title: Middle-term mortality and re-bleeding after initial diverticular bleeding: A nationwide study of 365 mostly elderly French patients.
abstract: OBJECTIVE
  The aim of this study was to determine the mortality and re-bleeding rates, and the risk factors involved, in a cohort of patients with previous diverticular bleeding (DB).
  
  
  METHODS
  In 2007, data on 2462 patients with lower gastrointestinal (GI) bleeding were collected prospectively at several French hospitals. We studied the follow-up of patients with DB retrospectively. The following data were collected: age, mortality rates and re-bleeding rates, drug intake, surgery and comorbidities.
  
  
  RESULTS
  Data on 365 patients, including 181 women (mean age 83.6 ± 9.8 years) were available. The median follow-up time was 3.9 years (IQR 25-75: 1.7-5.4). Of these, 148 patients died (40.5%). Among the 70 patients (19.2%) who had at least one re-bleeding episode, nine died and three underwent surgical procedures. Anticoagulation and antiplatelet therapy was discontinued in 70 cases (19.2%). The independent risk factors contributing to mortality were age > 80 years (HR = 3.18 (2.1-4.9);p< 0.001) and a Charlson comorbidity score > 2 (1.91 (1.31-2.79);p= 0.003). Discontinuation of therapy was not significantly associated with a risk of death due to cardiovascular events. No risk factors responsible for re-bleeding were identified, such as antiplatelet and anticoagulant therapy in particular.
  
  
  CONCLUSIONS
  In this cohort, the rates of mortality and DB re-bleeding after a median follow-up time of 3.9 years were 19.2% and 40.5%, respectively. The majority of the deaths recorded were not due to re-bleeding.
authors.affiliation: Service d'Hépato-Gastroentérologie. Groupe Hospitalier Intercommunal Le Raincy-Montfermeil, Montfermeil, France.
authors.forename: Diane
authors.initials: D
authors.lastname: Lorenzo
authors.affiliation: Service d'Hépato-Gastroentérologie. Groupe Hospitalier Intercommunal Le Raincy-Montfermeil, Montfermeil, France.
authors.forename: Claire
authors.initials: C
authors.lastname: Gallois
authors.affiliation: Service d'addictologie. Hôpital Emile Roux AP-HP, Limeil-Brévannes, France.
authors.forename: Pierre
authors.initials: P
authors.lastname: Lahmek
authors.affiliation: Service d'Hépato-Gastroentérologie. Groupe Hospitalier Intercommunal Le Raincy-Montfermeil, Montfermeil, France.
authors.forename: Bruno
authors.initials: B
authors.lastname: Lesgourgues
authors.affiliation: Service d'Hépato-Gastroentérologie. Groupe Hospitalier Intercommunal Le Raincy-Montfermeil, Montfermeil, France.
authors.forename: Christine
authors.initials: C
authors.lastname: Champion
authors.affiliation: Service d'Hépato-Gastroentérologie. Centre Hospitalier Intercommunal Villeneuve Saint-Georges, Villeneuve Saint-Georgess, France.
authors.forename: Claire
authors.initials: C
authors.lastname: Charpignon
authors.affiliation: Service d'Hépato-Gastroentérologie. Centre hospitalier départemental de Vendée, La Roche-sur-Yon, France.
authors.forename: Roger
authors.initials: R
authors.lastname: Faroux
authors.affiliation: Service d'Hépato-Gastroentérologie. Centre hospitalier-LeMans, Le Mans, France.
authors.forename: Bruno
authors.initials: B
authors.lastname: Bour
authors.affiliation: Service d'Hépato-Gastroentérologie. Centre hospitalier de Perpignan, Perpignan, France.
authors.forename: André-Jean
authors.initials: AJ
authors.lastname: Remy
authors.affiliation: Service d'Hépato-Gastroentérologie. Centre hospitalier de Mâcon, Mâcon, France.
authors.forename: Chantal
authors.initials: C
authors.lastname: Naouri
authors.affiliation: Service d'Hépato-Gastroentérologie. Centre hospitalier d'Aix-en-Provence, Aix-en-Provence, France.
authors.forename: Magali
authors.initials: M
authors.lastname: Picon
authors.affiliation: Service d'Hépato-Gastroentérologie. Centre hospitalier de Dax, Dax, France.
authors.forename: Eric
authors.initials: E
authors.lastname: Poncin
authors.affiliation: Service d'Hépato-Gastroentérologie. Centre hospitalier de Marne La Vallée, Lagny-sur-Marne, France.
authors.forename: Gilles
authors.initials: G
authors.lastname: Macaigne
authors.affiliation: Service d'Hépato-Gastroentérologie. Centre hospitalier du centre Bretagne, Pontivy, France.
authors.forename: Jacques-Arnaud
authors.initials: JA
authors.lastname: Seyrig
authors.affiliation: Service d'Hépato-Gastroentérologie. Centre hospitalier intercommunal de Toulon, Toulon, France.
authors.forename: David
authors.initials: D
authors.lastname: Bernardini
authors.affiliation: Service d'Hépato-Gastroentérologie. Centre hospitalier intercommunal d'Aulnay-sous-Bois, Aulnay-sous-Bois, France.
authors.forename: Guy
authors.initials: G
authors.lastname: Bellaïche
authors.affiliation: Service d'Hépato-Gastroentérologie. Centre hospitalier Bretagne Atlantique, Vannes, France.
authors.forename: Denis
authors.initials: D
authors.lastname: Grasset
authors.affiliation: Service d'Hépato-Gastroentérologie. Hôpital de Jolimont, Haine-Saint-Paul, Belgium.
authors.forename: Jean
authors.initials: J
authors.lastname: Henrion
authors.affiliation: Service d'Hépato-Gastroentérologie. Centre hospitalier Annecy Genevois, Annecy, France.
authors.forename: Frédéric
authors.initials: F
authors.lastname: Heluwaert
authors.affiliation: Service d'Hépato-Gastroentérologie. Centre hospitalier de Laon, Laon, France.
authors.forename: René
authors.initials: R
authors.lastname: Piperaud
authors.affiliation: Service d'Hépato-Gastroentérologie. Centre hospitalier de Digne les Bains, Dignes, France.
authors.forename: Gilbert
authors.initials: G
authors.lastname: Bordes
authors.affiliation: Service d'Hépato-Gastroentérologie. Hôpital d'Aix Les Bains et de Chambery, Chambery, France.
authors.forename: Francois
authors.initials: F
authors.lastname: Bourhis
authors.affiliation: Service d'Hépato-Gastroentérologie. Centre hospitalier d'Avignon, Avignon, France.
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Arpurt
authors.affiliation: Service d'Hépato-Gastroentérologie. Centre hospitalier de Pau, Pau, France.
authors.forename: Alexandre
authors.initials: A
authors.lastname: Pariente
authors.affiliation: Service d'Hépato-Gastroentérologie. Groupe Hospitalier Intercommunal Le Raincy-Montfermeil, Montfermeil, France.
authors.forename: Stéphane
authors.initials: S
authors.lastname: Nahon
keywords: Aging; anticoagulant therapy; antiplatelet therapy; bleeding; diverticular bleeding; gastrointestinal bleeding; lower intestine; mortality; risk factors