title: Recurrence and mortality among patients hospitalized for acute lower gastrointestinal bleeding.
abstract: OBJECTIVE
  The long-term recurrence of lower gastrointestinal bleeding (LGIB) and associated mortality have not been studied extensively. We investigated rates of recurrence of LGIB, mortality, and associated risk factors.
  
  
  METHODS
  In a retrospective study, we analyzed data from 342 patients hospitalized for overt LGIB at the National Center for Global Health and Medicine in Japan from December 2004 through June 2013. All patients underwent colonoscopy. We assessed Charlson comorbidity index scores and the use of nonsteroidal anti-inflammatory drugs, low-dose aspirin, other antiplatelet drugs, or warfarin. Rebleeding, the total number of rebleeding episodes, and mortality were measured. The Cox proportional hazards model was used to estimate hazard ratios (HRs).
  
  
  RESULTS
  Rebleeding occurred in 84 patients, at a mean follow-up time of 19 months. The cumulative percentages of patients with rebleeding at 1 and 5 years were 19% and 46%, respectively. During the follow-up period, 29 patients (39%) had secondary rebleeding and 18 patients (62%) had subsequent rebleeding. Multivariate analysis showed age 65 years and older (HR, 1.7; P = .04) and the use of nonsteroidal anti-inflammatory drugs (HR, 2.0; P < .01) and nonaspirin antiplatelet drugs (HR, 1.8; P < .05) as independent risk factors for rebleeding. Dual therapy had a higher risk than single therapy (adjusted HR, 1.8; P < .05). During the mean follow-up period of 28 months, 21 patients died (2 from bleeding). Cumulative mortality rates at 1 and 5 years were 4.2% and 13%, respectively. Mortality was associated significantly with age ≥65 years (P < .05), Charlson comorbidity index score, and warfarin use.
  
  
  CONCLUSIONS
  Based on a retrospective analysis of patients with LGIB, 46% of all patients have rebleeding, and the overall mortality rate is 13% within 5 years after hospitalization. Besides age ≥65 years, use of antithrombotic drugs increases the risk of bleeding recurrence and mortality among patients with LGIB.
authors.affiliation: Department of Gastroenterology and Hepatology, National Center for Global Health and Medicine, Tokyo, Japan.
authors.forename: Tomonori
authors.initials: T
authors.lastname: Aoki
authors.affiliation: Department of Gastroenterology and Hepatology, National Center for Global Health and Medicine, Tokyo, Japan. Electronic address: nnagata_ncgm@yahoo.co.jp.
authors.forename: Naoyoshi
authors.initials: N
authors.lastname: Nagata
authors.affiliation: Department of Gastroenterology and Hepatology, National Center for Global Health and Medicine, Tokyo, Japan.
authors.forename: Ryota
authors.initials: R
authors.lastname: Niikura
authors.affiliation: Department of Clinical Research and Informatics, National Center for Global Health and Medicine, Tokyo, Japan.
authors.forename: Takuro
authors.initials: T
authors.lastname: Shimbo
authors.affiliation: Department of Gastroenterology and Hepatology, National Center for Global Health and Medicine, Tokyo, Japan.
authors.forename: Shohei
authors.initials: S
authors.lastname: Tanaka
authors.affiliation: Department of Gastroenterology and Hepatology, National Center for Global Health and Medicine, Tokyo, Japan.
authors.forename: Katsunori
authors.initials: K
authors.lastname: Sekine
authors.affiliation: Department of Gastroenterology and Hepatology, National Center for Global Health and Medicine, Tokyo, Japan.
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Kishida
authors.affiliation: Department of Gastroenterology and Hepatology, National Center for Global Health and Medicine, Tokyo, Japan.
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Watanabe
authors.affiliation: Department of Gastroenterology and Hepatology, National Center for Global Health and Medicine, Tokyo, Japan.
authors.forename: Toshiyuki
authors.initials: T
authors.lastname: Sakurai
authors.affiliation: Department of Gastroenterology and Hepatology, National Center for Global Health and Medicine, Tokyo, Japan.
authors.forename: Chizu
authors.initials: C
authors.lastname: Yokoi
authors.affiliation: Department of Gastroenterology and Hepatology, National Center for Global Health and Medicine, Tokyo, Japan.
authors.forename: Junichi
authors.initials: J
authors.lastname: Akiyama
authors.affiliation: Department of Gastroenterology and Hepatology, National Center for Global Health and Medicine, Tokyo, Japan.
authors.forename: Mikio
authors.initials: M
authors.lastname: Yanase
authors.affiliation: The Research Center for Hepatitis and Immunology, Kohnodai Hospital, National Center for Global Health and Medicine, Kohnodai, Chiba, Japan.
authors.forename: Masashi
authors.initials: M
authors.lastname: Mizokami
authors.affiliation: Department of Gastroenterology and Hepatology, Kohnodai Hospital, National Center for Global Health and Medicine, Kohnodai, Chiba, Japan.
authors.forename: Naomi
authors.initials: N
authors.lastname: Uemura
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D000925:Anticoagulants / Q000627:therapeutic use; D001241:Aspirin / Q000627:therapeutic use; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000453:epidemiology* / Q000401:mortality*; D006760:Hospitalization; D006801:Humans; D007564:Japan; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D016019:Survival Analysis; D014859:Warfarin / Q000627:therapeutic use
chemical_list: D000893:Anti-Inflammatory Agents; D000925:Anticoagulants; D010975:Platelet Aggregation Inhibitors; D014859:Warfarin; D001241:Aspirin
keywords: Anticoagulants; Antithrombotic Agents; LGIB; Lower Gastrointestinal Hemorrhage; Mortality; Poor Clinical Outcomes; Recurrence