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Timing of endoscopy for acute variceal bleeding in patients with cirrhosis (CHESS1905): A nationwide cohort study

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作者：
Zhang Wenhui[1,2] * ; Huang Yifei[3] * ; Xiang Huiling[4] * ; Zhang LiYao[5] * ; Yuan Lili[6] * ; Wang Xing[7] * ; Dang Tong[8] * ; Zhang Guo[9] * ; Hu Shengjuan[10] * ; Liu Chuan[3] ; Zhang Xiuping[11] ; Peng Lijun[12] ; Gao Min[13] ; Xia Dongli[14] ; Li Jia[15] ; Song Ying[16] ; Zhou Xiqiao[17] ; Qi Xingsi[18] ; Zeng Jing[19] ; Tan Xiaoyan[20] ; Deng Mingming[21] ; Fang Haiming[22] ; Qi Shenglin[23] ; He Song[24] ; He Yongfeng[25] ; Ye Bin[26] ; Wu Wei[27] ; Shao Jiangbo[28] ; Wei Wei[29] ; Hu Jianping[30] ; Yong Xin[31] ; He Chaohui[32] ; Bao Jinlun[33] ; Zhang Yuening[34] ; Ji Rui[35] ; Bo Yang[36] ; Yan Wei[37] ; Li Hongjiang[38] ; Wang Yong[39,40] ; Wang Yanling[2] ; Li Mengmeng[2] ; Lian Jia[4] ; Liu Chang'en[4] ; Wu Yunhai[5] ; Gu Ye[5] ; Wang Yan[5] ; Cao Ping[6] ; Wu Bin[7] ; Ren Limei[8] ; Pan Hongduo[8] ; Liang Yunxiao[9] ; Tian Shuni[12] ; Lu Lin[12] ; Fang Yanfei[13] ; Jiang Pan[13] ; Liu Zhenbei[14] ; Liu Aimin[14] ; Zhao Lili[15] ; Li Shuang[15] ; Qiao Jinggui[16] ; Sun Lihui[16] ; Li Mengyu[17] ; Fang Chengwen[17] ; Chen Hao[18] ; Tian Zibin[18] ; Lin Gaoyang[41] ; Huang Xuanhui[19] ; Chen Jitao[20] ; Deng Ying[20] ; Lv Muhan[21] ; Liao Jingyuan[21] ; Zhang Lijiu[22] ; Lu Junyu[24] ; Wu Suhua[24] ; Yang Xiaocui[25] ; Guo Wenwei[25] ; Wang Jianbo[26] ; Chen Chao[27] ; Huang Erjiong[27] ; Yu Yuehua[30] ; Yang Ming[31] ; Cheng Shuangping[31] ; Yang Yang[32] ; Wu Xiaoli[33] ; Rang Limaocai[33] ; Han Ping[37] ; Zhang Yanmin[38] ; Li Xiaoguo[3] ; Wang Fengmei[4] ; McAlindon Mark Edward[42] ; Seto Wai-Kay[43,44] ; Lv Chuanzhu[40,45,46,47] ; Rockey Don C[48] ; Qi Xiaolong[3,*1] ;
单位： [1]Digestive System Department, Beijing Daxing District People's Hospital, Beijing, China. [2]Diagnosis and Treatment Center, The Fifth Medical Center of PLA General Hospital, Beijing, China. [3]Department of Radiology, Center of Portal Hypertension, Zhongda Hospital, Medical School, Southeast University, Nanjing, China. [4]Department of Gastroenterology and Hepatology, Tianjin Third Central Hospital, Tianjin Key Laboratory of Extracorporeal Life Support for Critical Diseases, Institute of Hepatobiliary Disease, Tianjin, China. [5]CHESS Center, The Sixth People's Hospital of Shenyang Shenyang, China. [6]Department of Gastroenterology, Shanxi Bethune Hospital, Taiyuan, China. [7]Department of Gastroenterology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China. [8]Inner Mongolia Institute of Digestive Diseases, The Second Affiliated Hospital of Baotou Medical College, Inner Mongolia University of Science and Technology, Baotou, China. [9]The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, China. [10]Department of Gastroenterology, Endoscopic Center, People's Hospital of Ningxia Hui Autonomous Region, Yinchuan, China. [11]Faculty of Hepato-Biliary-Pancreatic Surgery, The First Medical Center of Chinese People's Liberation Army (PLA) General Hospital, Beijing, China. [12]Department of Gastroenterology, Linyi People's Hospital, Linyi, China. [13]Department of Gastroenterology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China. [14]Department of Gastroenterology, Chongqing University Fuling Hospital, Chongqing, China. [15]Department of Gastroenterology and Hepatology, Tianjin Second People's Hospital, Tianjin, China. [16]Department of Gastroenterology, Xi'an GaoXin Hospital, Xi'an, China. [17]Department of Gastroenterology, First Affiliated Hospital of Nanjing Medical University, Nanjing, China. [18]Department of Gastroenterology, The Affiliated Hospital of Qingdao University, Qingdao, China. [19]Department of Emergency, Huizhou Third People's Hospital, Guangzhou Medical University, Huizhou, China. [20]Department of Gastroenterology, Maoming People's Hospital, Maoming, China. [21]Department of Gastroenterology, The Affiliated Hospital of Southwest Medical University, Luzhou, China. [22]Department of Gastroenterology and Hepatology, The Second Hospital of Anhui Medical University, Hefei, China. [23]Department of Hepatology, Dalian Sixth People's Hospital, Dalian, China. [24]Department of Gastroenterology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China. [25]Department of Gastroenterology, Endoscopic Center, Ankang Central Hospital, Ankang, China. [26]Department of Gastroenterology, Lishui Hospital of Zhejiang University, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui Central Hospital, Lishui, China. [27]Department of Gastroenterology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China. [28]Department of Liver Disease, The Third People's Hospital of Zhenjiang, Zhenjiang, China. [29]Gastroenterology Department, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua, China. [30]Department of Gastroenterology, First People's Hospital of Yinchuan City, Yinchuan, China. [31]Gastroenterology, General Hospital of Western Theater Command, Chengdu, China. [32]Department of Gastroenterology and Endoscopy, The Fifth Affiliated Zhuhai Hospital of Zunyi Medical University, Zhuhai, China. [33]Department of Gastroenterology, Shannan People's Hospital, Shannan, China. [34]Center of Hepatology and Gastroenterology, Beijing You'an Hospital, Capital Medical University, Beijing, China. [35]Department of Gastroenterology, The First Hospital of Lanzhou University, Lanzhou, China. [36]Department of Hepatobiliary Surgery, People's Hospital of Ningxia Hui Autonomous Region, Yinchuan, China. [37]Department of Gastroenterology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China. [38]Department of Hepatology, Baoding People's Hospital, Baoding, China. [39]Department of Interventional Radiology, Hainan Clinical Research Center for Acute and Critical Diseases, The Second Affiliated Hospital of Hainan Medical University, Haikou, Hainan, China. [40]Emergency and Trauma College, Hainan Medical University, Haikou, Hainan, China. [41]Department of Cardiothoracic Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China. [42]Academic Department of Gastroenterology and Hepatology, Sheffield Teaching Hospitals NHS Trust, Sheffield, UK. [43]Department of Medicine and State Key Laboratory of Liver Research, The University of Hong Kong, Hong Kong, China. [44]Department of Medicine, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China. [45]Department of Emergency, Hainan Clinical Research Center for Acute and Critical Diseases, The Second Affiliated Hospital of Hainan Medical University, Haikou, Hainan, China. [46]Research Unit of Island Emergency Medicine, Chinese Academy of Medical Sciences, Hainan Medical University, Haikou, Hainan, China. [47]Key Laboratory of Emergency and Trauma of Ministry of Education, Hainan Medical University, Haikou, Hainan, China. [48]Division of Gastroenterology and Hepatology, Medical University South Carolina, Charleston, South Carolina, USA.
出处：
DOI： 10.1097/HC9.0000000000000152
ISSN：

