Usefulness of the comprehensive geriatric assessment in older patients with upper gastrointestinal bleeding: a two-year follow-up study.
BACKGROUND
The potential usefulness of standardized comprehensive geriatric assessment (CGA) in evaluating treatment and follow-up of older patients with upper gastrointestinal bleeding is unknown.


OBJECTIVE
To evaluate the usefulness of the CGA as a 2-year mortality multidimensional prognostic index (MPI) in older patients hospitalized for upper gastrointestinal bleeding.


METHODS
Patients aged > or =65 years consecutively hospitalized for acute upper gastrointestinal bleeding were included. Diagnosis of bleeding was based on clinical and endoscopic features. All patients underwent a CGA that included six standardized scales, i.e., Activities of Daily Living (ADL), Instrumental Activities of Daily Living (IADL), Short Portable Mental Status Questionnaire (SPMSQ), Mini Nutritional Assessment (MNA), Exton-Smith Score (ESS) and Comorbity Index Rating Scale (CIRS), as well as information on medication history and cohabitation, for a total of 63 items. A MPI was calculated from the integrated total scores and expressed as MPI 1 = low risk, MPI 2 = moderate risk, and MPI 3 = severe risk. The predictive value of the MPI for mortality over a 24-month follow-up was calculated.


RESULTS
36 elderly patients (M 16/F 20, mean age 82.8 +/- 7.9 years, range 70-101 years) were included in the study. A significant difference in mean age was observed between males and females (M 80.1 +/- 4.8 vs. F 84.9 +/- 9.3 years; p < 0.05). The causes of upper gastrointestinal bleeding were duodenal ulcer in 38.8%, gastric ulcer in 22.2%, and erosive gastritis in 16.6% of the patients, while 16.6% had gastrointestinal bleeding from unknown origin. The overall 2-year mortality rate was 30.5%. 18 patients (50%) were classified as having a low-risk MPI (mean value 0.18 +/- 0.09), 12 (33.3%) as having a moderate-risk MPI (mean value 0.48 +/- 0.08) and 6 (16.6%) as having a severe-risk MPI (mean value 0.83 +/- 0.06). Higher MPI grades were significantly associated with higher mortality (grade 1 = 12.5%, grade 2 = 41.6%, grade 3 = 83.3%; p = 0.001). Adjusting for age and sex, the prognostic efficacy of MPI for mortality was confirmed and highly significant (odds ratio 10.47, 95% CI 2.04-53.6).


CONCLUSIONS
CGA is a useful tool for calculating a MPI that significantly predicts the risk of 2-year mortality in older patients with upper gastrointestinal bleeding.
Pilotto
Alberto
A
Geriatric Unit and Gerontology & Geriatrics Research Laboratories, IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy. alberto.pilotto@libero.it
Ferrucci
Luigi
L
Scarcelli
Carlo
C
Niro
Valeria
V
Di Mario
Francesco
F
Seripa
Davide
D
Andriulli
Angelo
A
Leandro
Gioacchino
G
Franceschi
Marilisa
M
D000203:Activities of Daily Living; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D004932:Esophageal and Gastric Varices / Q000175:diagnosis / Q000401:mortality / Q000628:therapy; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000175:diagnosis* / Q000401:mortality* / Q000628:therapy; D015577:Geriatric Assessment; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D008297:Male; D010438:Peptic Ulcer Hemorrhage / Q000175:diagnosis / Q000401:mortality / Q000628:therapy; D011237:Predictive Value of Tests; D011336:Probability; D011379:Prognosis; D012008:Recurrence; D018570:Risk Assessment; D012720:Severity of Illness Index; D012737:Sex Factors; D018709:Statistics, Nonparametric; D016019:Survival Analysis; D013997:Time Factors