Dergiler / Journal of Medicine and Palliative Care / 2026 / Volume: 7 Issue: 2

Gastrointestinal bleeding in the oldest old: predictors of emergency outcomes and 30-day mortality

Banu Arslan(SAĞLIK BİLİMLERİ ÜNİVERSİTESİ, İSTANBUL BAŞAKŞEHİR ÇAM VE SAKURA ŞEHİR SAĞLIK UYGULAMA VE ARAŞTIRMA MERKEZİ, DAHİLİ TIP BİLİMLERİ BÖLÜMÜ)0000-0003-0982-5351
Mehmet Necmeddin Sutaşır(SAĞLIK BİLİMLERİ ÜNİVERSİTESİ, İSTANBUL BAŞAKŞEHİR ÇAM VE SAKURA ŞEHİR SAĞLIK UYGULAMA VE ARAŞTIRMA MERKEZİ, DAHİLİ TIP BİLİMLERİ BÖLÜMÜ)0000-0001-6472-5092
Sayfa
—
Yayın Tarihi
2026-03-27
🏛️Bu makalenin bibliyografik verileri ve tam metin bağlantısı DergiPark üzerinden sağlanmıştır.
DergiPark Kaydı ↗
✨

Yapay Zeka Hızlı Bakış & Çıkarımlar

AI Insight
⚡ TL;DR(1 Cümlede Hızlı Çıkarım)

Larger multicenter studies are needed to validate these findings and better define anticoagulant safety in this high-risk population.

📌 3 Maddede Bu Makale

🎯
Amaç & Hipotez:Aims: “Oldest old” (patients aged 85 years and older) represent a particularly vulnerable group, yet data identifying predictors of adverse outcomes in this population remain limited.
📊
Temel Bulgular & Veri:This study aimed to identify clinical, physiological, and laboratory predictors of adverse emergency department (ED) outcomes and 30-day mortality in patients aged ≥85 years presenting with gastrointestinal (GI) bleeding, and to evaluate the impact of antithrombotic therapy on these outcomes.
💡
Sonuç & Katkı:Larger multicenter studies are needed to validate these findings and better define anticoagulant safety in this high-risk population.
🔬Tür:Research Article
📍Kapsam:2020 Verileri
⚙️Değişkenler:Gastrointestinal bleeding · oldest old · antithrombotic

Abstract

Aims: “Oldest old” (patients aged 85 years and older) represent a particularly vulnerable group, yet data identifying predictors of adverse outcomes in this population remain limited. This study aimed to identify clinical, physiological, and laboratory predictors of adverse emergency department (ED) outcomes and 30-day mortality in patients aged ≥85 years presenting with gastrointestinal (GI) bleeding, and to evaluate the impact of antithrombotic therapy on these outcomes. Methods: This retrospective observational study included patients aged ≥85 years who presented to a tertiary ED with GI bleeding between May 2020 and May 2023. Demographic characteristics, comorbidities, antithrombotic therapy, vital signs, laboratory parameters, and clinical outcomes were extracted from electronic medical records. Primary outcomes were ED disposition (discharge, ward admission, intensive care unit admission, or ED death). Secondary outcomes included 30-day mortality, erythrocyte transfusion within 24 hours, and emergency gastroscopy. Univariable and multivariable logistic regression analyses were performed to identify predictors of severe emergency outcomes and 30-day mortality. Results: A total of 88 patients were included. Shock index, serum lactate, neutrophil-to-lymphocyte ratio (NLR), and erythrocyte transfusion requirement were independently associated with adverse outcomes. Antithrombotic therapy was common (61.4%) and demonstrated a stepwise increase in adverse outcomes from no therapy to monotherapy and dual therapy; however, antithrombotic agent class was not independently associated with mortality after adjustment for physiological severity. Conclusion: In oldest olds with GI bleeding, markers of acute physiological instability are stronger predictors of adverse outcomes than antithrombotic therapy alone. Larger multicenter studies are needed to validate these findings and better define anticoagulant safety in this high-risk population.

🔖

Bu Makaleye Atıf Yap

Arslan, B., Sutaşır, M. N. (2026). Gastrointestinal bleeding in the oldest old: predictors of emergency outcomes and 30-day mortality. Journal of Medicine and Palliative Care, Volume: 7 Issue: 2. https://doi.org/10.47582/jompac.1870074

📄 Tam Metin PDF Okuyucu

📄

PDF görüntüleyici hazırlanıyor...