摘要：
Endoscopy plays an important role in the management of acute variceal bleeding (AVB) in patients with cirrhosis. This study aimed at determining the optimal endoscopy timing for cirrhotic AVB.Patients with cirrhosis with AVB across 34 university hospitals in 30 cities 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 <6 h after admission) and an early endoscopy group (endoscopy 6-24 h after admission). Multivariable analysis was performed to identify risk factors for treatment failure. Primary outcome was the incidence of 5-day treatment failure. Secondary outcomes included in-hospital mortality, need for intensive care unit, and length of hospital stay. A propensity score matching analysis was performed. In addition, we performed an analysis, in which we compared the 5-day treatment failure incidence and the in-hospital mortality among patients with endoscopy performed at <12 hours and 12-24 hours.A total of 3319 patients were enrolled: 2383 in the urgent endoscopy group and 936 in the early endoscopy group. After propensity score matching, on multivariable analysis, Child-Pugh class was identified as an independent risk factor for 5-day treatment failure (HR, 1.61; 95% CI: 1.09-2.37). The incidence of 5-day treatment failure was 3.0% in the urgent endoscopy group and 2.9% in the early group ( p = 0.90). The in-hospital mortality was 1.9% in the urgent endoscopy group and 1.2% in the early endoscopy group ( p = 0.26). The incidence of need for intensive care unit was 18.2% in the urgent endoscopy group and 21.4% in the early endoscopy group ( p = 0.11). The mean length of hospital stay was 17.9 days in the urgent endoscopy group and 12.9 days in the early endoscopy group ( p < 0.05). The incidence of 5-day treatment failure in the <12-hour group was 2.3% and 2.2% in the 12-24 hours group ( p = 0.85). The in-hospital mortality was 2.2% in the <12-hour group and 0.5% in the 12-24 hours group ( p < 0.05).The data suggest that performance of endoscopy within 6-12 or within 24 hours of presentation among patients with cirrhosis with AVB led to similar treatment failure outcomes.Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the American Association for the Study of Liver Diseases.

