Cirrhosis, Liver, Portal Hypertension, Varice Bleed
Conditions
Brief summary
Cirrhotic patients with AVB across 34 university medical centers in 30 cities in China 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 \<6h after admission) and an early endoscopy group (endoscopy 6-24h after admission). Outcomes included the incidence of 5-day rebleeding, in-hospital mortality, need for intensive care unit (ICU) and the length of hospital stay after the endoscopy management. Multivariable analysis was performed to identify risk factors for rebleeding. A propensity score matching (PSM) analysis was performed to achieve a balance at baseline between the urgent and early groups.
Interventions
DEVICEemergency endoscopic therapy
When cirrhotic patients presented with AVB to the emergency department, emergency physicians consulted gastroenterologists on duty to assess the patient for suitability for endoscopy, usually after initial stabilization. Performance of endoscopy and its timing was at the discretion of the gastroenterologist on call. Therapeutic endoscopy for AVB was performed within 24 hours after consultation by an experienced attending endoscopist, using standard forward-viewing upper gastrointestinal video endoscopes at individual centers. Written informed consent for endoscopy was obtained before each procedure. The standard of care at all hospitals was to administer a vasoactive agent and antibiotics upon the patient's presentation. Packed red blood cells were transfused at the discretion of the attending gastroenterologist.
Sponsors
LanZhou University
Beijing Shijitan Hospital, Capital Medical University
Beijing 302 Hospital
Tianjin Third Central Hospital
The Sixth People's Hospital of Shenyang
Shanxi Bethune Hospital
Linyi People's Hospital
Sir Run Run Shaw Hospital
Hepatopancreatobiliary Surgery Institute of Gansu Province
Study design
Observational model
COHORT
Time perspective
RETROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to 75 Years
Healthy volunteers
No
Inclusion criteria
* established diagnosis of cirrhosis (based on liver biopsy or the combination of clinical, biochemical, and imaging findings) * witnessed or reported evidence of gastrointestinal haemorrhage (hematemesis, melenemesis, or hematochezia) * esophageal or gastric varices confirmed endoscopically as the source of bleeding
Exclusion criteria
* severe dysfunction of a major extrahepatic organ (e.g., heart failure, pulmonary disease, and terminal malignancy except hepatocellular carcinoma) * history of endoscopic therapy for varices (ligation or sclerotherapy) within three months * incomplete or missing data
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| the incidence of 5-day rebleeding after emergency endoscopy | 6 months |
Secondary
| Measure | Time frame |
|---|---|
| the in-hospital mortality | 6 months |
| need for ICU | 6 months |
| the length of hospital stay | 6 months |
Countries
China
Outcome results
None listed