Kaynakça (47)

  1. Bullain SS, Corrada MM. Dementia in the oldest old. Continuum (Minneap Minn). 2013;19(2 Dementia):457-469. doi:10.1212/01.CON. 0000429172.27815.3f
  2. Miilunpohja S, Kärkkäinen J, Hartikainen J, Jyrkkä J, Rantanen T, Paajanen H. Need of emergency surgery in elderly patients with upper gastrointestinal bleeding: survival analysis during 2009-2015. Dig Surg. 2019;36(1):20-26. doi:10.1159/000485846
  3. Kaplan RC, Heckbert SR, Koepsell TD, et al. Risk factors for hospitalized gastrointestinal bleeding among older persons. J Am Geriatr Soc. 2001; 49(2):126-133. doi:10.1046/j.1532-5415.2001.49032.x
  4. Lenti MV, Pasina L, Cococcia S, et al. Mortality rate and risk factors for gastrointestinal bleeding in elderly patients. Eur J Intern Med. 2019;61: 54-61. doi:10.1016/j.ejim.2018.11.003
  5. Elsebaey MA, Elashry H, Elbedewy TA, et al. Predictors of in-hospital mortality in a cohort of elderly Egyptian patients with acute upper gastrointestinal bleeding. Medicine (Baltimore). 2018;97(16):e0403. doi: 10.1097/MD.000000000001040
  6. Miilunpohja S, Jyrkkä J, Kärkkäinen JM, et al. Long-term mortality and causes of death in endoscopically verified upper gastrointestinal bleeding: comparison of bleeding patients and population controls. Scand J Gastroenterol. 2017;52(11):1211-1218. doi:10.1080/00365521.2017. 1347811
  7. Navar AM, Kolkailah AA, Overton R, et al. Trends in oral anticoagulant use among 436 864 patients with atrial fibrillation in community practice, 2011 to 2020. J Am Heart Assoc. 2022;11(22):e026723. doi:10. 1161/JAHA.122.026723
  8. Aloysius MM, Perisetti A, Goyal H, et al. Direct-acting oral anticoagulants versus warfarin in relation to risk of gastrointestinal bleeding: a systematic review and meta-analysis of randomized controlled trials. Ann Gastroenterol. 2021;34(5):651-659. doi:10.20524/aog.2021.0658
  9. Jansson M, Själander S, Sjögren V, et al. Reduced dose direct oral anticoagulants compared with warfarin with high time in therapeutic range in nonvalvular atrial fibrillation. J Thromb Thrombolysis. 2023; 55(3):415-425. doi:10.1007/s11239-022-02763-w
  10. Laursen SB, Leontiadis GI, Stanley AJ, Møller MH, Hansen JM, Schaffalitzky de Muckadell OB. Relationship between timing of endoscopy and mortality in patients with peptic ulcer bleeding: a nationwide cohort study. Gastrointest Endosc. 2017;85:936-944.e3. doi: 10.1016/j.gie.2016.08.049
  11. Parker ME, Khasawneh MA, Thiels CA, et al. Prehospital transfusion for gastrointestinal bleeding. Air Med J. 2017;36:315-319. doi:10.1016/j.amj.2017.06.002
  12. Obeidat M, Teutsch B, Rancz A, et al. One in four patients with gastrointestinal bleeding develops shock or hemodynamic instability: a systematic review and meta-analysis. World J Gastroenterol. 2023;29(28): 4466-4480. doi:10.3748/wjg.v29.i28.4466
  13. Bourque JSC, Cliche J, Chauny J, Daoust R, Paquet J, Piette É. Accuracy of the shock index and various modified shock indexes to predict early mortality in patients suffering from gastrointestinal haemorrhage. Crit Care. 2013;17(Suppl 2):P219. doi:10.1186/cc12157
  14. Lowe J, Lowe Z, Ely R. Shock index as a predictor of mortality and hospital admission in prehospital gastrointestinal bleeding: a retrospective cohort study. Prehosp Emerg Care. 2024;28(5):689-695. doi:10.1080/10903127. 2024.2331739
  15. Kocaoğlu S, Çetinkaya HB. Use of age shock index in determining severity of illness in patients presenting to the emergency department with gastrointestinal bleeding. Am J Emerg Med. 2021;47:274-278. doi: 10.1016/j.ajem.2021.05.008
