目的:本研究旨在调查发病率,预测因子,以及下消化道出血(LGIB)对结直肠癌患者住院死亡率的影响,由于其临床意义和对患者预后的潜在影响。
方法:我们对2009年至2019年国家住院患者样本数据库的数据进行了回顾性分析,包括2,598,326例有和没有LGIB的结直肠癌患者。进行单变量和多变量逻辑回归分析以确定LGIB的预测因子及其与住院患者预后的关联。
结果:在直肠癌患者中观察到LGIB的最高发生率(3.8%),其次是远端结肠癌患者(1.4%)和近端结肠癌患者(1.2%).几个因素与LGIB显著相关,包括年龄较大;男性;某些种族,如黑人,西班牙裔,和亚洲/太平洋岛民患者;或较低的社会经济地位。多变量分析确定了LGIB的独立预测因子,比如严重的败血症,使用抗凝剂,长期使用阿司匹林或抗血小板药物,姑息治疗,营养不良,恶病质,化疗或免疫疗法,转移,酗酒,高血压,肥胖,消化道肿瘤家族史.在有和没有LGIB的患者之间没有观察到住院死亡率的显着差异。
结论:我们的研究强调了在LGIB评估中考虑结直肠癌位置和确定危险因素的重要性。临床医生应该解决可改变的风险因素和医疗保健差距。未来的研究应该探索潜在的机制,有针对性的干预措施,以及超出住院患者死亡率的长期结果。
OBJECTIVE: This study aimed to investigate the incidence, predictors, and impact of lower gastrointestinal bleeding (LGIB) on inpatient mortality among colorectal cancer patients, due to its clinical significance and potential influence on patient outcomes.
METHODS: We conducted a retrospective analysis of data from the National Inpatient Sample database between 2009 and 2019, including 2,598,326 colorectal cancer patients with and without LGIB. Univariate and multivariate logistic regression analyses were performed to determine predictors of LGIB and its association with inpatient outcomes.
RESULTS: The highest incidence of LGIB was observed in rectal cancer patients (3.8%), followed by distal colon cancer patients (1.4%) and proximal colon cancer patients (1.2%). Several factors were significantly associated with LGIB, including older age; male sex; certain racial such as Black, Hispanic, and Asia/Pacific Islander patients; or lower socioeconomic status. Multivariate analysis identified independent predictors of LGIB, such as severe sepsis, use of anticoagulants, long-term use of aspirin or antiplatelet drugs, palliative care, malnutrition, cachexia, chemotherapy or immunotherapy, metastasis, alcohol abuse, hypertension, obesity, and family history of digestive cancer. No significant difference in inpatient mortality was observed between patients with and without LGIB.
CONCLUSIONS: Our study underscores the importance of considering colorectal cancer location and identified risk factors for LGIB assessment. Clinicians should address modifiable risk factors and healthcare disparities. Future research should explore underlying mechanisms, targeted interventions, and long-term outcomes beyond inpatient mortality.