title: Risk factors for adverse in-hospital outcomes in acute colonic diverticular hemorrhage.
abstract: OBJECTIVE
  To investigate the factors associated with transfusion, further bleeding, and prolonged length of stay.
  
  
  METHODS
  In total, 153 patients emergently hospitalized for diverticular bleeding who were examined by colonoscopy were prospectively enrolled. Patients in whom the bleeding source was identified received endoscopic treatment such as clipping or endoscopic ligation. After spontaneous cessation of bleeding with conservative treatment or hemostasis with endoscopic treatment, all patients were started on a liquid food diet and gradually progressed to a solid diet over 3 d, and were discharged. At enrollment, we assessed smoking, alcohol, medications [non-steroidal anti-inflammatory drugs (NSAIDs)], low-dose aspirin, and other antiplatelets, warfarin, acetaminophen, and oral corticosteroids), and co-morbidities [hypertension, diabetes mellitus, dyslipidemia, cerebro-cardiovascular disease, chronic liver disease, and chronic kidney disease (CKD)]. The in-hospital outcomes were need for transfusion, further bleeding after spontaneous cessation of hemorrhage, and length of hospital stay. The odds ratio (OR) for transfusion need, further bleeding, and prolonged length of stay were estimated by logistic regression analysis.
  
  
  RESULTS
  No patients required angiographic embolization or surgery. Stigmata of bleeding occurred in 18% of patients (27/153) and was treated by endoscopic procedures. During hospitalization, 40 patients (26%) received a median of 6 units of packed red blood cells. Multivariate analysis revealed that female sex (OR = 2.5, P = 0.02), warfarin use (OR = 9.3, P < 0.01), and CKD (OR = 5.9, P < 0.01) were independent risk factors for transfusion need. During hospitalization, 6 patients (3.9%) experienced further bleeding, and NSAID use (OR = 5.9, P = 0.04) and stigmata of bleeding (OR = 11, P < 0.01) were significant risk factors. Median length of hospital stay was 8 d. Multivariate analysis revealed that age > 70 years (OR = 2.1, P = 0.04) and NSAID use (OR = 2.7, P = 0.03) were independent risk factors for prolonged hospitalization (≥ 8 d).
  
