Timing of upper gastrointestinal endoscopy does not influence short-term outcomes in patients with acute variceal bleeding

Table 1 Baseline characteristics of patients before and after inverse probability weighting n (%)

Characteristics	Unweighted				Inverse probability weighting
	All patients(n = 274)	Urgent endoscopy(n = 173)	Non-urgent endoscopy(n = 101)	P value	All patients(n = 272)	Urgent endoscopy(n = 172)	Non-urgent endoscopy(n = 100)	P value
Demographics
Age (yr)	58.05 ± 12.10	57.62 ± 12.09	58.77 ± 12.22	0.45	58.14 ± 0.85	58.17 ± 1.03	58.10 ± 1.34	0.971
Sex (male)	207 (75.5)	128 (74.0)	79 (78.2)	0.469	205 (74.6)	127 (37.2)	78 (37.4)	0.956
Hepatocellular carcinoma	149 (54.4)	97 (56.1)	52 (51.5)	0.452	148 (54.8)	97 (27.8)	51 (27.0)	0.830
Prior variceal upper GI bleeding	179 (65.3)	110 (63.6)	69 (68.3)	0.511	178 (65.7)	109 (32.3)	69 (33.5)	0.713
Prior non-variceal upper GI bleeding	8 (2.9)	2 (1.2)	6 (5.9)	0.055	8 (2.9)	2 (1.4)	6 (1.5)	0.890
Initial hepatic encephalopathy				< 0.001				0.939
None	241 (88.0)	164 (94.8)	77 (76.2)		239 (88.6)	163 (44.5)	76 (44.4)
Grade I-II	16 (5.8)	5 (2.9)	11 (10.9)		16 (5.4)	5 (2.5)	11 (2.9)
Grade III-IV	17 (6.2)	4 (2.3)	13 (12.9)		17 (5.7)	4 (2.6)	13 (3.1)
Initial ascites				0.067				0.994
None	111 (40.5)	77 (44.5)	34 (33.7)		111 (41.1)	77 (20.3)	34 (20.8)
Mild	77 (28.1)	50 (28.9)	27 (26.7)		76 (29.4)	49 (14.7)	27 (14.7)
Moderate to severe	86 (31.4)	46 (26.6)	40 (39.6)		85 (29.5)	46 (14.6)	39 (14.9)
Etiology				0.985				0.930
HBV	137 (50.0)	86 (49.8)	51 (50.5)		136 (49.7)	86 (24.4)	50 (25.33)
HCV	25 (9.1)	16 (9.2)	9 (8.9)		25 (9.4)	16 (5.4)	9 (4.0)
Alcohol	69 (25.2)	43 (24.9)	26 (25.7)		68 (24.0)	42 (12.3)	26 (12.7)
Others	43 (15.7)	28 (16.2)	15 (14.9)		43 (16.0)	28 (8.0)	15 (8.0)
Vital signs
Systolic blood pressure (mm Hg)	117 ± 26	116 ± 26	120 ± 26	0.221	118 ± 2	116 ± 2	119 ± 3	0.408
Heart rate (beat/min)	95 ± 18	96 ± 19	94 ± 17	0.551	95 ± 1	95 ± 1	95 ± 2	0.827
Laboratory values
Hemoglobin	9.2 ± 2.5	9.0 ± 2.5	9.6 ± 2.5	0.044	9.1 ± 0.2	8.8 ± 0.2	9.3 ± 0.3	0.105
Platelet count (103/mL)	117 + 79	118 ± 78	114 ± 80	0.701	118 ± 5	119 ± 6	118 ± 8	0.917
Total bilirubin	3.8 ± 5.8	3.5 ± 5.3	4.5 ± 6.5	0.148	3.7 ± 0.4	3.6 ± 0.5	3.8 ± 0.5	0.817
Serum albumin	2.9 ± 0.6	2.9 ± 0.6	2.9 ± 0.7	0.702	3.0 ± 0.1	3.0 ± 0.1	4.0 ± 0.1	0.736
Prothromin time (INR)	1.6 ± 1.8	1.4 ± 0.6	1.8 ± 2.9	0.046	1.6 ± 0.1	1.5 ± 0.1	1.7 ± 0.2	0.157
Serum creatinine	1.3 ± 1.5	1.4 ± 1.8	1.2 ± 1.0	0.24	1.2 ± 0.1	1.4 ± 0.1	1.1 ± 0.1	0.07
MELD score	15.9 ± 7.8	15.4 ± 6.9	16.9 ± 9.2	0.112	15.6 ± 0.5	15.6 ± 0.5	15.6 ± 0.8	0.964
Prognostic scores
Glasgow-Blatchford score	9.1 ± 3.5	9.2 ± 3.3	9.1 ± 3.9	0.818	9.3 ± 0.2	9.3 ± 0.3	9.3 ± 0.4	0.907
Rockall score	3.9 ± 1.4	4.0 ± 1.4	3.6 ± 1.5	0.021	3.4 ± 0.1	3.9 ± 0.1	3.9 ± 0.2	0.875
Endoscopy
Time to endoscopy, hours, median (IQR)	12.7 (2.8-16.5)	4.0 (2.1-6.8)	19.5 (15.0-35.5)	< 0.001	12.5 (2.8-16.4)	4.0 (2.2-6.8)	19.5 (15.1-35.4)	< 0.001

