Relationship between timing of endoscopy and mortality in patients with peptic ulcer bleeding: a nationwide cohort study

TY - JOUR

T1 - Relationship between timing of endoscopy and mortality in patients with peptic ulcer bleeding

T2 - a nationwide cohort study

AU - Laursen, Stig B

AU - Leontiadis, Grigorios I

AU - Stanley, Adrian J

AU - Møller, Morten H

AU - Hansen, Jane M

AU - Schaffalitzky de Muckadell, Ove B

N1 - Copyright © 2017 American Society for Gastrointestinal Endoscopy. All rights reserved.

PY - 2017/5

Y1 - 2017/5

N2 - BACKGROUND AND AIMS: The optimal timing of endoscopy in patients with peptic ulcer bleeding (PUB) remains unclear. The aim of this study was to examine the association between timing of endoscopy and mortality in PUB.METHODS: In a nationwide cohort study based on a database of consecutive patients admitted to the hospital with PUB in Denmark, patients were stratified according to the presence of hemodynamic instability at presentation and American Society of Anesthesiologists (ASA) score. Using descriptive statistics and logistic regression analyses, we identified optimal time frames for endoscopy and analyzed the association between timing of endoscopy and in-hospital mortality after adjusting for confounding factors.RESULTS: In total, 12,601 patients were included. We did not find any universal association between timing of endoscopy and mortality in hemodynamically stable patients with an ASA score of 1 to 2. In hemodynamically stable patients with an ASA score of 3 to 5, endoscopy 12 to 36 hours after admission to the hospital was associated with lower in-hospital mortality (OR, .48; 95% CI, .34-.67) compared with endoscopy outside this time frame. In patients with hemodynamic instability, endoscopy 6 to 24 hours after admission to the hospital was associated with lower in-hospital mortality (OR, .73; 95% CI, .54-.98) compared with endoscopy outside this time frame.CONCLUSIONS: Timing of endoscopy is associated with mortality in patients with PUB and an ASA score of 3 to 5 or hemodynamic instability. Our findings suggest that in these patients, a period of time to optimize resuscitation and manage comorbidities before endoscopy may improve outcome.

AB - BACKGROUND AND AIMS: The optimal timing of endoscopy in patients with peptic ulcer bleeding (PUB) remains unclear. The aim of this study was to examine the association between timing of endoscopy and mortality in PUB.METHODS: In a nationwide cohort study based on a database of consecutive patients admitted to the hospital with PUB in Denmark, patients were stratified according to the presence of hemodynamic instability at presentation and American Society of Anesthesiologists (ASA) score. Using descriptive statistics and logistic regression analyses, we identified optimal time frames for endoscopy and analyzed the association between timing of endoscopy and in-hospital mortality after adjusting for confounding factors.RESULTS: In total, 12,601 patients were included. We did not find any universal association between timing of endoscopy and mortality in hemodynamically stable patients with an ASA score of 1 to 2. In hemodynamically stable patients with an ASA score of 3 to 5, endoscopy 12 to 36 hours after admission to the hospital was associated with lower in-hospital mortality (OR, .48; 95% CI, .34-.67) compared with endoscopy outside this time frame. In patients with hemodynamic instability, endoscopy 6 to 24 hours after admission to the hospital was associated with lower in-hospital mortality (OR, .73; 95% CI, .54-.98) compared with endoscopy outside this time frame.CONCLUSIONS: Timing of endoscopy is associated with mortality in patients with PUB and an ASA score of 3 to 5 or hemodynamic instability. Our findings suggest that in these patients, a period of time to optimize resuscitation and manage comorbidities before endoscopy may improve outcome.

KW - Aged

KW - Aged, 80 and over

KW - Cohort Studies

KW - Databases, Factual

KW - Denmark

KW - Disease Management

KW - Endoscopy, Digestive System/methods

KW - Female

KW - Hemostasis, Endoscopic/methods

KW - Hospital Mortality

KW - Humans

KW - Logistic Models

KW - Male

KW - Middle Aged

KW - Multivariate Analysis

KW - Peptic Ulcer Hemorrhage/therapy

KW - Registries

KW - Resuscitation

KW - Retrospective Studies

KW - Time Factors

U2 - 10.1016/j.gie.2016.08.049

DO - 10.1016/j.gie.2016.08.049

M3 - Journal article

C2 - 27623102

SN - 0016-5107

VL - 85

SP - 936-944.e3

JO - Gastrointestinal Endoscopy

JF - Gastrointestinal Endoscopy

IS - 5

ER -