Upper gastrointestinal bleeding differences between older and younger adults: should bleeding in non-cirrhotic patients be considered a geriatric syndrome?
Francisco Vara-Luiz, Ivo Mendes, Carolina Palma, Paulo Mascarenhas, Diogo Simas, Plácido Gomes, André Ruge Gonçalves, Inês Simão, Madalena Teixeira, Sara Ramos Lopes, Francisca Côrte-Real, Maria Antónia Duarte, Catarina Bravo, Marta Patita, Gonçalo Nunes, Pedro Pinto-Marques, Jorge Fonseca
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引用次数: 0
Abstract
Background: Upper gastrointestinal bleeding (UGIB) is a major medical emergency. Although older citizens have an increased risk of UGIB, guidelines do not fully address specific concerns in this population.
Objectives: We aimed to report characteristics/differences between the older (⩾65 years) and the younger adult patients (<65 years) with UGIB.
Design: Retrospective multicenter cohort study.
Methods: Adult patients consecutively admitted due to evidence of UGIB at six participating centers or who developed UGIB while hospitalized for another reason during a 6-month enrollment period, were eligible for this study.
Results: Of 600 patients included, 58.2% were men. Patients aged ⩾65 years comprised 72.8% of the cohort; in this group, most comorbidities (except liver cirrhosis) and use of antiplatelet/anticoagulant therapy were more frequent (p < 0.001). Variceal UGIB was more common in the younger group and non-variceal UGIB in the older (p < 0.001). The risk scores Glasgow-Blatchford (p = 0.003) and Complete Rockall (p < 0.001) were higher in the older group. Peptic ulcer disease was the most common cause in both groups, and angiodysplasia was an almost exclusive diagnosis in the elderly. Overall mortality was 15% (n = 90), with 76 deaths attributed to non-bleeding causes. In a post hoc subgroup analysis excluding cirrhotic patients, older adults required hospitalization (p = 0.007) and longer hospital stays (p = 0.005) more frequently, while younger patients had higher intensive care unit admission rates (p = 0.018). Multivariate analysis in this subgroup suggested that antiplatelet (p = 0.047) or anticoagulant use (p = 0.021), Rockall score (p < 0.001), and Charlson Comorbidity Index (CCI, p = 0.011) were independently associated with in-hospital mortality. The CCI, higher in older patients, also correlated with the need for blood transfusions (p = 0.001), rebleeding (p = 0.013), second-look endoscopy (p < 0.001), and re-hospitalization (p = 0.028).
Conclusion: Older adults with UGIB exhibit clinical features associated with higher healthcare resource utilization and worse outcomes. Cirrhosis was linked to adverse outcomes in younger patients. In non-cirrhotic patients, UGIB may share features of geriatric syndromes, reflecting multifactorial risks in this population.
期刊介绍：
Therapeutic Advances in Gastroenterology is an open access journal which delivers the highest quality peer-reviewed original research articles, reviews, and scholarly comment on pioneering efforts and innovative studies in the medical treatment of gastrointestinal and hepatic disorders. The journal has a strong clinical and pharmacological focus and is aimed at an international audience of clinicians and researchers in gastroenterology and related disciplines, providing an online forum for rapid dissemination of recent research and perspectives in this area.
The editors welcome original research articles across all areas of gastroenterology and hepatology.
The journal publishes original research articles and review articles primarily. Original research manuscripts may include laboratory, animal or human/clinical studies – all phases. Letters to the Editor and Case Reports will also be considered.
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