Clinical and pharmacological characteristics of elderly patients admitted for bleeding: impact on in-hospital mortality.

Abstract

INTRODUCTION:

Clinical and pharmacological characteristics of elderly patients hospitalized for bleeding and in-hospital mortality according to bleeding type are barely described.

METHODS:

Retrospective cohort study of 13,496 consecutive patients admitted to internal medicine wards. Clinical characteristics, comorbidities and pharmacological treatments were collected for each patient. Predictors of in-hospital mortality were investigated.

RESULTS:

Overall, 531 (3.9%) patients were admitted for bleeding: 189 clinically relevant non-major bleeding, 106 cerebral and 236 major non-cerebral (95.8% gastrointestinal (GI)). Among 106 cerebral bleedings, 28.3% and 24.5% were typical and atypical intracranial, respectively, and 47.2% were subdural haemorrhages. Most of patients with GI bleeding presented with anaemia (90.7%). A similar rate of GI bleeding was found in aspirin-treated patients taking or not proton pump inhibitors (PPI). In-hospital mortality was 9.98%. Age ≥80 years (odds ratio (OR) 2.513, p=.005), cerebral bleeding (OR 5.373, p<.001), eGFR <30 ml/min/m2 (OR 2.388, p=.035) and COPD (OR 2.362, p=.024) were positively associated with mortality, while ACE inhibitors/ARBs use was negatively associated (OR 0.383, p=.028).

CONCLUSIONS:

The most frequent type of major haemorrhage was GI bleeding, which was not modified by the use of PPI in patients taking aspirin. Cerebral bleeding increased all-cause death, which was lower in ACE inhibitors/ARBs users. KEY MESSAGE Gastrointestinal (GI) bleeding was the most common reason for hospital admission. The rate of GI bleeding was similar in patients on aspirin using or not PPI. Cerebral bleeding increased in-hospital mortality, which was lower in patients taking ACE inhibitors/ARBs.

• Authors: Arianna Pani, Daniele Pastori, Michele Senatore, Alessandra Romandini, Giulia Colombo, Francesca Agnelli, Francesco Scaglione, Fabrizio Colombo
• Journal: Annals of medicine (Ann Med) Vol. 52 Issue 7 Pg. 413-422 (11 2020) ISSN: 1365-2060 [Electronic] England
• PMID: 32795156 (Publication Type: Journal Article)

Chemical References

• Angiotensin Receptor Antagonists
• Angiotensin-Converting Enzyme Inhibitors
• Anticoagulants
• Platelet Aggregation Inhibitors
• Proton Pump Inhibitors
• Aspirin

Topics

• Aged
• Aged, 80 and over
• Anemia (etiology)
• Angiotensin Receptor Antagonists
• Angiotensin-Converting Enzyme Inhibitors
• Anticoagulants (adverse effects)
• Aspirin (adverse effects)
• Cerebral Hemorrhage (diagnosis, epidemiology, mortality)
• Comorbidity
• Female
• Gastrointestinal Hemorrhage (chemically induced, diagnosis, epidemiology, mortality)
• Hemorrhage (diagnosis, drug therapy, epidemiology, mortality)
• Hospital Mortality (trends)
• Hospitalization
• Humans
• Italy (epidemiology)
• Male
• Middle Aged
• Platelet Aggregation Inhibitors (adverse effects)
• Predictive Value of Tests
• Prevalence
• Protective Factors
• Proton Pump Inhibitors (therapeutic use)
• Retrospective Studies