Colon to Rectum
Clin Gastroenterol Hepatol. 2023;21(13):3258–69.e6
Long-term risks of recurrence after hospital discharge for acute lower gastrointestinal bleeding: A large nationwide cohort study
Background and aims: Currently, large, nationwide, long-term follow-up data on acute lower gastrointestinal bleeding (ALGIB) are scarce. The authors investigated long-term risks of recurrence after hospital discharge for ALGIB using a large multicenter dataset.
Methods: They retrospectively analyzed 5048 patients who were urgently hospitalized for ALGIB at 49 hospitals across Japan (CODE BLUE-J study). Risk factors for the long-term recurrence of ALGIB were analyzed by using competing risk analysis, treating death without rebleeding as a competing risk.
Results: Rebleeding occurred in 1304 patients (25.8%) during a mean follow-up period of 31 months. The cumulative incidences of rebleeding at 1 and 5 years were 15.1% and 25.1%, respectively. The mortality risk was significantly higher in patients with out-of-hospital rebleeding episodes than in those without (hazard ratio = 1.42). Of the 30 factors, multivariate analysis showed that shock index ≥ 1 (subdistribution hazard ratio [SHR] = 1.25), blood transfusion (SHR = 1.26), in-hospital rebleeding (SHR = 1.26), colonic diverticular bleeding (SHR = 2.38), and thienopyridine use (SHR = 1.24) were significantly associated with increased rebleeding risk. Multivariate analysis of colonic diverticular bleeding patients showed that blood transfusion (SHR = 1.20), in-hospital rebleeding (SHR = 1.30), and thienopyridine use (SHR = 1.32) were significantly associated with increased rebleeding risk, whereas endoscopic hemostasis (SHR = 0.83) significantly decreased the risk.
Conclusions: These large, nationwide follow-up data highlighted the importance of endoscopic diagnosis and treatment during hospitalization and the assessment of the need for ongoing thienopyridine use to reduce the risk of out-of-hospital rebleeding. This information also aids in the identification of patients at high risk of rebleeding.