The interaction of patients' physical status and time to endoscopy on mortality risk in patients with upper gastrointestinal bleeding: A national prospective cohort study

Cristina Bucci; Clelia Marmo; Marco Soncini; Maria Elena Riccioni; Stig B Laursen; Ian M Gralnek; Riccardo Marmo; GISED study group

doi:10.1016/j.dld.2023.11.024

The interaction of patients' physical status and time to endoscopy on mortality risk in patients with upper gastrointestinal bleeding: A national prospective cohort study

Dig Liver Dis. 2023 Dec 16:S1590-8658(23)01042-3. doi: 10.1016/j.dld.2023.11.024. Online ahead of print.

Authors

Cristina Bucci¹, Clelia Marmo², Marco Soncini³, Maria Elena Riccioni², Stig B Laursen⁴, Ian M Gralnek⁵, Riccardo Marmo⁶; GISED study group

Affiliations

¹ Gastroenterology and Hepatology Unit, AORN Santobono-Pausilipon Napoli, Italy.
² Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy.
³ Department of Internal Medicine "A. Manzoni" Hospital, Lecco, Italy.
⁴ Department of Gastroenterology and Hepatology, Odense University Hospital, Odense, Denmark.
⁵ Rappaport Faculty of Medicine Technion Israel Institute of Technology Haifa, Israel; Ellen and Pinchas Mamber Institute of Gastroenterology and Hepatology Emek Medical Center Afula, Israel.
⁶ Gastroenterology and Endoscopy Unit, "L. Curto" Hospital 84035 Polla, ASL Salerno, Italy. Electronic address: c.bucci@santobonopausilipon.it.

PMID: 38105145
DOI: 10.1016/j.dld.2023.11.024

Abstract

Background and aim: The correct time to perform an upper endoscopy is decisive in acutely GI bleeding patients. However, patients' physical status may affect mortality. We speculated that the physical status and procedural time could be the principal factors accountable for death-risk. The primary aim was to verify the interaction between physical status and time to endoscopy on mortality; the secondary aim was to verify the interaction of the physical status and time to endoscopy on the length of stay (LOS).

Methods: Consecutive patients admitted to 50 Italian hospitals were included. Clinical and endoscopic data were recorded. A multiple logistic regression analysis was performed and the interaction of adjusted clinical physical status and time to endoscopy on mortality was calculated.

Results: Complete data were available for 3.190 patients. The time frames did not interfere with outcomes but influenced LOS. Conversely, the ASA score correlated with mortality, LOS, need for transfusions and rebleeding risk.

Conclusion: Endoscopy time should be tailored to the patient's physical. In our experience, ASA 1-2-3 patients can be safely submitted to endoscopy to reduce the LOS; on the contrary, keen attention should be paid to ASA4 patients, following the 'not too early-not too late' rule (12-24 h from admission).

Keywords: ASA score; Acute upper gastrointestinal bleeding; Mortality; Physical status; Timing to endoscopy.