Haemoglobin level predicts mortality in patients with suspected small bowel bleeding

In patients with suspected small bowel bleeding (SSBB), having a haemoglobin level of <8.0 g/dL appears to increase the risk of mortality, suggests a study.

Patients aged ≥20 years with SSBB who underwent capsule endoscopy (CE) at Hokkaido University Hospital in Japan from April 2015 to March 2022 were included in this retrospective observational study. The investigators used electronic medical records to collect patient characteristics, blood transfusion history, CE results, blood test results, and post-CE mortality events.

Ninety-nine patients underwent CE to examine the causes of SSBB, of whom 40.4 percent had their bleeding sources identified. Thirty-four patients died over a median follow-up of 35 months, with an overall survival rate of 71.1 percent at 3 years.

In multivariate analysis, haemoglobin levels <8.0 g/dL (hazard ratio [HR], 9.75, 95 percent confidence interval [CI], 1.26‒75.15; p=0.003) and end-stage cancer (HR, 4.94, 95 percent CI, 2.02‒12.10; p<0.001) independently predicted mortality after CE for SSBB.

Notably, haemoglobin levels <8.0 g/dL (HR, 5.07, 95 percent CI, 1.10‒23.03; p=0.037) remained independently associated with an increased risk of mortality even after excluding patients with small bowel tumours and end-stage cancer.

At 5 years, the overall survival rates for patients without small bowel tumours and end-stage cancer in the groups with haemoglobin levels <8.0 and ≥8.0 g/dL were 56.8 percent and 89.0 percent, respectively.

“SSBB is characterized by an inability to identify the cause of bleeding despite esophagogastroduodenoscopy and colonoscopy,” the investigators said.