New index predicts colonoscopy risks in older adults: study

Korean researchers have developed an index that can predict the likelihood of adverse events when performing colonoscopies on elderly patients.

Gangnam Severance Hospital said Tuesday that a research team led by Professors Chun Jae-young and Kim Min-jae of the Department of Gastroenterology has created an objective metric to assess colonoscopy risk in elderly patients and help determine whether and when to perform the procedure.

The researchers defined an adverse event as an emergency department visit or unplanned hospitalization within 30 days of a colonoscopy for patients aged 60 years or older. They also quantified risk factors for adverse events, such as frailty and antiplatelet and anticoagulant medication status, into a score.

They followed 8,154 patients 60 and older who underwent colonoscopy procedures at Gangnam Severance Hospital between August 2017 and August 2022. The average age of the patients was 67.9 (60-94).

The Frailty Index by Laboratory Findings (FI-LAB) score was developed by reviewing the patients' emergency department visits, hospitalization records, blood test results, and vital signs. Frailty was categorized as low (<0.25), intermediate (0.25 to 0.40), or high (>0.40) based on the measurements.

The researchers also assigned a risk trigger score to everyday medications that could cause side effects. Aspirin and P2Y12 inhibitors, both antiplatelet drugs, were given one point each, as were anticoagulant medications, which were given one point. They also assigned a score of two points for moderate frailty and three points for high frailty.

Finally, the frailty score and usual medication score were summed and divided into three groups: low risk (0 points), medium risk (1-3 points), and high risk (4-6 points) for adverse events.

The study found that 13 out of 4,877 people in the low-risk group (score of 0) had a 0.3 percent chance of experiencing an adverse event, while 64 out of 2,922 people in the medium-risk group (score of 1-3) had a 2.2 percent chance of experiencing an adverse event. The high-risk group (score of 4-6) had 38 out of 355 people experience an adverse event, for a 10.7 percent chance of occurrence. Compared to the low-risk group, the intermediate-risk group was about 8.4 times more likely to have an adverse event, and the high-risk group was about 45 times more likely to have an adverse event.

The researchers found a 1.4 percent (114 patients) chance of an adverse event within 30 days, with usual aspirin, P2Y12 inhibitor, and anticoagulant use as independent factors. Using the low frailty index as a reference value, the moderate and high levels of frailty were each independent factors in adverse events.

“In the past, procedures were often restricted simply because of advanced age, but in fact, colonoscopy-associated adverse events are associated with other factors,” Professor Chun said. “The standardized indicators will help clinicians, as well as patients and their caregivers, to determine the direction of treatment. Furthermore, it can be applied to pre- and post-treatment patient management to reduce complications and save healthcare resources.”

The findings were published in Gut and Liver, an international gastroenterology journal, under “Novel Risk Score for 30-Day Adverse Events Following Colonoscopy in Older Adults.”