Usefulness of the comprehensive geriatric assessment in older patients with upper gastrointestinal bleeding: A two-year follow-up study

Alberto Pilotto, Luigi Ferrucci, Carlo Scarcelli, Valeria Niro, Francesco Di Mario, Davide Seripa, Angelo Andriulli, Gioacchino Leandro, Marilisa Franceschi

Research output: Contribution to journalArticle

Abstract

Background: The potential usefulness of standardized comprehensive geriatric assessment (CGA) in evaluating treatment and follow-up of older patients with upper gastrointestinal bleeding is unknown. Aim: To evaluate the usefulness of the CGA as a 2-year mortality multidimensional prognostic index (MPI) in older patients hospitalized for upper gastrointestinal bleeding. Materials and Methods: Patients aged ≥65 years consecutively hospitalized for acute upper gastrointestinal bleeding were included. Diagnosis of bleeding was based on clinical and endoscopic features. All patients underwent a CGA that included six standardized scales, i.e., Activities of Daily Living (ADL), Instrumental Activities of Daily Living (IADL), Short Portable Mental Status Questionnaire (SPMSQ), Mini Nutritional Assessment (MNA), Exton-Smith Score (ESS) and Comorbity Index Rating Scale (CIRS), as well as information on medication history and cohabitation, for a total of 63 items. A MPI was calculated from the integrated total scores and expressed as MPI 1 = low risk, MPI 2 = moderate risk, and MPI 3 = severe risk. The predictive value of the MPI for mortality over a 24-month follow-up was calculated. Results: 36 elderly patients (M 16/F 20, mean age 82.8 ± 7.9 years, range 70-101 years) were included in the study. A significant difference in mean age was observed between males and females (M 80.1 ± 4.8 vs. F 84.9 ± 9.3 years; p <0.05). The causes of upper gastrointestinal bleeding were duodenal ulcer in 38.8%, gastric ulcer in 22.2%, and erosive gastritis in 16.6% of the patients, while 16.6% had gastrointestinal bleeding from unknown origin. The overall 2-year mortality rate was 30.5%. 18 patients (50%) were classified as having a low-risk MPI (mean value 0.18 ± 0.09), 12 (33.3%) as having a moderate-risk MPI (mean value 0.48 ± 0.08) and 6 (16.6%) as having a severe-risk MPI (mean value 0.83 ± 0.06). Higher MPI grades were significantly associated with higher mortality (grade 1 = 12.5%, grade 2 = 41.6%, grade 3 = 83.3%; p = 0.001). Adjusting for age and sex, the prognostic efficacy of MPI for mortality was confirmed and highly significant (odds ratio 10.47, 95% CI 2.04-53.6). Conclusion: CGA is a useful tool for calculating a MPI that significantly predicts the risk of 2-year mortality in older patients with upper gastrointestinal bleeding.

Original languageEnglish
Pages (from-to)124-128
Number of pages5
JournalDigestive Diseases
Volume25
Issue number2
DOIs
Publication statusPublished - Apr 2007

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Geriatric Assessment
Hemorrhage
Mortality
Activities of Daily Living
Nutrition Assessment
Gastritis
Stomach Ulcer
Duodenal Ulcer
Odds Ratio

Keywords

  • Comprehensive geriatric assessment
  • Multidimensional prognostic index
  • Upper gastrointestinal bleeding, diagnosis

ASJC Scopus subject areas

  • Gastroenterology

Cite this

Usefulness of the comprehensive geriatric assessment in older patients with upper gastrointestinal bleeding : A two-year follow-up study. / Pilotto, Alberto; Ferrucci, Luigi; Scarcelli, Carlo; Niro, Valeria; Di Mario, Francesco; Seripa, Davide; Andriulli, Angelo; Leandro, Gioacchino; Franceschi, Marilisa.

In: Digestive Diseases, Vol. 25, No. 2, 04.2007, p. 124-128.

