Gastroenterology Today Winter 2023

Peng et al. BMC Gastroenterology (2023) 23:219
FEATURE
Page 5 of 9
Peng et al. BMC Gastroenterology (2023) 23:219
Page 6 of 9
FEATURE
GASTROENTEROLOGY TODAY – WINTER 2023
Table 1 Characteristics of included patients
Variables No. Pts Mean ± SD or
Median (Range) or
Frequency (Percentage)
Age (years) 534 55.66 (6.28–92.31)
55.78 ± 11.61
Male 534 376 (70.4%)
Etiology of underlying liver diseases 534
Hepatitis B virus 222 (41.6%)
Hepatitis C virus 47 (8.8%)
Alcohol abuse 150 (28.1%)
Hepatocellular carcinoma 534 48 (9.0%)
Hematemesis 534 332 (62.2%)
Hemodynamics
Heart rate (beats per minute) 534 80.00 (44.00-148.00)
83.36 ± 13.24
Heart rate > 100 beats per minute 534 54 (10.1%)
Systolic blood pressure (mmHg) 533 115.00 (75.00-176.00)
116.07 ± 17.59
Systolic blood pressure < 90mmHg 533 18 (3.4%)
Laboratory tests
Hemoglobin (g/L) 533 73.00 (23.00-158.00)
77.53 ± 22.51
White blood cell (10 12 /L) 533 4.40 (1.00-46.10)
5.45 ± 3.98
Platelet count (10 9 /L) 533 72.00 (15.00-457.00)
87.44 ± 58.82
Total bilirubin (µmol/L) 529 19.90 (3.30-187.40)
25.01 ± 18.35
Albumin (g/L) 524 30.50 (10.00-50.70)
30.57 ± 6.53
Alanine aminotransferase (U/L) 527 22.73 (5.00-1064.00)
32.70 ± 58.03
Blood urea nitrogen (mmol/L) 512 8.03 (1.54–42.83)
8.95 ± 4.79
Serum creatinine (µmol/L) 510 62.00 (25.00-715.00)
69.30 ± 45.29
Sodium (mmol/L) 524 138.5 (109.2-160.10)
138.44 ± 4.22
Prothrombin time (seconds) 510 16.00 (10.50–55.00)
16.85 ± 4.00
Child-Pugh score 498 7.00 (5.00–13.00)
7.47 ± 1.82
Child-Pugh class A/B + C 498 165 (33.1%)/333 (66.9%)
MELD score 502 10.51 (6.43–38.01)
11.92 ± 4.61
Source of variceal bleeding 519 *
Esophageal varices (%) 313 (60.3%)
Gastric varices (%) 77 (14.8%)
Esophageal and gastric varices (%) 129 (24.9%)
Active variceal bleeding on endoscopy 528 # 39 (7.4%)
Endoscopic variceal therapy 534 496 (92.9%)
Surgery or interventional treatment 534 3 (0.6%)
Rate of 5-day failure to control bleeding 534 27 (5.1%)
In-hospital mortality 534 13 (2.4%)
Abbreviations: MELD, model for end-stage liver disease. Notes: * Source of variceal bleeding was unclear in 15 patients because of missing medical records or poor
visual fields under endoscopy; # Active variceal bleeding on endoscopy cannot be identified in 6 patients because of missing endoscopic reports.
Table 2 Outcomes according to the timing of endoscopy defined as the interval from the last presentation of AVB to endoscopy
Overall analysis
< 12h ≥ 12h P value < 24h ≥ 24h P value < 48h ≥ 48h P value
(N = 55) (N = 434)
(N = 114) (N = 357)
(N = 226) (N = 242)
Rate of 5-day failure to control bleeding 6 (10.9%) 14 (3.2%) 0.007 15 (13.2%) 8 (2.2%) < 0.001 20 (8.8%) 5 (2.1%) 0.001
In-hospital mortality 5 (9.1%) 6 (1.4%) < 0.001 6 (5.3%) 6 (1.7%) 0.035 8 (3.5%) 5 (2.1%) 0.332
PSM analysis
hematemesis, systolic blood pressure < 90 mmHg, Child-
Multivariate logistic regression analysis demonstrated that the interval
Pugh class B/C, and active variceal bleeding on endoscopy,
white blood cell, and blood urea nitrogen than
from last presentation of AVB to endoscopy < 12 h was not significantly
associated with 5-day failure to control bleeding (OR = 2.889, 95% CI:
delayed endoscopy group (Supplementary Table 5). Early
0.912–9.151; P = 0.071). Multivariate Cox regression analysis showed
endoscopy group had a significantly higher rate of 5-day
that the interval from last presentation of AVB to endoscopy < 12 h was
failure to control bleeding than delayed endoscopy group,
not significantly associated with in-hospital death (HR = 2.828, 95% CI:
but a statistically similar in-hospital mortality (Table 2).
