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老年消化道出血住院患者不良预后的影响因素分析

Risk Factors for Adverse Outcomes in the Elderly Inpatients with Gastrointestinal Bleeding

    摘要
  • 摘要:
      目的   探讨老年消化道出血住院患者不良预后的影响因素。
      方法   回顾性分析2016年1月–2021年1月就诊于四川大学华西医院的60岁及以上老年消化道出血住院患者的临床资料，不良预后定义为住院期间入住重症监护室和/或死亡的复合指标，采用单因素和多因素logistic回归筛选不良预后的危险因素。
      结果   共纳入885例老年消化道出血住院患者（中位年龄72.00岁，其中男性517例，女性368例），包括上消化道出血患者436例，下消化道出血患者449例。住院期间老年患者的不良预后发生率为13.22%（117/885），老年上消化道出血患者的不良预后发生率高于老年下消化道出血患者（P<0.001）。单因素logistic回归结果表明上消化道出血（P<0.001）、入院时休克指数>1（P<0.001）、 血红蛋白（P<0.001）、尿素氮（P<0.001）、血肌酐（P<0.001）、国际标准化比值（international normalized ratio, INR）（P<0.001）、输注红细胞（P<0.001）、输注新鲜冰冻血浆（fresh frozen plasma, FFP）（P<0.001）和输注血小板（P<0.001）是不良预后的影响因素。多因素logistic回归表明上消化道出血（P<0.001）、入院时休克指数>1（P＝0.001）、入院时INR越高（P＝0.015）和住院期间输注FFP（P<0.001）均是老年消化道出血患者不良预后的独立影响因素。进一步研究表明入院时INR>1.5显著增加患者不良预后的发生风险（P<0.001）。
      结论   老年上消化道出血患者的预后比下消化道出血患者预后更差。在调整年龄和出血部位后，入院时休克指数>1、入院时INR>1.5和住院期间输注FFP是老年消化道出血患者不良预后的独立危险因素。

     

    Abstract:
      Objective   To explore the factors affecting the adverse prognosis of elderly inpatients with gastrointestinal bleeding (GIB).
      Methods   We retrospectively analyzed the clinical data of elderly patients aged 60 and over admitted with GIB to the Department of Gastroenterology, West China Hospital, Sichuan University between January 2016 and January 2021. The adverse outcome was defined as admission to the intensive care unit and/or in-hospital death during the patient’s stay at the hospital. Univariate and multivariate logistic regression analyses were done to identify the risk factors associated with the adverse outcome of the elderly.
      Results   A total of 885 elderly patients (median age: 72.00 years, 517 males and 368 females) with GIB were enrolled, including 436 cases of upper GIB (UGIB) and 449 cases of lower GIB (LGIB). The overall rate of adverse outcome was 13.22% (117/885), which was significantly higher in the UGIB patients than that in the LGIB patients (P<0.001). Univariate logistic regression identified UGIB (P<0.001), shock index>1 (P<0.001), hemoglobin (P<0.001), blood urea nitrogen (P<0.001), creatinine (P<0.001), and international normalized ratio (INR) (P<0.001) on admission, as well as erythrocyte transfusion (P<0.001), fresh frozen plasma (FFP) transfusion (P<0.001), and platelet transfusion (P<0.001) were associated with adverse outcome. Multivariate logistic analysis showed that UGIB (P<0.001), shock index >1 on admission (P=0.001), higher INR on admission (P=0.015) and FFP transfusion during hospitalization (P<0.001) were independent risk factors for adverse outcome of elderly patients with GIB. Further analysis showed that INR>1.5 on admission significantly increased the risks of adverse outcome (P<0.001).
      Conclusion   Elderly patients with UGIB exhibited worse prognosis than those with LGIB. After adjusting for age and the location of bleeding, shock index>1, INR>1.5 on admission and FFP transfusion were considered independent risk factors for the adverse outcome of elderly inpatients with GIB.

     

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