Management and predictors of early mortality in elderly patients with iron deficiency anemia: a prospective study of 111 patients.
OBJECTIVE
Iron deficiency anemia (IDA) is common in the elderly. It usually results from gastrointestinal (GI) bleeding and requires endoscopic exploration of the gastrointestinal tract. The aim of this prospective study in elderly patients was to evaluate the feasibility of endoscopy, the therapeutic impact, and identify predictors of early mortality.


METHODS
From June 2003 to May 2005, all patients over 75 years, hospitalized for anemia were screened for iron deficiency. Clinical (including serious comorbidities), biological, endoscopic and therapeutic data were collected. One month after treatment, a follow-up was carried out to assess the tolerance of such investigation and treatment.


RESULTS
One hundred and eleven patients (69 women, 82.3 +/- 6.4 years) had IDA, 102 (92%) underwent an upper endoscopy and 91 (82%) a colonoscopy. Nine (8%) patients were not investigated because of poor clinical condition (N=4) or dementia (N=5). Of the 75 (68%) patients with an identified source of bleeding, 12 (11%) had a synchronous lesion, 43 (39%) a colorectal source including 31 (72%) colorectal cancer, and 44 (40%) an upper GI source. Sixty-nine (92%) of the 75 patients received at least one of the following treatments: medical (N=27), endoscopic (N=20), and surgical (N=31). Surgery was curative in 28/31 (90%) cases of which 25/27 were colorectal cancers. One month after treatment, overall mortality was 11/111 (10%) and 4/31 (13%) after surgery. Predictors of early mortality (Odd ratio, 95% Confidence Interval) were: a malign cause (42; 3-588), no specific treatment (34; 3-423), at least 2 co-morbidities (20; 1-400).


CONCLUSIONS
In an unselected hospitalized population of elderly patients with IDA, endoscopy was generally feasible, allowing identification of a source of bleeding, especially colorectal cancer. A specific treatment was usually possible and proved curative without increase in early mortality.
Nahon
Stéphane
S
Service d'Hépato-Gastroentérologie, Centre Hospitalier Intercommunal Le Raincy-Montfermeil. snahon@ch-montfermeil.fr
Lahmek
Pierre
P
Aras
Nazmye
N
Poupardin
Cécile
C
Lesgourgues
Bruno
B
Macaigne
Gilles
G
Delas
Nicolas
N
D000369:Aged, 80 and over; D018798:Anemia, Iron-Deficiency / Q000209:etiology / Q000401:mortality* / Q000628:therapy; D015897:Comorbidity; D016145:Endoscopy, Digestive System; D005240:Feasibility Studies; D005260:Female; D005602:France / Q000453:epidemiology; D005767:Gastrointestinal Diseases / Q000150:complications / Q000175:diagnosis; D006801:Humans; D008297:Male; D011446:Prospective Studies