  16. Choudhary MK, Holmström K, Bouquin H, et al. Impact of aging on cardiovascular dynamics and heart rate variability during passive head-up tilt. Physiol Rep. 2025;13(14):e70477. doi:10.14814/phy2.70477
  17. Chester JG, Rudolph JL. Vital signs in older patients: age-related changes. J Am Med Dir Assoc. 2011;12(5):337-343. doi:10.1016/j.jamda. 2010.04.009
  18. Madden KM, Feldman B, Meneilly GS. Baseline shock index and baroreflex function in older adults. Aging Health Res. 2025;5(1):100198. doi:10.1016/j.ahr.2025.100198
  19. Vandrajabpour Z, Paknezhad S, Ghaffarzad A, Parsian Z, Mortezabagi H, Akhgari A. Determining the predictive value of shock index, reverse shock index, and modified shock index in hospital outcome of gastrointestinal bleeding in elderly patients. Int J Aging. 2024;2:e25. doi: 10.34172/ija.2024.e25
  20. Dogru U, Yuksel M, Ay MO, et al. The effect of the shock index and scoring systems for predicting mortality among geriatric patients with upper gastrointestinal bleeding: a prospective cohort study. Sao Paulo Med J. 2022;140(4):531-539. doi:10.1590/1516-3180.2021.0735.13102021
  21. Chung JY, Hsu CC, Chen JH, et al. Shock index predicted mortality in geriatric patients with influenza in the emergency department. Am J Emerg Med. 2019;37(3):391-394. doi:10.1016/j.ajem.2018.05.059
  22. Pandit V, Rhee P, Hashmi A, et al. Shock index predicts mortality in geriatric trauma patients: an analysis of the National Trauma Data Bank. J Trauma Acute Care Surg. 2014;76(4):1111-1115. doi:10.1097/TA. 0000000000000160
  23. Rafieezadeh A, Prabhakaran K, Kirsch J, et al. Shock index is a stronger predictor of outcomes in older compared to younger patients. J Surg Res. 2024;300:8-14. doi:10.1016/j.jss.2024.04.064
  24. Neville AL, Nemtsev D, Manasrah R, Bricker SD, Putnam BA. Mortality risk stratification in elderly trauma patients based on initial arterial lactate and base deficit levels. Am Surg. 2011;77(10):1337-1341. doi:10. 1177/00031348110770101
  25. Olcay HÖ, Emektar E, Öztürk ZS, Akkan S, Çevik Y. Association of serum lactate levels measured in the emergency department with 30-day mortality in older patients with unilateral hip fractures. Ann Geriatr Med Res. 2024;28(3):301-306. doi:10.4235/agmr.24.0011
  26. Wang H, Li Z, Yin M, et al. Combination of acute physiology and chronic health evaluation II score, early lactate area, and N-terminal prohormone of brain natriuretic peptide levels as a predictor of mortality in geriatric patients with septic shock. J Crit Care. 2015;30(2):304-309. doi:10.1016/j.jcrc.2014.11.013
  27. Salottolo KM, Mains CW, Offner PJ, Bourg PW, Bar-Or D. A retrospective analysis of geriatric trauma patients: venous lactate is a better predictor of mortality than traditional vital signs. Scand J Trauma Resusc Emerg Med. 2013;21:7. doi:10.1186/1757-7241-21-7
  28. Zhang X, Xiao X, Ma L, Long Y, Yan HL, Yang JL. Risk factors for adverse outcomes in the elderly inpatients with gastrointestinal bleeding. Sichuan Da Xue Xue Bao Yi Xue Ban. 2021;52(6):1028-1033. doi:10.12182/20211160501
  29. Zahorec R. Neutrophil-to-lymphocyte ratio, past, present and future perspectives. Bratisl Lek Listy. 2021;122(7):474-488. doi:10.4149/BLL_ 2021_078
  30. Buonacera A, Stancanelli B, Colaci M, Malatino L. Neutrophil to lymphocyte ratio: an emerging marker of the relationships between the immune system and diseases. Int J Mol Sci. 2022;23(7):3636. doi:10.3390/ijms23073636
  31. Makay B, Gücenmez ÖA, Duman M, Ünsal E. The relationship of neutrophil-to-lymphocyte ratio with gastrointestinal bleeding in Henoch-Schonlein purpura. Rheumatol Int. 2014;34:1323-1327. doi:10. 1007/s00296-014-2986-2
