Retrospective analysis of patients aged 65 and over who presented to the emergency department with gastrointestinal system bleeding and had endoscopy or colonoscopy

Aim: The aim of our study is to evaluate the clinical and prognostic features of patients aged 65 and over who applied to our emergency department with acute GI bleeding and underwent endoscopy and/or colonoscopy. Patients and methods: In the present study, the data of patients aged 65 years and over who applied to the Emergency Department of Uşak University Training and Research Hospital between January 2020 and January 2023 with the complaint of gastrointestinal bleeding and underwent endoscopy and/or colonoscopy were obtained from the electronic medical record system and emergency department admission documents. Results: The mean age of the total 371 patients (186 women, 185 men) was 78.2±7.8 years. 93% of the patients had at least one comorbid disease and 62% of the patients were using anticoagulant and/or antiplatelet medication. Upper and lower GI bleeding was detected in a total of 309 and 62 patients, respectively. While 127 patients underwent massive transfusion in the emergency department, 207 patients were admitted to intensive care. The one-month mortality rate was found to be 13.5% (50/371 patients). Warfarin use (p=0.016), presence of melena (p<0.001), upper GI bleeding (compared to lower GI tract, p=0.034) and duodenal ulcer (p=0.009) were associated with the need for massive transfusion. The frequency of atrial fibrillation (p=0.038) and heart failure (p=0.002), the median number of comorbid diseases (p=0.009), warfarin use (p=0.012), the presence of hematemesis (p=0.043) and the presence of upper GI bleeding (compared to lower GI tract, p=0.033) were found to be high, while mean hemoglobin (p<0.001) and albumin (p<0.001) levels were found to be low in patients with intensive care admission compared to those without The presence of cirrhosis (p=0.006), esophageal variceal bleeding (p<0.001) and prolonged hospitalization (p=0.026) were shown to be associated with one-month mortality. The increase in BUN/albumin ratio, CRP/albumin ratio and neutrophil/lymphocyte ratio measured at the first admission was shown to be related to one-month mortality. Conclusion: In conclusion, acute GI bleeding in geriatric patients is characterized by high morbidity and mortality rates. Although the presence of multiple comorbid diseases is an important factor determining prognosis in this group, warfarin use may be associated with massive bleeding.