent colonic diverticular bleeding (rCDB) is a frequent event in patients with a history of CDB.
- Higher comorbidity burden (CCI) and specific patterns of diverticula distribution (bilateral, sigmoid) are significant predictors of rCDB.
- Clinical assessment for rCDB should incorporate patient age, comorbidity status, and the anatomical location of colonic diverticula.
Background/Aims:
Colonic diverticular bleeding (CDB) is a common cause of acute lower gastrointestinal bleeding. Patients with CDB are at increased risk for recurrence. Here, we aimed to evaluate the clinical course of patients with CDB and identify risk factors for recurrent CDB (rCDB).
Methods:
We included patients who were hospitalized at a single tertiary center for management of CDB between January 2005 and March 2020. A Cox proportional hazards regression analysis was performed to evaluate the risk factors of patients with rCDB as follows: model 1 adjusted by age, Charlson comorbidity index (CCI), and presence of bilateral colon diverticula; model 2 adjusted by age, CCI, and presence of left side colon diverticula; model 3 adjusted by age, CCI, and presence of sigmoid colon diverticula.
Results:
Among 219 patients (mean age, 68.0 years; 55 females), 56 and 163 had definite and presumptive CDB, respectively. During the median period of 506 days, 62 patients (28.3%) experienced rCDB. CCI score ≥ 4 was independently associated with rCDB in models 1, 2 and 3 (all p < 0.05). Age ≥ 75 years was independently associated with rCDB in models 1 and 2 (both p < 0.05). The presence of bilateral colon and sigmoid colon diverticula were independently associated with rCDB in models 1 and 3, respectively (both p < 0.05).
Conclusion:
rCDB frequently occurred at any time in patients with previous CDB. High CCI scores and distribution of colon diverticula were associated with rCDB. Clinicians should consider a possible rCDB for a patient considering age, comorbidity, and distribution of colon diverticula.
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