S1349 Impact of Dementia on Clinical Outcomes in Patients With Gastrointestinal Bleeding: A Propensity Score-Matched Retrospective Cohort Study

Introduction: Gastrointestinal bleeding (GIB) is a major cause of morbidity and mortality, particularly among older adults. Dementia, a common comorbidity in this population, may impact clinical outcomes due to late recognition and delayed presentation. However, few studies have examined the influence of dementia on outcomes in GIB patients. This study aims to evaluate the impact of dementia on mortality and other clinical outcomes in GIB using real-world data and robust statistical matching. Methods: A retrospective cohort study was conducted using the TriNetX Global Collaborative Network. Two matched cohorts were identified: patients with both dementia and GIB (n = 6,603), and patients with GIB but without dementia (n = 6,603), matched 1:1 using propensity scores based on demographic, diagnostic, and laboratory data. The index event was the first recorded GIB diagnosis, with outcomes assessed over a follow-up period of 1 to 1,825 days. Analyses included risk assessment, Kaplan-Meier survival, event frequency, and lab value distribution. The primary outcome was all-cause mortality; secondary outcomes included hospital admissions, emergency department visits, and recurrent GIB. Results: The dementia and GIB cohort showed significantly higher mortality (37.3% vs 25.8%; risk difference: 0.115 [95% CI: 0.100–0.131]; RR: 1.447; OR: 1.713; P < 0.001). One-year survival was lower in patients with dementia (33.43% vs 51.06%; HR: 1.490; P < 0.001). Hospital admissions (13.0% vs 10.1%; RR: 1.297; P < 0.001) and emergency visits (9.0% vs 7.6%; RR: 1.177; P = 0.005) were also more frequent in the dementia group. Interestingly, dementia patients had fewer recurrent GIB episodes (24.0% vs 28.4%; RR: 0.844; P < 0.001). All outcomes were based on matched cohorts of 6,603 patients each. Conclusion: Dementia is associated with significantly worse clinical outcomes in patients with GIB, including higher mortality and increased healthcare utilization. These findings may be due to late recognition of GIB symptoms in patients with dementia, leading to late presentation and worse outcomes. These findings highlight the need for individualized care strategies to manage GIB in patients with Dementia and call for further studies to explore contributing factors and optimize outcomes in this high-risk group.