title: Risk of comorbidities and outcomes in patients with lower gastrointestinal bleeding - a nationwide study.
abstract: BACKGROUND
  The impact of comorbidities on outcomes of patients with lower gastrointestinal bleeding (LGIB) remains unknown.
  
  
  OBJECTIVE
  Investigate the prevalence of comorbidities and impact on outcomes of patients with LGIB.
  
  
  METHODS
  The Nationwide Inpatient Sample 2010 was used to identify patients who had a primary discharge diagnosis of LGIB based on International Classification of Diseases, the 9th revision, clinical modification codes. The presence of comorbid illness was assessed using the Elixhauser index. Logistic regression models were used to assess the contributions of the individual Elixhauser comorbidities to predict in-hospital mortality.
  
  
  RESULTS
  A total of 58,296 discharges with LGIB were identified. The overall mortality was 2.3 %. Among the patients who underwent colonoscopy, 17.3 % of patients had therapeutic intervention. As the number of comorbidities increased (i.e., 0, 1, 2, or >3), mortality increased (1.7, 2.0, 2.4, and 2.4 %, respectively). The mortality rate was highest in patients >65 years of age (2.7 %). Patients >65 years of age with two or more comorbidities had a mortality rate of 5 % as compared to 2.6 % in those with less than two comorbidities. Congestive heart failure (odds ratio, 1.67 [95 % confidence interval, 1.48-1.95]), liver disease (2.64 [1.83-3.80]), renal failure (1.99 [1.70-2.33]), and weight loss (2.66 [2.27-3.12]) were associated with a significant increase in mortality rate. Comorbidities increased hospital stay and costs.
  
  
  CONCLUSIONS
  Comorbidities were associated with increased the risk of mortality and health care utilization in patients with LGIB. Identification of comorbidities and development of risk-adjustment tools may improve the outcome of patients with LGIB.
authors.affiliation: Digestive Disease Institute, The Cleveland Clinic, 9500 Euclid Ave., Cleveland, OH, 44195, USA.
authors.forename: Preethi G K
authors.initials: PG
authors.lastname: Venkatesh
authors.forename: Basile
authors.initials: B
authors.lastname: Njei
authors.forename: Madhusudhan R
authors.initials: MR
authors.lastname: Sanaka
authors.forename: Udayakumar
authors.initials: U
authors.lastname: Navaneethan
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D003710:Demography; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000150:complications* / Q000191:economics / Q000453:epidemiology*; D006801:Humans; D007902:Length of Stay / Q000191:economics / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012307:Risk Factors; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology