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

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Laursen, Stig B ; Leontiadis, Grigorios I ; Stanley, Adrian J ; Møller, Morten H ; Hansen, Jane M ; Schaffalitzky de Muckadell, Ove B. / Relationship between timing of endoscopy and mortality in patients with peptic ulcer bleeding : a nationwide cohort study. In: Gastrointestinal Endoscopy. 2017 ; Vol. 85, No. 5. pp. 936-44.

Bibtex

@article{38cef960fc784dc7a2edc414db906c2b,
title = "Relationship between timing of endoscopy and mortality in patients with peptic ulcer bleeding: a nationwide cohort study",
abstract = "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.",
author = "Laursen, {Stig B} and Leontiadis, {Grigorios I} and Stanley, {Adrian J} and M{\o}ller, {Morten H} and Hansen, {Jane M} and {Schaffalitzky de Muckadell}, {Ove B}",
note = "Copyright {\circledC} 2016 American Society for Gastrointestinal Endoscopy. All rights reserved.",
year = "2017",
doi = "10.1016/j.gie.2016.08.049",
language = "English",
volume = "85",
pages = "936--44",
journal = "Gastrointestinal Endoscopy",
issn = "0016-5107",
publisher = "Mosby, Inc",
number = "5",

}

RIS

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 © 2016 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.

U2 - 10.1016/j.gie.2016.08.049

DO - 10.1016/j.gie.2016.08.049

M3 - Journal article

VL - 85

SP - 936

EP - 944

JO - Gastrointestinal Endoscopy

JF - Gastrointestinal Endoscopy

SN - 0016-5107

IS - 5

ER -

ID: 49791799