Timing of endoscopy for acute variceal bleeding in patients with cirrhosis (CHESS1905): A nationwide cohort study

被引：5

作者：

Zhang, Wenhui ^{[1
,2
]}

Huang, Yifei ^{[3
]}

Xiang, Huiling ^{[4
]}

Zhang, LiYao ^{[5
]}

Yuan, Lili ^{[6
]}

Wang, Xing ^{[7
]}

Dang, Tong ^{[8
]}

Zhang, Guo ^{[9
]}

Hu, Shengjuan ^{[10
]}

Liu, Chuan ^{[3
]}

Zhang, Xiuping ^{[11
]}

Peng, Lijun ^{[12
]}

Gao, Min ^{[13
]}

Xia, Dongli ^{[14
]}

Li, Jia ^{[15
]}

Song, Ying ^{[16
]}

Zhou, Xiqiao ^{[17
]}

Qi, Xingsi ^{[18
]}

Zeng, Jing ^{[19
]}

Tan, Xiaoyan ^{[20
]}

Deng, Mingming ^{[21
]}

Fang, Haiming ^{[22
]}

Qi, Shenglin ^{[23
]}

He, Song ^{[24
]}

He, Yongfeng ^{[25
]}

Ye, Bin ^{[26
]}

Wu, Wei ^{[27
]}

Shao, Jiangbo ^{[28
]}

Wei, Wei ^{[29
]}

Hu, Jianping ^{[30
]}

Yong, Xin ^{[31
]}

He, Chaohui ^{[32
]}

Bao, Jinlun ^{[33
]}

Zhang, Yuening ^{[34
]}

Ji, Rui ^{[35
]}

Bo, Yang ^{[36
]}

Yan, Wei ^{[37
]}

Li, Hongjiang ^{[38
]}

Wang, Yong ^{[39
,40
]}

Wang, Yanling ^{[2
]}

Li, Mengmeng ^{[2
]}

Lian, Jia ^{[4
]}

Liu, Chang'en ^{[4
]}

Wu, Yunhai ^{[5
]}

Gu, Ye ^{[5
]}

Wang, Yan ^{[5
]}

Cao, Ping ^{[6
]}

Wu, Bin ^{[7
]}

Ren, Limei ^{[8
]}

Pan, Hongduo

机构：

[1] Beijing Daxing Dist Peoples Hosp, Digest Syst Dept, Beijing, Peoples R China

[2] Peoples Liberat Army Gen Hosp, Med Ctr 5, Diag & Treatment Ctr, Beijing, Peoples R China

[3] Southeast Univ, Sch Med, Zhongda Hosp, Dept Radiol,Ctr Portal Hypertens, Nanjing, Peoples R China

[4] Tianjin Third Cent Hosp, Inst Hepatobiliary Dis, Dept Gastroenterol & Hepatol, Tianjin Key Lab Extracorporeal Life Support Crit, Tianjin, Peoples R China

[5] Sixth Peoples Hosp Shenyang, CHESS Ctr, Shenyang, Peoples R China

[6] Shanxi Bethune Hosp, Dept Gastroenterol, Taiyuan, Peoples R China

[7] Sun Yat Sen Univ, Affiliated Hosp 3, Dept Gastroenterol, Guangzhou, Peoples R China

[8] Inner Mongolia Univ Sci & Technol, Baotou Med Coll, Affiliated Hosp 2, Inner Mongolia Inst Digest Dis, Baotou, Peoples R China

[9] Peoples Hosp Guangxi Zhuang Autonomous Reg, Nanning, Peoples R China

[10] Peoples Hosp Ningxia Hui Autonomous Reg, Endoscop Ctr, Dept Gastroenterol, Yinchuan, Ningxia, Peoples R China

[11] Chinese Peoples Liberat Army PLA Gen Hosp, Med Ctr 1, Fac Hepatobiliary Pancreat Surg, Beijing, Peoples R China

[12] Linyi Peoples Hosp, Dept Gastroenterol, Linyi, Shandong, Peoples R China

[13] Zhejiang Univ, Sch Med, Sir Run Run Shaw Hosp, Dept Gastroenterol, Hangzhou, Peoples R China

[14] Chongqing Univ, Fuling Hosp, Dept Gastroenterol, Chongqing, Peoples R China

[15] Tianjin Second Peoples Hosp, Dept Gastroenterol & Hepatol, Tianjin, Peoples R China

[16] Xian GaoXin Hosp, Dept Gastroenterol, Xian, Peoples R China

[17] Nanjing Med Univ, Affiliated Hosp 1, Dept Gastroenterol, Nanjing, Peoples R China

[18] Affiliated Hosp Qingdao Univ, Dept Gastroenterol, Qingdao, Peoples R China

[19] Guangzhou Med Univ, Huizhou Peoples Hosp 3, Dept Emergency, Huizhou, Peoples R China

[20] Maoming Peoples Hosp, Dept Gastroenterol, Maoming, Peoples R China

[21] Affiliated Hosp Southwest Med Univ, Dept Gastroenterol, Luzhou, Peoples R China

[22] Second Hosp Anhui Med Univ, Dept Gastroenterol & Hepatol, Hefei, Peoples R China

[23] Dalian Sixth Peoples Hosp, Dept Hepatol, Dalian, Peoples R China

[24] Chongqing Med Univ, Affiliated Hosp 2, Dept Gastroenterol, Chongqing, Peoples R China

[25] Ankang Cent Hosp, Endoscop Ctr, Dept Gastroenterol, Ankang, Peoples R China

[26] Wenzhou Med Univ, Zhejiang Univ, Lishui Cent Hosp, Dept Gastroenterol,Lishui Hosp,Affiliated Hosp 5, Lishui, Peoples R China

