A nationwide analysis of risk factors for mortality and time to endoscopy in upper gastrointestinal haemorrhage

Background We analysed nationwide in-patient data from 2002 to 2007 to determine significant demographic variables when predicting mortality and receipt of prompt oesophagogastroduodenoscopy (OGD) for acute variceal haemorrhage (AVH) and nonvariceal upper gastrointestinal haemorrhage (NVUGIH). Aim To study the effects of demographic variables in predicting time to endoscopy and mortality in AVH and NVUGIH. Methods We analysed the United States' Nationwide Inpatient Sample (NIS), for risk factors for mortality and receipt of OGD within 1day of admission for upper gastrointestinal haemorrhage. Results Risk factors for increased mortality in AVH included: age >60, men, African Americans, comorbidities, insurance type and delayed OGD. Risk factors for increased mortality in NVUGIH were similar to AVH, except race which was not significant. After correction for factors such as insurance type, comorbidity, hospital location and time to endoscopy, this increased risk of mortality persisted, suggesting that none of these factors was the primary cause of the observed differences. For AVH, OGD within 1day of admission was more likely in men, White Americans, patients aged 1840 years, privately insured and those with no comorbidities. OGD within 1day of admission in NVUGIH was more likely in men, patients age 4060, Whites, Hispanics, privately insured and those with a single comorbidity. Conclusions In multivariate analysis, in-patient mortality in AVH and NVUGIH increased with age, comorbidity, male gender, and delayed time to endoscopy. Young, healthier men were most likely to receive OGD within 1day of admission. African Americans were less likely to receive OGD within 1day of admission and had increased mortality in cases of AVH.