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Delayed endoscopy as a risk factor for in-hospital mortality in cirrhotic patients with acute variceal hemorrhage

Authors

  • Yao-Chun Hsu,

    1. Division of Gastroenterology, Department of Internal Medicine, Lotung Poh-Ai Hospital, Yilan, Departments of
    2. Integrated Diagnostics and Therapeutics and
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  • Chen-Shuan Chung,

    1. Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine,
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  • Cheng-Hao Tseng,

    1. Department of Internal Medicine, Tao Yuan General Hospital, Tao-Yuan,
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  • Tzu-Ling Lin,

    1. Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine,
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  • Jyh-Ming Liou,

    1. Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine,
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  • Ming-Shiang Wu,

    1. Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine,
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  • Fu-Chang Hu,

    1. Department of Medical Research and National Center of Excellence for General Clinical Trial and Research, National Taiwan University Hospital, Taipei,
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  • Hsiu-Po Wang

    Corresponding author
    1. Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine,
    2. Department of Internal Medicine, National Taiwan University Hospital Yun-lin Branch, Yun-lin, Taiwan
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Dr Hsiu-Po Wang, Department of Internal Medicine, National Taiwan University Hospital, 7 Chung-Shan South Road, Taipei 100, Taiwan. Email: wanghp@ntu.edu.tw

Abstract

Background and Aims:  Risk factors for mortality in acute variceal hemorrhage remain incompletely understood. Whether endoscopy timing is associated with risk of mortality has not been investigated. We aimed to investigate risk factors for in-hospital mortality in cirrhotic patients with acute variceal hemorrhage, with emphasis on endoscopy timing.

Methods:  Three hundred and eleven (73% male and 23% female) consecutive cirrhotic patients presenting with acute variceal hemorrhage from July 2004 to July 2007 were investigated. The univariate association of endoscopy timing as the predictor for in-hospital mortality was examined. Independent risk factors for mortality were determined by multivariate logistic regression analysis consisting of clinical, laboratory and endoscopic parameters.

Results:  Twenty-five (8.04%) patients died within admission. By plotting the receiver operating curve of endoscopy timing for mortality, we selected 15 h as the optimal cut-off point to define delayed endoscopy. Multivariate regression analysis revealed that independent risk factors predictive for in-hospital mortality included delayed endoscopy performed 15 h after admission (adjusted odds ratio [aOR] = 3.67; 95% confidence interval [CI], 1.27–10.39), every point increment of model for end-stage liver disease (MELD) score (aOR = 1.16; 95% CI, 1.07–1.25), failure of the first endoscopy (aOR = 4.36; 95% CI, 1.54–12.30) and hematemesis as the chief complaint (compared with melena, aOR = 8.66; 95% CI, 1.06–70.94).

Conclusion:  Delayed endoscopy for more than 15 h, high MELD score, failure of the first endoscopy and hematemesis are independent risk factors for in-hospital mortality in cirrhotic patients with acute variceal hemorrhage.

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