Comorbid pathology and role of diabetes mellitus in patients with gastrointestinal bleedings: the experience of one hospital
- Authors: Kozlova A.A.1,2, Komissarova K.V.1,2, Lapochkina N.D.1,2, Ovchinnikov S.V.1, Anosov V.D.1
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Affiliations:
- O.M. Filatov City Clinical Hospital No. 15 of the Department of Healthcare of Moscow
- N.I. Pirogov Russian National Research Medical University of the Ministry of Healthcare of Russia
- Issue: Vol 10, No 4 (2024)
- Pages: 65-73
- Section: ORIGINAL STUDIES
- URL: https://journals.eco-vector.com/2412-4036/article/view/634445
- DOI: https://doi.org/10.18565/therapy.2024.4.65-73
- ID: 634445
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Abstract
Gastrointestinal bleeding (GIB) is a life-threatening condition. Comorbid pathology, especially diabetes mellitus (DM), has a significant impact at the efficacy of treatment and prognosis of the disease.
The aim: to estimate the structure of comorbid pathology in GIB patients in a multidisciplinary hospital, identify predictors of unfavorable prognosis in patients with diabetes mellitus and GIB.
Material and methods. The study consisted of 1267 patients, including 724 male individuals (57.1%), hospitalized for gastrointestinal tract problems. The median age of participants was 66 (52–78) years. The structure of concomitant diseases was assessed. Subsequently, patients were divided into 2 groups: 1st – 288 patients diagnosed with diabetes mellitus, 2nd – 979 patients without it. The groups were compared in terms of frequency of taking various drugs at an outpatient stage, laboratory parameters, and location of bleeding. In group 1, an additional analysis of the nature and severity of kidney damage was performed. The frequency of deaths was determined, and factors that could influence the outcome of the disease in the hospital were searched.
Results. Comorbidity occurred in 71.4% (n = 905) of the participants of the study (95% confidence interval (CI): 68.9–73.9). Patients with diabetes mellitus more often took proton pump inhibitors, anticoagulants, and antiplatelet agents at the outpatient stage. Also in this group a more expressed prolongation of prothrombin time (PTT) and higher level of creatinine took place. Incidence of deaths was higher in patients with diabetes – 37.8% (n = 109) versus 27.7% (n = 271) in the group of patients without diabetes mellitus (odds ratio 1.591; 95% CI: 1.207–2.097; p < 0.001). Clinical data that may be associated with death were chosen from a binary logistic regression model. The following statistically significant associations were obtained: in the 1st group, the levels of creatinine and PTT were associated with a lethal outcome, in the 2nd group – the levels of creatinine, PTT, leukocytes and older age.
Conclusion. The incidence of deaths in patients with diabetes mellitus was 10.1% higher than the same among patients without diabetes. Current study confirms the importance of diabetes as a pathology that worsens the prognosis in case of GIB.
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About the authors
Anna A. Kozlova
O.M. Filatov City Clinical Hospital No. 15 of the Department of Healthcare of Moscow; N.I. Pirogov Russian National Research Medical University of the Ministry of Healthcare of Russia
Author for correspondence.
Email: annakoz15@mail.ru
ORCID iD: 0009-0002-4321-1927
MD, assistant at the Department of Hospital Therapy named after Academician P.E. Lukomsky of the Faculty of General Medicine
Russian Federation, Moscow; MoscowKsenia V. Komissarova
O.M. Filatov City Clinical Hospital No. 15 of the Department of Healthcare of Moscow; N.I. Pirogov Russian National Research Medical University of the Ministry of Healthcare of Russia
Email: Komissarova_kv@mail.ru
ORCID iD: 0009-0000-4277-3456
MD, laboratory assistant at the Department of Hospital Therapy named after academician P.E. Lukomsky of the Faculty of General Medicine
Russian Federation, Moscow; MoscowNina D. Lapochkina
O.M. Filatov City Clinical Hospital No. 15 of the Department of Healthcare of Moscow; N.I. Pirogov Russian National Research Medical University of the Ministry of Healthcare of Russia
Email: n_lapochkina@bk.ru
ORCID iD: 0009-0001-3485-8633
MD, assistant at the Department of Hospital Therapy named after Academician P.E. Lukomsky of the Faculty of General Medicine
Russian Federation, Moscow; MoscowSergey V. Ovchinnikov
O.M. Filatov City Clinical Hospital No. 15 of the Department of Healthcare of Moscow
Email: annakoz15@mail.ru
ORCID iD: 0009-0006-0265-4659
MD, surgeon
Russian Federation, MoscowViktor D. Anosov
O.M. Filatov City Clinical Hospital No. 15 of the Department of Healthcare of Moscow
Email: annakoz15@mail.ru
ORCID iD: 0000-0002-8486-7159
MD, PhD (Medicine), deputy chief physician for surgical care
Russian Federation, MoscowReferences
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