Risk factors for mortality in lower intestinal bleeding.
OBJECTIVE
Previous studies of lower intestinal bleeding (LIB) have limited power to study mortality. We sought to identify characteristics associated with in-hospital mortality in a large cohort of patients with LIB.


METHODS
We used the 2002 Healthcare Cost and Utilization Project Nationwide Inpatient Sample to study a cross-sectional cohort of 227,022 hospitalized patients with discharge diagnoses indicating LIB. Predictors of mortality were identified by using multiple logistic regression.


RESULTS
In 2002, an estimated 8737 patients with LIB (3.9%) died while hospitalized. Independent predictors of in-hospital mortality were age (age >70 vs <50 years; odds ratio [OR], 4.91; 95% confidence interval [CI], 2.45-9.87), intestinal ischemia (OR, 3.47; 95% CI, 2.57-4.68), comorbid illness (>or=2 vs 0 comorbidities, OR, 3.00; 95% CI, 2.25-3.98), bleeding while hospitalized for a separate process (OR, 2.35; 95% CI, 1.81-3.04), coagulation defects (OR, 2.34; 95% CI, 1.50-3.65), hypovolemia (OR, 2.22; 95% CI, 1.69-2.90), transfusion of packed red blood cells (OR, 1.60; 95% CI, 1.23-2.08), and male gender (OR, 1.52; 95% CI, 1.21-1.92). Colorectal polyps (OR, 0.26; 95% CI, 0.15-0.45), and hemorrhoids (OR, 0.42; 95% CI, 0.28-0.64) were associated with a lower risk of mortality, as was diagnostic testing for LIB when added to the multivariate model (OR, 0.37; 95% CI, 0.28-0.48). Hospital characteristics were not significantly related to mortality. Predictors of mortality were similar in an analysis restricted to patients with diverticular bleeding.


CONCLUSIONS
The all-cause in-hospital mortality rate in LIB was low (3.9%). Advanced age, intestinal ischemia, and comorbid illness were the strongest predictors of mortality.
Strate
Lisa L
LL
Division of Gastroenterology, University of Washington School of Medicine, Harborview Medical Center, Seattle, Washington 98104, USA. lstrate@u.washington.edu
Ayanian
John Z
JZ
Kotler
Gregory
G
Syngal
Sapna
S
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001778:Blood Coagulation Disorders / Q000150:complications; D015331:Cohort Studies; D003108:Colonic Diseases / Q000453:epidemiology / Q000401:mortality*; D015897:Comorbidity; D003430:Cross-Sectional Studies; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000453:epidemiology / Q000401:mortality*; D006760:Hospitalization; D006801:Humans; D020896:Hypovolemia / Q000150:complications; D007511:Ischemia / Q000150:complications; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D012737:Sex Factors; D065227:Transfusion Reaction