Diane Lorenzo1, Claire Gallois1, Pierre Lahmek2, Bruno Lesgourgues1, Christine Champion1, Claire Charpignon3, Roger Faroux4, Bruno Bour5, André-Jean Remy6, Chantal Naouri7, Magali Picon8, Eric Poncin9, Gilles Macaigne10, Jacques-Arnaud Seyrig11, David Bernardini12, Guy Bellaïche13, Denis Grasset14, Jean Henrion15, Frédéric Heluwaert16, René Piperaud17, Gilbert Bordes18, Francois Bourhis19, Jean-Pierre Arpurt20, Alexandre Pariente21, Stéphane Nahon1. 1. Service d'Hépato-Gastroentérologie. Groupe Hospitalier Intercommunal Le Raincy-Montfermeil, Montfermeil, France. 2. Service d'addictologie. Hôpital Emile Roux AP-HP, Limeil-Brévannes, France. 3. Service d'Hépato-Gastroentérologie. Centre Hospitalier Intercommunal Villeneuve Saint-Georges, Villeneuve Saint-Georgess, France. 4. Service d'Hépato-Gastroentérologie. Centre hospitalier départemental de Vendée, La Roche-sur-Yon, France. 5. Service d'Hépato-Gastroentérologie. Centre hospitalier-LeMans, Le Mans, France. 6. Service d'Hépato-Gastroentérologie. Centre hospitalier de Perpignan, Perpignan, France. 7. Service d'Hépato-Gastroentérologie. Centre hospitalier de Mâcon, Mâcon, France. 8. Service d'Hépato-Gastroentérologie. Centre hospitalier d'Aix-en-Provence, Aix-en-Provence, France. 9. Service d'Hépato-Gastroentérologie. Centre hospitalier de Dax, Dax, France. 10. Service d'Hépato-Gastroentérologie. Centre hospitalier de Marne La Vallée, Lagny-sur-Marne, France. 11. Service d'Hépato-Gastroentérologie. Centre hospitalier du centre Bretagne, Pontivy, France. 12. Service d'Hépato-Gastroentérologie. Centre hospitalier intercommunal de Toulon, Toulon, France. 13. Service d'Hépato-Gastroentérologie. Centre hospitalier intercommunal d'Aulnay-sous-Bois, Aulnay-sous-Bois, France. 14. Service d'Hépato-Gastroentérologie. Centre hospitalier Bretagne Atlantique, Vannes, France. 15. Service d'Hépato-Gastroentérologie. Hôpital de Jolimont, Haine-Saint-Paul, Belgium. 16. Service d'Hépato-Gastroentérologie. Centre hospitalier Annecy Genevois, Annecy, France. 17. Service d'Hépato-Gastroentérologie. Centre hospitalier de Laon, Laon, France. 18. Service d'Hépato-Gastroentérologie. Centre hospitalier de Digne les Bains, Dignes, France. 19. Service d'Hépato-Gastroentérologie. Hôpital d'Aix Les Bains et de Chambery, Chambery, France. 20. Service d'Hépato-Gastroentérologie. Centre hospitalier d'Avignon, Avignon, France. 21. Service d'Hépato-Gastroentérologie. Centre hospitalier de Pau, Pau, France.
Abstract
BACKGROUND AND AIMS: 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.
BACKGROUND AND AIMS: 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.