背景食管胃十二指肠镜检查(EGD)通常在出现非静脉曲张性上消化道出血(UGIB)的患者入院后24小时内进行。迄今为止,在非静脉曲张性UGIB中,尚未进行研究以确定患者年龄对住院EGD时机和患者结局的影响.我们的目的是评估EGD时间的差异,输血要求,失血性休克的发展,急性肾功能衰竭的发展,死亡率,逗留时间,以及18-59岁及60岁及以上患者的总住院费用。方法从2016年和2017年的国家(全国)住院患者样本(NIS)数据库中确定非静脉曲张性UGIB的招生。最初出现出血性休克的患者被排除在外。患者分为两个年龄组,18-59岁的人和60岁以上的人。我们将EGD分为早期和延迟。由于NIS数据库将天标识为午夜到午夜,我们将早期EGD分类为第0天和第1天进行的EGD。延迟EGD被分类为在第2天和第3天进行的那些。对倾向匹配数据进行多变量逻辑回归,以比较EGD时机,输血要求,住院后失血性休克的发展,急性肾功能衰竭的发展,和死亡率。回归模型中使用了以下患者和医院变量:种族,性别,保险状况,收入四分位数,死亡风险评分,疾病严重程度评分,入学月,入院日,录取类型,区域,床尺寸,医院教学现状。最后,采用加权双样本T检验比较住院时间和总住院费用.结果本研究共纳入12,449例非静脉曲张性UGIB住院病例。60岁及以上的患者在住院期间更容易死亡(OR=1.661,95CI:1.108-2.490,p=0.014),需要输血(OR=1.257,95CI:1.131-1.396,p<0.001),并发展为急性肾功能衰竭(OR=1.672,95CI:1.447-1.945,p<0.001)。60岁及以上的患者也不太可能接受早期EGD(OR=0.850,95CI:0.752-0.961,p=0.009)。18-59岁患者的总住院费用(95CI:-1397.77--4005.68,p<0.001)和住院时间(95CI:-0.428-0.594,p<0.001)均较低。两组住院后失血性休克的发生无差异(OR=0.984,95CI:0.707-1.369,p=0.923)。结论60岁及以上的患者早期EGD的可能性较小,预后较差的可能性更大。他们增加了住院死亡率,输血要求,急性肾功能衰竭的发展,医院总成本增加,和更长的停留时间。两组住院后失血性休克的发生没有差异。
Background Esophagogastroduodenoscopy (EGD) is typically performed within 24 hours of presentation for patients admitted to a hospital for patients presenting with a non-variceal upper gastrointestinal bleed (UGIB). To date, no studies have been performed to identify the impact of patient age on the timing of inpatient EGD and patient outcomes in non-variceal UGIB. Our aim was to assess the differences in the timing of EGD, blood transfusion requirements, development of hemorrhagic shock, development of acute renal failure, mortality, length of stay, and total hospital charges for patients aged 18-59 and those aged 60 and older. Methods Admissions for non-variceal UGIB were identified from the National (Nationwide) Inpatient Sample (NIS) database from 2016 and 2017. Patients who initially presented with hemorrhagic shock were excluded. Patients were divided into two age groups, those aged 18-59 and those aged 60 or older. We classified EGDs as early and delayed. Since the NIS database identifies days as midnight to midnight, we categorized early EGDs as those performed on day 0 and day 1. Delayed EGD were categorized as those performed on days 2 and 3. Multivariate logistic regression was performed on propensity-matched data to compare EGD timing, blood transfusion requirements, development of post-hospitalization hemorrhagic shock, development of acute renal failure, and mortality. The following patient and hospital variables were used in regression models: race, sex, insurance status, income quartile, mortality risk score, illness severity score, admission month, admission day, type of admission, region, bed size, and hospital teaching status. Finally, weighted two-sample T-tests were used to compare the length of stay and total hospitalization cost. Results A total of 12,449 weighted cases of inpatient non-variceal UGIB were included in this study. Patients aged 60 and older were more likely to die during the hospitalization (OR= 1.661, 95%CI: 1.108-2.490, p= 0.014), require blood transfusion (OR= 1.257, 95%CI: 1.131-1.396, p<0.001), and develop acute renal failure (OR= 1.672, 95%CI: 1.447-1.945, p<0.001). Patients aged 60 and older were also less likely to receive an early EGD (OR= 0.850, 95%CI: 0.752-0.961, p= 0.009). Total hospital costs (95%CI: -1397.77 - -4005.68, p<0.001) and length of stay (95%CI: -0.428 - -0.594, p<0.001) were both lower in patients aged 18-59 years. There was no difference in the development of post-hospitalization hemorrhagic shock between the two groups (OR= 0.984, 95%CI: 0.707-1.369, p= 0.923). Conclusions Patients aged 60 and older were less likely to have an early EGD and more likely to have worse outcomes. They had increased rates of inpatient mortality, blood transfusion requirements, development of acute renal failure, increased total hospital costs, and longer lengths of stay. There were no differences in the development of post-hospitalization hemorrhagic shock between the two groups.