Upper gastrointestinal bleeding in patients 80 years old and over. A comparison with younger patients and risk factors analysis for in‐hospital and delayed mortality

Abstract

Introduction Outcomes in old patients with upper gastrointestinal bleeding (UGIB) have been scarcely studied. Our aim was to compare very old individuals (>80 years old) with younger patients with UGIB, and to identify risk factors for the main outcomes. Methods A single‐centre prospectively collected database was analysed. Descriptive, inferential and multivariate logistic regression models were performed. Main clinical outcomes were in‐hospital and delayed 6‐month mortality. Results 698 patients were included, 143 very old and 555 aged <80. Old patients differed from younger ones in comorbidities (85.9% vs. 62%, P < .0001), oral anticoagulants (32.3% vs. 12.7%; P < .0001), and antiplatelets intake (32.3% vs. 21.2%; P < .007). No differences were found in the need for endoscopic interventions, blood unit transfusions, hospital stay, in‐hospital rebleeding and mortality. Among very old patients, creatinine levels were higher in those who died compared with the ones who survived (1.92 ± 1.46 vs. 1.25 ± 0.59 mg/dL; P = .002), they had lower haemoglobin levels (8.1 ± 1.4 vs. 9.1 ± 2.4 g/dL; P = .04) and longer hospital stays (17.75 ± 15.5 vs. 8.1 ± 8.4 days; P < .0001). Logistic regression showed creatinine levels (OR: 2.42; 95% CI: 1.24–4.74; P = .01), cirrhosis (OR: 2.88, 95% CI: 1.88–17.34; P = .04) and being an impatient (OR: 3.90; 95% CI: 1.11–20; P = .035) were independent risk factors for mortality in older patients. They had an increased delayed 6‐month mortality compared with younger patients (17.5% vs. 8%, P = .001). Conclusions Creatinine levels, cirrhosis or the onset of UGIB while being an inpatient were independent risk factors for mortality in very old patients. Delayed mortality was higher among them, mostly caused by cardiovascular events and neoplasms, but not in‐hospital mortality.

Application of Antithrombotic Drugs in Different Age-Group Patients with Upper Gastrointestinal Bleeding

“…In terms of prognosis and application of antithrombotic drugs (Table 2), we found that elderly patients had a longer hospital stay, a higher proportion of patients with a history of antiplatelet drugs, and a higher proportion of patients who used anticoagulants during hospitalization. The median time for elderly patients to use antiplatelet drugs after admission was 10 [4, 14] days, and the median time for using anticoagulant drugs was 6 [3,13] days. The median time for young patients to use antiplatelet drugs after admission was 8 [3,13] days, and the median time for using anticoagulant drugs was 8 [4,11] days.…”

“…The median time for elderly patients to use antiplatelet drugs after admission was 10 [4, 14] days, and the median time for using anticoagulant drugs was 6 [3,13] days. The median time for young patients to use antiplatelet drugs after admission was 8 [3,13] days, and the median time for using anticoagulant drugs was 8 [4,11] days. There was no statistical difference between the two groups in the time interval between the resumption of drug application.…”

“…In exploring the independent risk factors of rebleeding and mortality, the previous study had pointed out that cirrhosis was an independent risk factor for mortality in very old patients [ 13 ]. This was consistent with the results in our article that cirrhosis or variceal bleeding was independently related to death or rebleeding.…”

Prediction of 30-day in-hospital mortality in older UGIB patients using a simplified risk score and comparison with AIMS65 score

“…Previous studies have primarily relied on multivariable logistic regression to identify risk factors associated with outcomes in older populations with UGIB [ 17 ]. We employed a combination of traditional methods and innovative techniques, such as StepAIC, LASSO, ENT, RFE, and Best subset selection, to facilitate the selection of key variables during the training and prediction modeling process.…”

Are Short-Stay Units Safe and Effective in the Treatment of Non-Variceal Upper Gastrointestinal Bleeding?

“…Higher creatinine levels are associated with higher patient frailty and complexity, although the correlation with creatinine level remains after adjusting for these factors in this study. However, creatinine is an important risk factor for gastrointestinal bleeding and has been associated with increased mortality in several studies [ 14 , 15 , 16 ]. For this reason, the emergency physicians and endoscopists could be more motivated to request and perform early EGDS in these patients.…”