  32. Chen X, Li X, Zhao G, Xu W. Neutrophil-lymphocyte ratio predict outcome of upper gastrointestinal bleeding in emergency. Front Med (Lausanne). 2024;11:1366715. doi:10.3389/fmed.2024.1366715
  33. Song M, Graubard BI, Rabkin CS, Engels EA. Neutrophil-to-lymphocyte ratio and mortality in the United States general population. Sci Rep. 2021;11:464. doi:10.1038/s41598-020-79431-7
  34. Di Rosa M, Sabbatinelli J, Soraci L, et al. Neutrophil-to-lymphocyte ratio (NLR) predicts mortality in hospitalized geriatric patients independent of the admission diagnosis: a multicenter prospective cohort study. J Transl Med. 2023;21(1):835. doi:10.1186/s12967-023-04717-z
  35. Antognoli L, Sabbatinelli J, Rosa MD, et al. Admission neutrophil-to-lymphocyte ratio predicts short- and long-term mortality in hospitalized older adults: a retrospective multicenter study. Aging Dis. 2025. doi:10.14336/AD.2025.1209
  36. Fest J, Ruiter R, Ikram MA, Voortman T, van Eijck CHJ, Stricker BH. Reference values for white blood-cell-based inflammatory markers in the Rotterdam study: a population-based prospective cohort study. Sci Rep. 2018;8(1):10566. doi:10.1038/s41598-018-28646-w
  37. Baigent C, Blackwell L, Collins R, et al. Aspirin in the primary and secondary prevention of vascular disease: collaborative meta-analysis of individual participant data from randomised trials. Lancet. 2009; 373(9678):1849-1860. doi:10.1016/S0140-6736(09)60503-1
  38. Selak V, Kerr A, Poppe K, et al. Annual risk of major bleeding among persons without cardiovascular disease not receiving antiplatelet therapy. JAMA. 2018;319(24):2507-2520. doi:10.1001/jama.2018.8194
  39. Coleman CI, Peacock WF, Bunz TJ, Alberts MJ. Effectiveness and safety of apixaban, dabigatran, and rivaroxaban versus warfarin in patients with nonvalvular atrial fibrillation and previous stroke or transient ischemic attack. Stroke. 2017;48(8):2142-2149. doi:10.1161/STROKEAHA.117.017474
  40. Yamashita Y, Uozumi R, Hamatani Y, et al. Current status and outcomes of direct oral anticoagulant use in real-world atrial fibrillation patients-Fushimi AF Registry. Circ J. 2017;81(9):1278-1285. doi:10.1253/circj.CJ-16-1337
  41. Jun M, Lix LM, Durand M, et al. Comparative safety of direct oral anticoagulants and warfarin in venous thromboembolism: multicentre, population based, observational study. BMJ. 2017;359:j4323. doi:10.1136/bmj.j4323
  42. Granger CB, Alexander JH, McMurray JJ, et al. Apixaban versus warfarin in patients with atrial fibrillation. N Engl J Med. 2011;365(11):981-992. doi:10.1056/NEJMoa1107039
  43. Abraham NS, Noseworthy PA, Inselman J, et al. Risk of gastrointestinal bleeding increases with combinations of antithrombotic agents and patient age. Clin Gastroenterol Hepatol. 2020;18(2):337-346.e19. doi:10. 1016/j.cgh.2019.05.017
  44. Lane DA, Kamphuisen PW, Minini P, Büller HR, Lip GYH. Bleeding risk in patients with atrial fibrillation: the AMADEUS study. Chest. 2011;140(1):146-155. doi:10.1378/chest.10-3270
  45. Pérez-Gómez F, Iriarte JA, Zumalde J, et al. Antithrombotic therapy in elderly patients with atrial fibrillation: effects and bleeding complications: a stratified analysis of the NASPEAF randomized trial. Eur Heart J. 2007;28(8):996-1003. doi:10.1093/eurheartj/ehl364
  46. Laine L, Jensen DM. Management of patients with ulcer bleeding. Am J Gastroenterol. 2012;107(3):345-360. doi:10.1038/ajg.2011.480
  47. Kim BJ, Park MK, Kim SJ, et al. Comparison of scoring systems for the prediction of outcomes in patients with nonvariceal upper gastrointestinal bleeding: a prospective study. Dig Dis Sci. 2009;54(11): 2523-2529. doi:10.1007/s10620-008-0654-7