Research output: Contribution to journalArticle

Pilotto, Alberto ; Ferrucci, Luigi ; Scarcelli, Carlo ; Niro, Valeria ; Di Mario, Francesco ; Seripa, Davide ; Andriulli, Angelo ; Leandro, Gioacchino ; Franceschi, Marilisa. / Usefulness of the comprehensive geriatric assessment in older patients with upper gastrointestinal bleeding : A two-year follow-up study. In: Digestive Diseases. 2007 ; Vol. 25, No. 2. pp. 124-128.
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title = "Usefulness of the comprehensive geriatric assessment in older patients with upper gastrointestinal bleeding: A two-year follow-up study",
abstract = "Background: The potential usefulness of standardized comprehensive geriatric assessment (CGA) in evaluating treatment and follow-up of older patients with upper gastrointestinal bleeding is unknown. Aim: To evaluate the usefulness of the CGA as a 2-year mortality multidimensional prognostic index (MPI) in older patients hospitalized for upper gastrointestinal bleeding. Materials and Methods: Patients aged ≥65 years consecutively hospitalized for acute upper gastrointestinal bleeding were included. Diagnosis of bleeding was based on clinical and endoscopic features. All patients underwent a CGA that included six standardized scales, i.e., Activities of Daily Living (ADL), Instrumental Activities of Daily Living (IADL), Short Portable Mental Status Questionnaire (SPMSQ), Mini Nutritional Assessment (MNA), Exton-Smith Score (ESS) and Comorbity Index Rating Scale (CIRS), as well as information on medication history and cohabitation, for a total of 63 items. A MPI was calculated from the integrated total scores and expressed as MPI 1 = low risk, MPI 2 = moderate risk, and MPI 3 = severe risk. The predictive value of the MPI for mortality over a 24-month follow-up was calculated. Results: 36 elderly patients (M 16/F 20, mean age 82.8 ± 7.9 years, range 70-101 years) were included in the study. A significant difference in mean age was observed between males and females (M 80.1 ± 4.8 vs. F 84.9 ± 9.3 years; p <0.05). The causes of upper gastrointestinal bleeding were duodenal ulcer in 38.8{\%}, gastric ulcer in 22.2{\%}, and erosive gastritis in 16.6{\%} of the patients, while 16.6{\%} had gastrointestinal bleeding from unknown origin. The overall 2-year mortality rate was 30.5{\%}. 18 patients (50{\%}) were classified as having a low-risk MPI (mean value 0.18 ± 0.09), 12 (33.3{\%}) as having a moderate-risk MPI (mean value 0.48 ± 0.08) and 6 (16.6{\%}) as having a severe-risk MPI (mean value 0.83 ± 0.06). Higher MPI grades were significantly associated with higher mortality (grade 1 = 12.5{\%}, grade 2 = 41.6{\%}, grade 3 = 83.3{\%}; p = 0.001). Adjusting for age and sex, the prognostic efficacy of MPI for mortality was confirmed and highly significant (odds ratio 10.47, 95{\%} CI 2.04-53.6). Conclusion: CGA is a useful tool for calculating a MPI that significantly predicts the risk of 2-year mortality in older patients with upper gastrointestinal bleeding.",
keywords = "Comprehensive geriatric assessment, Multidimensional prognostic index, Upper gastrointestinal bleeding, diagnosis",
author = "Alberto Pilotto and Luigi Ferrucci and Carlo Scarcelli and Valeria Niro and {Di Mario}, Francesco and Davide Seripa and Angelo Andriulli and Gioacchino Leandro and Marilisa Franceschi",
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T1 - Usefulness of the comprehensive geriatric assessment in older patients with upper gastrointestinal bleeding