基金：
Tianjin Health Research Project (No. TJWJ2022XK029); Tianjin Key Medical Discipline (Specialty) Construction Project (TJYXZDXK-034A); Linyi Science and Technology Development Program (202020005); Qingdao Medical Scientific Research Guidance Program in 2020 (2020-WJZD036); Guangxi Digestive Disease Clinical Medical Research Center Construction Project (AD17129027); DCR (NIH-P30123704); Gansu Science Fund for Distinguished Young Scholars (20JR10RA713); National Natural Science Foundation of China (No. 81830053).
语种：
外文
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中科院(CAS)分区：
出版当年[2022]版：
大类 | 2 区 医学
小类 | 3 区 胃肠肝病学
最新[2025]版：
大类 | 2 区 医学
小类 | 3 区 胃肠肝病学
JCR分区：
出版当年[2021]版：
Q2 GASTROENTEROLOGY & HEPATOLOGY
最新[2023]版：
Q1 GASTROENTEROLOGY & HEPATOLOGY

影响因子： 最新[2023版] 最新五年平均 出版当年[2021版] 出版当年五年平均 出版前一年[2020版] 出版后一年[2022版]

第一作者：
第一作者单位： [1]Digestive System Department, Beijing Daxing District People's Hospital, Beijing, China. [2]Diagnosis and Treatment Center, The Fifth Medical Center of PLA General Hospital, Beijing, China.
共同第一作者：
通讯作者：
通讯机构： [3]Department of Radiology, Center of Portal Hypertension, Zhongda Hospital, Medical School, Southeast University, Nanjing, China. [*1]Chinese Portal Hypertension Alliance (CHESS), Department of Radiology, Center of Portal Hypertension, Zhongda Hospital, Medical School, Southeast University, Nanjing, 210000, China.
推荐引用方式(GB/T 7714)：
Zhang Wenhui,Huang Yifei,Xiang Huiling,et al.Timing of endoscopy for acute variceal bleeding in patients with cirrhosis (CHESS1905): A nationwide cohort study[J].HEPATOLOGY COMMUNICATIONS.2023,7(5):doi:10.1097/HC9.0000000000000152.
APA：
Zhang Wenhui,Huang Yifei,Xiang Huiling,Zhang LiYao,Yuan Lili...&Qi Xiaolong.(2023).Timing of endoscopy for acute variceal bleeding in patients with cirrhosis (CHESS1905): A nationwide cohort study.HEPATOLOGY COMMUNICATIONS,7,(5)
MLA：
Zhang Wenhui,et al."Timing of endoscopy for acute variceal bleeding in patients with cirrhosis (CHESS1905): A nationwide cohort study".HEPATOLOGY COMMUNICATIONS 7..5(2023)

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