Delayed endoscopy as a risk factor for in-hospital mortality in cirrhotic patients with acute variceal hemorrhage
Delayed endoscopy as a risk factor for in-hospital mortality in cirrhotic patients with acute variceal hemorrhage
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DOI：
10.1111/j.1440-1746.2009.05903.x
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发表时间：
2009-07-01
影响因子：
4.1
通讯作者：
Wang, Hsiu-Po
中科院分区：
文献类型：
--
作者：
Hsu, Yao-Chun;Chung, Chen-Shuan;Wang, Hsiu-Po
背景和目的：急性静脉曲张出血死亡率的危险因素仍不完全清楚。内镜检查时间是否与死亡风险相关尚未研究。我们的目的是调查急性静脉曲张出血的心脏病患者的住院死亡率的危险因素，重点是内镜timing.Methods：3011（73%男性和23%女性）连续心脏病患者急性静脉曲张出血，从2004年7月至2007年7月进行了调查。内镜检查时间作为院内死亡率预测因子的单变量相关性进行了研究。死亡率的独立危险因素进行了多因素Logistic回归分析，包括临床，实验室和内镜参数。通过绘制内镜检查时间对死亡率的受试者工作曲线，我们选择15小时作为定义延迟内镜检查的最佳截止点。多因素回归分析显示，预测住院死亡率的独立危险因素包括入院后15小时延迟内镜检查（校正比值比[aOR] = 3.67; 95%置信区间[CI]，1.27-10.39），终末期肝病模型（MELD）评分的每个点增量（aOR = 1.16; 95% CI，1.07-1.25），首次内镜检查失败（aOR = 4.36; 95%CI，1.54-12.30），以吐血为主要症状（与黑便相比，aOR = 8.66; 95%CI，1.06-70.94）。延迟内镜检查超过15小时，MELD评分较高，第一次内镜检查失败和呕血是急性静脉曲张出血患者住院死亡率的独立危险因素。
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.