Clinical Endoscopy

The Korean Society of Gastrointestinal Endoscopy (대한소화기내시경학회)
권호 표지
DOI QR코드

DOI QR Code

Clinical outcomes of nonvariceal upper gastrointestinal bleeding in nonagenarians and octogenarians: a comparative nationwide analysis

  • Khaled Elfert (Department of Internal Medicine, SBH Health System) ;
  • James Love (Department of Medicine, University of Illinois at Chicago) ;
  • Esraa Elromisy (Tanta University Faculty of Medicine) ;
  • Fouad Jaber (Department of Internal Medicine, University of Missouri-Kansas City School of Medicine) ;
  • Suresh Nayudu (Division of Gastroenterology, SBH Health System) ;
  • Sammy Ho (Division of Gastroenterology, Montefiore Medical Center, Albert Einstein College of Medicine) ;
  • Michel Kahaleh (Division of Gastroenterology, Department of Medicine, Robert Wood Johnson University Hospital)
  • Received : 2023.05.11
  • Accepted : 2023.07.13
  • Published : 2024.05.30
Download PDF
⟨ Previous Next ⟩

Abstract

Background/Aims: Nonagenarians will purportedly account for 10% of the United States population by 2050. However, no studies have assessed the outcomes of nonvariceal upper gastrointestinal bleeding (NVUGIB) in this age group. Methods: The National Inpatient Sample database between 2016 and 2020 was used to compare the clinical outcomes of NVUGIB in nonagenarians and octogenarians and evaluate predictors of mortality and the use of esophagogastroduodenoscopy (EGD). Results: Nonagenarians had higher in-hospital mortality than that of octogenarians (4% vs. 3%, p<0.001). EGD utilization (30% vs. 48%, p<0.001) and blood transfusion (27% vs. 40%, p<0.001) was significantly lower in nonagenarians. Multivariate logistic regression analysis revealed that nonagenarians with NVUGIB had higher odds of mortality (odds ratio [OR], 1.5; 95% confidence interval [CI], 1.3-1.7) and lower odds of EGD utilization (OR, 0.86; 95% CI, 0.83-0.89) than those of octogenarians. Conclusions: Nonagenarians admitted with NVUGIB have a higher mortality risk than that of octogenarians. EGD is used significantly in managing NVUGIB among nonagenarians; however, its utilization is comparatively lower than in octogenarians. More studies are needed to assess predictors of poor outcomes and the indications of EGD in this growing population.

Keywords

References

  1. Abougergi MS, Travis AC, Saltzman JR. The in-hospital mortality rate for upper GI hemorrhage has decreased over 2 decades in the United States: a nationwide analysis. Gastrointest Endosc 2015;81:882-888. https://doi.org/10.1016/j.gie.2014.09.027
  2. Antunes C, Copelin II EL. Upper gastrointestinal bleeding. StatPearls [Internet]. StatPearls Publishing; 2023 [updated 2023 Apr 7; cited 2023 Apr 27]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK470300/
  3. Jairath V, Martel M, Logan RF, et al. Why do mortality rates for nonvariceal upper gastrointestinal bleeding differ around the world?: a systematic review of cohort studies. Can J Gastroenterol 2012;26:537-543. https://doi.org/10.1155/2012/862905
  4. Chason R, Singal A, Rockey D. Mortality in acute upper gastrointestinal bleeding is uncommonly due to persistent hemorrhage: 1634. Am J Gastroenterol 2013;108:S490-S491. https://doi.org/10.14309/00000434-201310001-01634
  5. Biecker E. Diagnosis and therapy of non-variceal upper gastrointestinal bleeding. World J Gastrointest Pharmacol Ther 2015;6:172-182. https://doi.org/10.4292/wjgpt.v6.i4.172
  6. Alkhatib AA, Elkhatib FA, Alkhatib AA, et al. Acute upper gastrointestinal bleeding in elderly people: presentations, endoscopic findings, and outcomes. J Am Geriatr Soc 2010;58:182-185. https://doi.org/10.1111/j.1532-5415.2009.02633.x
  7. Theocharis GJ, Arvaniti V, Assimakopoulos SF, et al. Acute upper gastrointestinal bleeding in octogenarians: clinical outcome and factors related to mortality. World J Gastroenterol 2008;14:4047-4053. https://doi.org/10.3748/wjg.14.4047
  8. Rural Health Information Hub (RHIhub). Rural aging in place toolkit: demographic changes and aging population [Internet]. RHIhub; 2015 [cited 2023 Apr 27]. Available from: https://www.ruralhealthinfo.org/toolkits/aging/1/demographics
  9. Odden MC, Koh WJ, Arnold AM, et al. Trajectories of nonagenarian health: sex, age, and period effects. Am J Epidemiol 2019;188:382-388. https://doi.org/10.1093/aje/kwy241
  10. Healthcare Cost and Utilization Project (HCUP). Elixhauser comorbidity software refined for ICD-10-CM [Internet]. HCUP; 2022 [cited 2023 Jul 1]. Available from: https://hcup-us.ahrq.gov/toolssoftware/comorbidityicd10/comorbidity_icd10.jsp
  11. Glasheen WP, Cordier T, Gumpina R, et al. Charlson Comorbidity Index: ICD-9 update and ICD-10 translation. Am Health Drug Benefits 2019;12:188-197.
  12. Di Fiore F, Lecleire S, Merle V, et al. Changes in characteristics and outcome of acute upper gastrointestinal haemorrhage: a comparison of epidemiology and practices between 1996 and 2000 in a multicentre French study. Eur J Gastroenterol Hepatol 2005;17:641-647. https://doi.org/10.1097/00042737-200506000-00008
  13. van Leerdam ME, Vreeburg EM, Rauws EA, et al. Acute upper GI bleeding: did anything change? Time trend analysis of incidence and outcome of acute upper GI bleeding between 1993/1994 and 2000. Am J Gastroenterol 2003;98:1494-1499. https://doi.org/10.1111/j.1572-0241.2003.07517.x
  14. Diener HC. Preventing major gastrointestinal bleeding in elderly patients. Lancet 2017;390:435-437. https://doi.org/10.1016/S0140-6736(17)31507-6
  15. Yamaguchi Y, Yamato T, Katsumi N, et al. Endoscopic hemostasis: safe treatment for peptic ulcer patients aged 80 years or older? J Gastroenterol Hepatol 2003;18:521-525. https://doi.org/10.1046/j.1440-1746.2003.02960.x
  16. Choudari CP, Elton RA, Palmer KR. Age-related mortality in patients treated endoscopically for bleeding peptic ulcer. Gastrointest Endosc 1995;41:557-560. https://doi.org/10.1016/S0016-5107(95)70190-7