Data are expressed as mean ± standard deviation or number (percentage), unless otherwise stated. GI: Gastrointestinal; HBV: Hepatitis B virus; HCV: Hepatitis C virus; INR: International normalized ratio; MELD: Model for end-stage liver disease.

Table 2 Clinical outcomes of the patients n (%)

Outcomes	All patients(n = 274)	Urgent endoscopy(n = 173)	Non-urgent endoscopy(n = 101)	P value
Hospital admission duration, days, median (IQR)	4.0 (3.0-9.5)	4.0 (2.0-9.0)	4.0 (3.0-11.0)	0.033
In-hospital mortality	22 (8.0)	14 (8.1)	8 (7.9)	0.960
Re-bleeding rate	60 (21.9)	35 (20.2)	25 (24.8)	0.449
Six-week mortality	69 (25.2)	39 (22.5)	30 (29.7)	0.197
Liver transplantation	25 (9.1)	14 (8.1)	11 (10.9)	0.515

Data are expressed as number (percentage), unless otherwise stated. IQR: Interquartile range.

Table 3 Cox proportional hazards model for 6-wk mortality

Variable	Univariable		Multivariable
	HR (95%CI)	P value	HR (95%CI)	P value
Age	1.037 (1.016-1.059)	< 0.001	1.035 (1.011-1.059)	0.004
Sex
Female	1
Male	0.946 (0.543-1.664)	0.845
Etiology
Non-viral	1		1
Viral	0.536 (0.319-0.902)	0.019	0.683 (0.384-1.214)	0.194
Hepatocellular carcinoma	2.442 (1.439-4.142)	0.001	1.929 (1.072-3.469)	0.028
Diabetes Mellitus	0.535 (0.292-0.978)	0.042	0.423 (0.225-0.795)	0.008
Hypertension	0.994 (0.521-1.894)	0.984
Prior variceal upper GI bleeding	0.916 (0.561-1.497)	0.726
Prior non-variceal upper GI bleeding	3.92E-8 (0-INF)	0.996
Systolic blood pressure	1.003 (0.994-1.012)	0.489
Heart rate	1.005 (0.992-1.018)	0.477
MELD score1	1.062 (1.041-1.083)	< 0.001	1.049(1.024-1.074)	< 0.001
ALT	1.001 (0.999-1.002)	0.123
Serum creatinine1	1.075 (1.013-1.197)	0.018
Serum total bilirubin1	1.047 (1.012-1.083)	0.007
Prothrombin time1	1.128 (1.043-1.221)	0.003
Initial hepatic encephalopathy
None	1		1
Grade I-II	1.393 (0.558-3.477)	0.477	0.555 (0.200-1.537)	0.257
Grade III-IV	2.229 (1.062-4.677)	0.034	0.969 (0.449-2.088)	0.935
Initial ascites
None	1		1
Mild	2.064 (1.003-4.250)	0.049	1.604 (0.766-3.361)	0.210
Moderate to severe	4.675 (2.494-8.766)	< 0.001	3.346 (1.715-6.527)	< 0.001
Glasgow-Blatchford score	0.980 (0.917-1.047)	0.550
Rockall score	1.138 (0.968-1.338)	0.118
Timing of endoscopy
Non-urgent (≥ 12 h)	1
Urgent (< 12 h)	1.297 (0.806-2.088)	0.284

¹Considering the multicollinearity between model for end-stage liver disease (MELD) score and its individual components, only MELD score, the most relevant prognostic parameter in cirrhosis, was included in the final multivariable model. HR: Hazard ratio; GI: Gastrointestinal; MELD: Model for end-stage liver disease; ALT: Alanine aminotransferase.