Relationship between timing of endoscopy and mortality in patients with peptic ulcer bleeding: a nationwide cohort study
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Relationship between timing of endoscopy and mortality in patients with peptic ulcer bleeding : a nationwide cohort study. / Laursen, Stig B; Leontiadis, Grigorios I; Stanley, Adrian J; Møller, Morten H; Hansen, Jane M; Schaffalitzky de Muckadell, Ove B.
In: Gastrointestinal Endoscopy, Vol. 85, No. 5, 2017, p. 936-944.e3.Research output: Contribution to journal › Journal article › Research › peer-review
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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
Y1 - 2017
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
VL - 85
SP - 936-944.e3
JO - Gastrointestinal Endoscopy
JF - Gastrointestinal Endoscopy
SN - 0016-5107
IS - 5
ER -
ID: 196883130