0.706–11.320, P = 0.142).
Multivariate logistic regression analysis demonstrated
that the interval from last presentation of AVB to endoscopy
< 48 h was significantly associated with a higher rate
In the PSM analysis, 46 patients were matched to each group
(Supplementary Table 2). There was no significant difference in rate of
of 5-day failure to control bleeding (OR = 4.171, 95% CI:
5-day failure to control bleeding or in-hospital mortality between the
1.486–11.708; P = 0.007). Cox regression analysis showed
two groups (Table 2).
that the interval from last presentation of AVB to endoscopy
< 48 h was not significantly associated with in-hospital
death (HR = 0.808, 95% CI: 0.237–2.750, P = 0.733).
< 24 h versus ≥ 24 h. In the overall-analysis, early endoscopy group
was significantly older and had higher proportions of HCV infection,
In the PSM analysis, 165 patients were matched to each
hematemesis, systolic blood pressure < 90 mmHg, Child-Pugh class
group (Supplementary Table 6). Early endoscopy group
B/C, and active variceal bleeding on endoscopy and white blood
had a significantly higher rate of 5-day failure to control
cell than delayed endoscopy group (Supplementary Table 3). Early
bleeding than delayed endoscopy group, but a statistically
endoscopy group had significantly higher rate of 5-day failure to control
similar in-hospital mortality (Table 2).
bleeding and in-hospital mortality than delayed endoscopy group
(Table 2).
Time to endoscopy according to the interval from the
admission to endoscopy
Multivariate logistic regression analysis demonstrated that the interval
< 12 h versus ≥ 12 h. In the overall-analysis, early endoscopy
group was significantly older and had significantly
from last presentation of AVB to endoscopy < 24 h was associated with a higher rate of 5-day failure to control bleeding (OR =
higher proportions of HCV infection, Child-Pugh class
6.065, 95% CI: 2.336–15.749; P < 0.001). Multivariate Cox regression
B/C, and active variceal bleeding on endoscopy, white
analysis showed that the interval from last presentation of AVB to
blood cell, total bilirubin, blood urea nitrogen, Childendoscopy
< 24 h was not significantly associated with in-hospital
Pugh score, and MELD score than delayed endoscopy
death (HR = 1.400, 95% CI: 0.403–4.860, P = 0.597).
group (Supplementary Table 7). There was no significant
difference in rate of 5-day failure to control bleeding or
In the PSM analysis, 97 patients were matched to each group
in-hospital mortality between the two groups (Table 3).
(Supplementary Table 4). There was no significant difference in rate of
5-day failure to control bleeding or in-hospital mortality between the
two groups (Table 2).
< 12h
(N = 46)
≥ 12h
(N = 46)
P value
< 24h
(N = 97)
≥ 24h
(N = 97)
P value
< 48h
(N = 165)
≥ 48h
(N = 165)
Rate of 5-day failure to control bleeding 4 (8.7%) 3 (6.5%) 1.000 13 (13.4%) 6 (6.2%) 0.091 16 (9.7%) 4 (2.4%) 0.009
In-hospital mortality 3 (6.5%) 2 (4.3%) 1.000 4 (4.1%) 3 (3.1%) 1.000 5 (3.0%) 4 (2.4%) 1.000
Abbreviations: AVB, acute variceal bleeding; PSM, propensity score matching
P value
Table 3 Outcomes according to the timing of endoscopy defined as the interval from the admission to endoscopy
Overall analysis
< 12h ≥ 12h P value < 24h ≥ 24h P value < 48h ≥ 48h P value
(N = 75) (N = 453)
(N = 175) (N = 349)
(N = 289) (N = 236)
Rate of 5-day failure to control bleeding 5 (6.7%) 21 (4.6%) 0.451 10 (5.7%) 17 (4.9%) 0.680 13 (4.5%) 13 (5.5%) 0.596
In-hospital mortality 4 (5.3%) 8 (1.8%) 0.055 7 (4.0%) 6 (1.7%) 0.113 8 (2.8%) 5 (2.1%) 0.634
PSM analysis
< 12h
(N = 63)
≥ 12h
(N = 63)
P value
< 24h
(N = 155)
≥ 24h
(N = 155)
P value
< 48h
(N = 199)
≥ 48h
(N = 199)
Rate of 5-day failure to control bleeding 3 (4.8%) 8 (12.7%) 0.205 8 (5.2%) 12 (7.7%) 0.355 9 (4.5%) 12 (6.0%) 0.501
In-hospital mortality 3 (4.8%) 3 (4.8%) 1.000 6 (3.9%) 4 (2.6%) 0.750 4 (2.0%) 5 (2.5%) 1.000
Abbreviations: PSM, propensity score matching
P value
Multivariate logistic regression analysis demonstrated
< 48 h versus ≥ 48 h. In the overall-analysis, early endoscopy group
that the interval from admission to endoscopy < 12 h was
was significantly older and had significantly higher proportions of HCV
not significantly associated with 5-day failure to control
infection, hematemesis, systolic blood pressure < 90 mmHg, Childbleeding
(OR = 0.873, 95% CI: 0.243–3.144; P = 0.836).