[27] Wenzhou Med Univ, Affiliated Hosp 1, Dept Gastroenterol, Wenzhou, Peoples R China

[28] Third Peoples Hosp Zhenjiang, Dept Liver Dis, Zhenjiang, Jiangsu, Peoples R China

[29] Zhejiang Univ, Sch Med, Affiliated Jinhua Hosp, Gastroenterol Dept, Jinhua, Zhejiang, Peoples R China

[30] First Peoples Hosp Yinchuan City, Dept Gastroenterol, Yinchuan, Ningxia, Peoples R China

[31] Gen Hosp Western Theater Command, Gastroenterol, Chengdu, Peoples R China

[32] Zunyi Med Univ, Affiliated Zhuhai Hosp 5, Dept Gastroenterol & Endoscopy, Zhuhai, Peoples R China

[33] Shannan Peoples Hosp, Dept Gastroenterol, Shannan, Peoples R China

[34] Capital Med Univ, Beijing Youan Hosp, Ctr Hepatol & Gastroenterol, Beijing, Peoples R China

[35] First Hosp Lanzhou Univ, Dept Gastroenterol, Lanzhou, Peoples R China

[36] Peoples Hosp Ningxia Hui Autonomous Reg, Dept Hepatobiliary Surg, Yinchuan, Ningxia, Peoples R China

[37] Huazhong Univ Sci & Technol, Tongji Hosp, Tongji Med Coll, Dept Gastroenterol, Wuhan, Peoples R China

[38] Baoding Peoples Hosp, Dept Hepatol, Baoding, Peoples R China

[39] Hainan Med Univ, Affiliated Hosp 2, Hainan Clin Res Ctr Acute & Crit Dis, Dept Intervent Radiol, Haikou, Hainan, Peoples R China

[40] Hainan Med Univ, Emergency & Trauma Coll, Haikou, Hainan, Peoples R China

[41] Affiliated Hosp Qingdao Univ, Dept Cardiothorac Surg, Qingdao, Peoples R China

[42] Sheffield Teaching Hosp NHS Trust, Acad Dept Gastroenterol & Hepatol, Sheffield, S Yorkshire, England

[43] Univ Hong Kong, Dept Med, Hong Kong, Peoples R China

[44] Univ Hong Kong, State Key Lab Liver Res, Hong Kong, Peoples R China

[45] Univ Hong Kong Shenzhen Hosp, Dept Med, Shenzhen, Peoples R China

[46] Hainan Med Univ, Affiliated Hosp 2, Hainan Clin Res Ctr Acute & Crit Dis, Dept Emergency, Haikou, Hainan, Peoples R China

[47] Hainan Med Univ, Chinese Acad Med Sci, Res Unit Isl Emergency Med, Haikou, Hainan, Peoples R China

[48] Hainan Med Univ, Minist Educ, Key Lab Emergency & Trauma, Haikou, Hainan, Peoples R China

[49] Med Univ South Carolina, Div Gastroenterol & Hepatol, Charleston, SC 29425 USA

来源：

HEPATOLOGY COMMUNICATIONS | 2023年 / 7卷 / 05期

基金：

中国国家自然科学基金;

关键词：

MANAGEMENT; DIAGNOSIS; MORTALITY;

D O I：

10.1097/HC9.0000000000000152

中图分类号：

R57 [消化系及腹部疾病];

学科分类号：

摘要：

Background:Endoscopy plays an important role in the management of acute variceal bleeding (AVB) in patients with cirrhosis. This study aimed at determining the optimal endoscopy timing for cirrhotic AVB. Methods:Patients with cirrhosis with AVB across 34 university hospitals in 30 cities from February 2013 to May 2020 who underwent endoscopy within 24 hours were included in this study. Patients were divided into an urgent endoscopy group (endoscopy <6 h after admission) and an early endoscopy group (endoscopy 6-24 h after admission). Multivariable analysis was performed to identify risk factors for treatment failure. Primary outcome was the incidence of 5-day treatment failure. Secondary outcomes included in-hospital mortality, need for intensive care unit, and length of hospital stay. A propensity score matching analysis was performed. In addition, we performed an analysis, in which we compared the 5-day treatment failure incidence and the in-hospital mortality among patients with endoscopy performed at Results:A total of 3319 patients were enrolled: 2383 in the urgent endoscopy group and 936 in the early endoscopy group. After propensity score matching, on multivariable analysis, Child-Pugh class was identified as an independent risk factor for 5-day treatment failure (HR, 1.61; 95% CI: 1.09-2.37). The incidence of 5-day treatment failure was 3.0% in the urgent endoscopy group and 2.9% in the early group (p = 0.90). The in-hospital mortality was 1.9% in the urgent endoscopy group and 1.2% in the early endoscopy group (p = 0.26). The incidence of need for intensive care unit was 18.2% in the urgent endoscopy group and 21.4% in the early endoscopy group (p = 0.11). The mean length of hospital stay was 17.9 days in the urgent endoscopy group and 12.9 days in the early endoscopy group (p < 0.05). The incidence of 5-day treatment failure in the <12-hour group was 2.3% and 2.2% in the 12-24 hours group (p = 0.85). The in-hospital mortality was 2.2% in the <12-hour group and 0.5% in the 12-24 hours group (p < 0.05). Conclusions:The data suggest that performance of endoscopy within 6-12 or within 24 hours of presentation among patients with cirrhosis with AVB led to similar treatment failure outcomes.

引用

页数：10

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