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Risk factors for rebleeding in acute lower gastrointestinal bleeding: a systematic review and meta-analysis
Zhongqiao Lu1, Deshan Zong2, Zhongde Yang2
1Department of Cardiac and Vascular Diseases, The People's Hospital of Wenshan Prefecture, Yunnan Province, 663000, China.
International Journal of Colorectal Disease
|June 13, 2026
Summary
Older age, blood transfusions, shock, hypertension, chronic kidney disease, hyperlipidemia, NSAID use, active bleeding, diverticular bleeding, and antiplatelet use are key risk factors for rebleeding after acute lower gastrointestinal bleeding (ALGIB). Identifying these can improve patient outcomes.
Area of Science:
- Gastroenterology
- Internal Medicine
- Clinical Research
Background:
- Acute lower gastrointestinal bleeding (ALGIB) is a common medical emergency.
- Rebleeding after initial management of ALGIB is associated with significant morbidity and mortality.
- Identifying predictive factors for rebleeding is crucial for optimizing patient care.
Purpose of the Study:
- To conduct a meta-analysis to identify risk factors associated with rebleeding in patients with acute lower gastrointestinal bleeding (ALGIB).
- To synthesize current evidence on predictors of recurrent bleeding in ALGIB.
Main Methods:
- A comprehensive literature search was performed across major databases (PubMed, Embase, Web of Science, Cochrane Library) up to May 2024.
- Data extraction and risk of bias assessment were conducted independently by two researchers.
- Meta-analysis was performed using R and Stata software.
Main Results:
- Twenty-nine studies involving 14,069 patients with ALGIB were included, with 1930 experiencing rebleeding.
- Multivariable analysis identified age ≥70 years, blood transfusion, shock, hypertension, chronic kidney disease (CKD), hyperlipidemia, NSAID use, active colonoscopic bleeding, colonic diverticular bleeding, and non-aspirin antiplatelet use as significant risk factors.
- Univariable analysis also suggested associations with steroid, aspirin, and anticoagulant use.
Conclusions:
- Several clinical and treatment-related factors are associated with an increased risk of rebleeding after ALGIB.
- Early recognition of these risk factors is essential for targeted interventions.
- Individualized management strategies based on identified risk factors may improve outcomes for patients with ALGIB.
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