Pugh class B/C, and active variceal bleeding on endoscopy, white
blood
Multivariate
cell, and blood
Cox
urea
regression
nitrogen than
analysis
delayed endoscopy
showed that
group
the
(Supplementary
interval from
Table
admission
5). Early
to
endoscopy
endoscopy
group
<
had
12 h
a significantly
was not significantly
higher rate of
associated
5-day failure to
with
control
in-hospital
bleeding than
death
delayed
(HR
endoscopy
= 1.981,
group, 95% CI: but 0.467–8.406, a statistically similar P = 0.354). in-hospital mortality (Table 2).
In the PSM analysis, 63 patients were matched to each
Multivariate group (Supplementary logistic regression Table analysis 8). demonstrated There was that no significant
the interval
from difference last presentation in rate of of AVB 5-day to endoscopy failure to < 48 control h was significantly bleeding or
associated in-hospital with mortality a higher rate between of 5-day the failure two to control groups bleeding (Table(OR
3).
= 4.171, < 2495% h versus CI: 1.486–11.708; ≥ 24 h. P = In 0.007). the Cox overall-analysis, regression analysis early
showed endoscopy that the group interval was from significantly last presentation older of AVB and to endoscopy had significantly
48 h was higher not significantly proportion associated of Child-Pugh with in-hospital class death B/C (HR = and
<
0.808, Child-Pugh 95% CI: 0.237–2.750, score than P delayed = 0.733). endoscopy group (Supplementary
Table 9). There was no significant difference
In in the rate PSM of analysis, 5-day failure 165 patients to control were matched bleeding to each or group in-hospital
(Supplementary mortality between Table 6). the Early two endoscopy groups group (Table had 3). a significantly
higher Multivariate rate of 5-day logistic failure to regression control bleeding analysis than delayed demonstrated
endoscopy
group, that the but interval a statistically from similar admission in-hospital to mortality endoscopy (Table < 2). 24 h was
not significantly associated with 5-day failure to control
Time bleeding to endoscopy (OR = 0.867, according 95% to the CI: interval 0.353–2.132; from the admission P = 0.756).
to Multivariate endoscopy Cox regression analysis showed that the
< interval 12 h versus from ≥ 12 admission h. In the overall-analysis, to endoscopy early < 24 endoscopy h was not group sig-
was significantly associated older and with had significantly in-hospital higher death proportions (HR = of 2.554,
HCV 95% infection, CI: 0.747–8.732, Child-Pugh class P = 0.135). B/C, and active variceal bleeding
on In endoscopy, the PSM white analysis, blood cell, 155 total patients bilirubin, were blood matched urea nitrogen, to each
Child-Pugh group (Supplementary score, and MELD Table score than 10). delayed There was endoscopy no significant group
(Supplementary difference in Table rate 7). of There 5-day was failure no significant to control difference bleeding rate of or
5-day in-hospital failure to mortality control bleeding between or in-hospital the two mortality groups between (Table the 3).
two
<
groups
48 h
(Table
versus
3).
≥ 48 h. In the overall-analysis, early
endoscopy group was significantly older than delayed
Multivariate logistic regression analysis demonstrated that the interval
from admission to endoscopy < 12 h was not significantly associated
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