T2 - A two-year follow-up study

AU - Pilotto, Alberto

AU - Ferrucci, Luigi

AU - Scarcelli, Carlo

AU - Niro, Valeria

AU - Di Mario, Francesco

AU - Seripa, Davide

AU - Andriulli, Angelo

AU - Leandro, Gioacchino

AU - Franceschi, Marilisa

PY - 2007/4

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N2 - Background: The potential usefulness of standardized comprehensive geriatric assessment (CGA) in evaluating treatment and follow-up of older patients with upper gastrointestinal bleeding is unknown. Aim: To evaluate the usefulness of the CGA as a 2-year mortality multidimensional prognostic index (MPI) in older patients hospitalized for upper gastrointestinal bleeding. Materials and Methods: Patients aged ≥65 years consecutively hospitalized for acute upper gastrointestinal bleeding were included. Diagnosis of bleeding was based on clinical and endoscopic features. All patients underwent a CGA that included six standardized scales, i.e., Activities of Daily Living (ADL), Instrumental Activities of Daily Living (IADL), Short Portable Mental Status Questionnaire (SPMSQ), Mini Nutritional Assessment (MNA), Exton-Smith Score (ESS) and Comorbity Index Rating Scale (CIRS), as well as information on medication history and cohabitation, for a total of 63 items. A MPI was calculated from the integrated total scores and expressed as MPI 1 = low risk, MPI 2 = moderate risk, and MPI 3 = severe risk. The predictive value of the MPI for mortality over a 24-month follow-up was calculated. Results: 36 elderly patients (M 16/F 20, mean age 82.8 ± 7.9 years, range 70-101 years) were included in the study. A significant difference in mean age was observed between males and females (M 80.1 ± 4.8 vs. F 84.9 ± 9.3 years; p <0.05). The causes of upper gastrointestinal bleeding were duodenal ulcer in 38.8%, gastric ulcer in 22.2%, and erosive gastritis in 16.6% of the patients, while 16.6% had gastrointestinal bleeding from unknown origin. The overall 2-year mortality rate was 30.5%. 18 patients (50%) were classified as having a low-risk MPI (mean value 0.18 ± 0.09), 12 (33.3%) as having a moderate-risk MPI (mean value 0.48 ± 0.08) and 6 (16.6%) as having a severe-risk MPI (mean value 0.83 ± 0.06). Higher MPI grades were significantly associated with higher mortality (grade 1 = 12.5%, grade 2 = 41.6%, grade 3 = 83.3%; p = 0.001). Adjusting for age and sex, the prognostic efficacy of MPI for mortality was confirmed and highly significant (odds ratio 10.47, 95% CI 2.04-53.6). Conclusion: CGA is a useful tool for calculating a MPI that significantly predicts the risk of 2-year mortality in older patients with upper gastrointestinal bleeding.

AB - Background: The potential usefulness of standardized comprehensive geriatric assessment (CGA) in evaluating treatment and follow-up of older patients with upper gastrointestinal bleeding is unknown. Aim: To evaluate the usefulness of the CGA as a 2-year mortality multidimensional prognostic index (MPI) in older patients hospitalized for upper gastrointestinal bleeding. Materials and Methods: Patients aged ≥65 years consecutively hospitalized for acute upper gastrointestinal bleeding were included. Diagnosis of bleeding was based on clinical and endoscopic features. All patients underwent a CGA that included six standardized scales, i.e., Activities of Daily Living (ADL), Instrumental Activities of Daily Living (IADL), Short Portable Mental Status Questionnaire (SPMSQ), Mini Nutritional Assessment (MNA), Exton-Smith Score (ESS) and Comorbity Index Rating Scale (CIRS), as well as information on medication history and cohabitation, for a total of 63 items. A MPI was calculated from the integrated total scores and expressed as MPI 1 = low risk, MPI 2 = moderate risk, and MPI 3 = severe risk. The predictive value of the MPI for mortality over a 24-month follow-up was calculated. Results: 36 elderly patients (M 16/F 20, mean age 82.8 ± 7.9 years, range 70-101 years) were included in the study. A significant difference in mean age was observed between males and females (M 80.1 ± 4.8 vs. F 84.9 ± 9.3 years; p <0.05). The causes of upper gastrointestinal bleeding were duodenal ulcer in 38.8%, gastric ulcer in 22.2%, and erosive gastritis in 16.6% of the patients, while 16.6% had gastrointestinal bleeding from unknown origin. The overall 2-year mortality rate was 30.5%. 18 patients (50%) were classified as having a low-risk MPI (mean value 0.18 ± 0.09), 12 (33.3%) as having a moderate-risk MPI (mean value 0.48 ± 0.08) and 6 (16.6%) as having a severe-risk MPI (mean value 0.83 ± 0.06). Higher MPI grades were significantly associated with higher mortality (grade 1 = 12.5%, grade 2 = 41.6%, grade 3 = 83.3%; p = 0.001). Adjusting for age and sex, the prognostic efficacy of MPI for mortality was confirmed and highly significant (odds ratio 10.47, 95% CI 2.04-53.6). Conclusion: CGA is a useful tool for calculating a MPI that significantly predicts the risk of 2-year mortality in older patients with upper gastrointestinal bleeding.

KW - Comprehensive geriatric assessment

KW - Multidimensional prognostic index

KW - Upper gastrointestinal bleeding, diagnosis

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