  
  CONCLUSIONS
  In colonic diverticular bleeding, female sex, warfarin, and CKD increased the risk of transfusion requirement, while advanced age and NSAID increased the risk of prolonged hospitalization.
authors.affiliation: Naoyoshi Nagata, Ryota Niikura, Tomonori Aoki, Shiori Moriyasu, Toshiyuki Sakurai, Katsunori Sekine, Hidetaka Okubo, Kazuhiro Watanabe, Chizu Yokoi, Junichi Akiyama, Mikio Yanase, Department of Gastroenterology and Hepatology, National Center for Global Health and Medicine, Shinjuku, Tokyo 162-8655, Japan.
authors.forename: Naoyoshi
authors.initials: N
authors.lastname: Nagata
authors.affiliation: Naoyoshi Nagata, Ryota Niikura, Tomonori Aoki, Shiori Moriyasu, Toshiyuki Sakurai, Katsunori Sekine, Hidetaka Okubo, Kazuhiro Watanabe, Chizu Yokoi, Junichi Akiyama, Mikio Yanase, Department of Gastroenterology and Hepatology, National Center for Global Health and Medicine, Shinjuku, Tokyo 162-8655, Japan.
authors.forename: Ryota
authors.initials: R
authors.lastname: Niikura
authors.affiliation: Naoyoshi Nagata, Ryota Niikura, Tomonori Aoki, Shiori Moriyasu, Toshiyuki Sakurai, Katsunori Sekine, Hidetaka Okubo, Kazuhiro Watanabe, Chizu Yokoi, Junichi Akiyama, Mikio Yanase, Department of Gastroenterology and Hepatology, National Center for Global Health and Medicine, Shinjuku, Tokyo 162-8655, Japan.
authors.forename: Tomonori
authors.initials: T
authors.lastname: Aoki
authors.affiliation: Naoyoshi Nagata, Ryota Niikura, Tomonori Aoki, Shiori Moriyasu, Toshiyuki Sakurai, Katsunori Sekine, Hidetaka Okubo, Kazuhiro Watanabe, Chizu Yokoi, Junichi Akiyama, Mikio Yanase, Department of Gastroenterology and Hepatology, National Center for Global Health and Medicine, Shinjuku, Tokyo 162-8655, Japan.
authors.forename: Shiori
authors.initials: S
authors.lastname: Moriyasu
authors.affiliation: Naoyoshi Nagata, Ryota Niikura, Tomonori Aoki, Shiori Moriyasu, Toshiyuki Sakurai, Katsunori Sekine, Hidetaka Okubo, Kazuhiro Watanabe, Chizu Yokoi, Junichi Akiyama, Mikio Yanase, Department of Gastroenterology and Hepatology, National Center for Global Health and Medicine, Shinjuku, Tokyo 162-8655, Japan.
authors.forename: Toshiyuki
authors.initials: T
authors.lastname: Sakurai
authors.affiliation: Naoyoshi Nagata, Ryota Niikura, Tomonori Aoki, Shiori Moriyasu, Toshiyuki Sakurai, Katsunori Sekine, Hidetaka Okubo, Kazuhiro Watanabe, Chizu Yokoi, Junichi Akiyama, Mikio Yanase, Department of Gastroenterology and Hepatology, National Center for Global Health and Medicine, Shinjuku, Tokyo 162-8655, Japan.
authors.forename: Takuro
authors.initials: T
authors.lastname: Shimbo
authors.affiliation: Naoyoshi Nagata, Ryota Niikura, Tomonori Aoki, Shiori Moriyasu, Toshiyuki Sakurai, Katsunori Sekine, Hidetaka Okubo, Kazuhiro Watanabe, Chizu Yokoi, Junichi Akiyama, Mikio Yanase, Department of Gastroenterology and Hepatology, National Center for Global Health and Medicine, Shinjuku, Tokyo 162-8655, Japan.
authors.forename: Katsunori
authors.initials: K
authors.lastname: Sekine
authors.affiliation: Naoyoshi Nagata, Ryota Niikura, Tomonori Aoki, Shiori Moriyasu, Toshiyuki Sakurai, Katsunori Sekine, Hidetaka Okubo, Kazuhiro Watanabe, Chizu Yokoi, Junichi Akiyama, Mikio Yanase, Department of Gastroenterology and Hepatology, National Center for Global Health and Medicine, Shinjuku, Tokyo 162-8655, Japan.
authors.forename: Hidetaka
authors.initials: H
authors.lastname: Okubo
authors.affiliation: Naoyoshi Nagata, Ryota Niikura, Tomonori Aoki, Shiori Moriyasu, Toshiyuki Sakurai, Katsunori Sekine, Hidetaka Okubo, Kazuhiro Watanabe, Chizu Yokoi, Junichi Akiyama, Mikio Yanase, Department of Gastroenterology and Hepatology, National Center for Global Health and Medicine, Shinjuku, Tokyo 162-8655, Japan.
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Watanabe
authors.affiliation: Naoyoshi Nagata, Ryota Niikura, Tomonori Aoki, Shiori Moriyasu, Toshiyuki Sakurai, Katsunori Sekine, Hidetaka Okubo, Kazuhiro Watanabe, Chizu Yokoi, Junichi Akiyama, Mikio Yanase, Department of Gastroenterology and Hepatology, National Center for Global Health and Medicine, Shinjuku, Tokyo 162-8655, Japan.
authors.forename: Chizu
authors.initials: C
authors.lastname: Yokoi
authors.affiliation: Naoyoshi Nagata, Ryota Niikura, Tomonori Aoki, Shiori Moriyasu, Toshiyuki Sakurai, Katsunori Sekine, Hidetaka Okubo, Kazuhiro Watanabe, Chizu Yokoi, Junichi Akiyama, Mikio Yanase, Department of Gastroenterology and Hepatology, National Center for Global Health and Medicine, Shinjuku, Tokyo 162-8655, Japan.
authors.forename: Junichi
authors.initials: J
authors.lastname: Akiyama
authors.affiliation: Naoyoshi Nagata, Ryota Niikura, Tomonori Aoki, Shiori Moriyasu, Toshiyuki Sakurai, Katsunori Sekine, Hidetaka Okubo, Kazuhiro Watanabe, Chizu Yokoi, Junichi Akiyama, Mikio Yanase, Department of Gastroenterology and Hepatology, National Center for Global Health and Medicine, Shinjuku, Tokyo 162-8655, Japan.
authors.forename: Mikio
authors.initials: M
authors.lastname: Yanase
authors.affiliation: Naoyoshi Nagata, Ryota Niikura, Tomonori Aoki, Shiori Moriyasu, Toshiyuki Sakurai, Katsunori Sekine, Hidetaka Okubo, Kazuhiro Watanabe, Chizu Yokoi, Junichi Akiyama, Mikio Yanase, Department of Gastroenterology and Hepatology, National Center for Global Health and Medicine, Shinjuku, Tokyo 162-8655, Japan.
authors.forename: Masashi
authors.initials: M
authors.lastname: Mizokami
authors.affiliation: Naoyoshi Nagata, Ryota Niikura, Tomonori Aoki, Shiori Moriyasu, Toshiyuki Sakurai, Katsunori Sekine, Hidetaka Okubo, Kazuhiro Watanabe, Chizu Yokoi, Junichi Akiyama, Mikio Yanase, Department of Gastroenterology and Hepatology, National Center for Global Health and Medicine, Shinjuku, Tokyo 162-8655, Japan.
authors.forename: Kazuma
authors.initials: K
authors.lastname: Fujimoto
authors.affiliation: Naoyoshi Nagata, Ryota Niikura, Tomonori Aoki, Shiori Moriyasu, Toshiyuki Sakurai, Katsunori Sekine, Hidetaka Okubo, Kazuhiro Watanabe, Chizu Yokoi, Junichi Akiyama, Mikio Yanase, Department of Gastroenterology and Hepatology, National Center for Global Health and Medicine, Shinjuku, Tokyo 162-8655, Japan.
authors.forename: Naomi
authors.initials: N
authors.lastname: Uemura
mesh_terms: D000368:Aged; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D001241:Aspirin / Q000627:therapeutic use; D001803:Blood Transfusion; D003113:Colonoscopy; D004241:Diverticulum, Colon / Q000628:therapy*; D004724:Endoscopy; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000628:therapy*; D006470:Hemorrhage; D006760:Hospitalization; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D011446:Prospective Studies; D012307:Risk Factors
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D010975:Platelet Aggregation Inhibitors; D001241:Aspirin
keywords: Antithrombotic agents; Blood transfusion requirement; In-hospital adverse clinical outcomes; Length of hospital stay; Lower gastrointestinal hemorrhage