Risk factors for rebleeding in acute lower gastrointestinal bleeding: a systematic review and meta-analysis

To investigate the potential risk factors for rebleeding following acute lower gastrointestinal bleeding (ALGIB). A comprehensive literature review was performed utilizing the PubMed, Embase, Web of Science, and Cochrane Library databases, encompassing articles published up to May 10, 2024. Two researchers independently performed literature screening, data extraction, and risk of bias assessment to ensure methodological rigor and minimize potential biases. The meta-analysis was performed using R (version 4.3.2) and Stata 17.0 software. A total of 2799 studies were retrieved, of which 29 were ultimately included in the analysis, comprising 23 case–control studies and 6 cohort studies, involving 14,069 patients with ALGIB, of whom 1930 experienced rebleeding. The pooled results of multivariable meta-analysis indicated that age ≥ 70 years, blood transfusion requirements, shock at presentation, hypertension, comorbid chronic kidney disease (CKD), hyperlipidemia, NSAIDs use, active bleeding on colonoscopy, colonic diverticular bleeding, and non-aspirin antiplatelet treatment are risk factors for rebleeding after ALGIB. In addition, the results of univariable analysis also showed that steroids, aspirin, and anticoagulant drug use are associated factors for rebleeding. Based on available evidence, several factors, including age ≥ 70 years, blood transfusion requirements, shock at presentation, hypertension, CKD, hyperlipidemia, NSAIDs use, active bleeding on colonoscopy, colonic diverticular bleeding, and non-aspirin antiplatelet treatment, may be associated with an increased risk of rebleeding after ALGIB. Early identification of these risk factors and implementation of individualized interventions may help improve patient outcomes.