title: Delayed endoscopy as a risk factor for in-hospital mortality in cirrhotic patients with acute variceal hemorrhage.
abstract: OBJECTIVE
  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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, Lotung Poh-Ai Hospital, Yilan, Taiwan.
authors.forename: Yao-Chun
authors.initials: YC
authors.lastname: Hsu
authors.forename: Chen-Shuan
authors.initials: CS
authors.lastname: Chung
authors.forename: Cheng-Hao
authors.initials: CH
authors.lastname: Tseng
authors.forename: Tzu-Ling
authors.initials: TL
authors.lastname: Lin
authors.forename: Jyh-Ming
authors.initials: JM
authors.lastname: Liou
authors.forename: Ming-Shiang
authors.initials: MS
authors.lastname: Wu
authors.forename: Fu-Chang
authors.initials: FC
authors.lastname: Hu
authors.forename: Hsiu-Po
authors.initials: HP
authors.lastname: Wang
mesh_terms: D000208:Acute Disease; D000328:Adult; D004384:Duodenoscopy; D016099:Endoscopy, Gastrointestinal; D004932:Esophageal and Gastric Varices / Q000175:diagnosis* / Q000209:etiology / Q000401:mortality; D004945:Esophagoscopy; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000175:diagnosis* / Q000209:etiology / Q000401:mortality; D005773:Gastroscopy; D006396:Hematemesis / Q000209:etiology / Q000401:mortality; D017052:Hospital Mortality; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications / Q000175:diagnosis* / Q000401:mortality; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors