Risk factors for recurrent bleeding and mortality in human immunodeficiency virus-infected patients with acute lower GI hemorrhage

Background: Little is known about lower gastrointestinal (GI) hemorrhage in the human immunodeficiency virus (HIV)-infected population. Our aim was to determine the underlying causes, the clinical outcome, and the risk factor s for recurrent bleeding and mortality in HIV-infected patients with acute lower GI hemorrhage. Methods: We reviewed the medical records of consecutive HIV-infected patien ts with acute lower Gr hemorrhage who were evaluated with endoscopy from Ja nuary 1992 through January 1997 at Bellevue Hospital Center. Results: During the 5-year study period, 312 patients with acute lower GI h emorrhage underwent colonoscopy (n = 233) or flexible sigmoidoscopy (9 = 79 ). Cytomegalovirus colitis (25.3%), lymphoma (12.2%), and idiopathic coliti s (12.2%) were the most common causes identified. Within 30 days of present ation, recurrent bleeding occurred in 17.6% of patients. Independent predic tors of recurrent bleeding included the presence of at least one comorbid i llness, a hemoglobin level of less than 8 m/dL, a platelet count of less th an 100,000/mm(3), and major stigmata of hemorrhage. The 30-day mortality fr om lower GI hemorrhage was 14.4%, and the presence of comorbid disease, rec urrence of bleeding, and surgical intervention were found to be the only in dependent predictors of mortality in this patient population. Conclusions: Acute lower GI hemorrhage in HIV-infected patients is most com monly caused by cytomegalovirus colitis and is associated with a high short -term morbidity and mortality.