Predictors of ICU admission associated with gastrointestinal endoscopy in medical inpatients: A retrospective cohort study.
critical care
endoscopy
gastrointestinal
inpatient
medicine
Journal
Journal of gastroenterology and hepatology
ISSN: 1440-1746
Titre abrégé: J Gastroenterol Hepatol
Pays: Australia
ID NLM: 8607909
Informations de publication
Date de publication:
Nov 2022
Nov 2022
Historique:
revised:
24
06
2022
received:
16
02
2022
accepted:
05
07
2022
pubmed:
24
7
2022
medline:
22
11
2022
entrez:
23
7
2022
Statut:
ppublish
Résumé
Gastrointestinal (GI) endoscopic procedures are commonly performed in medical inpatients. Limited prior research has examined factors associated with intensive care unit (ICU) admission after GI endoscopy in medical inpatients. This retrospective cohort study was conducted using routinely-collected clinical and administrative data from all general medicine hospitalizations at five academic hospitals in Toronto, Canada between 2010 and 2020. We describe ICU admission and death within 48 h of GI endoscopy in medical inpatients. We examined adjusted associations of patient and procedural factors with ICU admission or death using multivariable logistic regression. Among 18 290 medical inpatients who underwent endoscopy, 900 (4.9%) required ICU admission or died within 48 h of endoscopy. Following risk adjustment, ICU admission or death were associated with the following procedural factors: endoscopy on the day of hospital admission (aOR 3.16 [2.38-4.21]) or 1 day after admission (aOR 1.92 [1.51-2.44]) and esophagogastroduodenoscopy (EGD) procedures; and the following patient factors: Charlson comorbidity index of two (aOR 1.38 [1.05-1.81]) or three or greater (aOR 1.84 [1.47-2.29]), older age, male sex, lower hemoglobin prior to endoscopy, increased creatinine prior to endoscopy, an admitting diagnosis of liver disease and certain medications (antiplatelet agents and corticosteroids). ICU admission or death after endoscopy was associated with procedural factors such as EGD and timing of endoscopy, and patient factors indicative of acute illness and greater comorbidity. These findings can contribute to improved triage and monitoring for patients requiring inpatient endoscopy.
Sections du résumé
BACKGROUND AND AIM
OBJECTIVE
Gastrointestinal (GI) endoscopic procedures are commonly performed in medical inpatients. Limited prior research has examined factors associated with intensive care unit (ICU) admission after GI endoscopy in medical inpatients.
METHODS
METHODS
This retrospective cohort study was conducted using routinely-collected clinical and administrative data from all general medicine hospitalizations at five academic hospitals in Toronto, Canada between 2010 and 2020. We describe ICU admission and death within 48 h of GI endoscopy in medical inpatients. We examined adjusted associations of patient and procedural factors with ICU admission or death using multivariable logistic regression.
RESULTS
RESULTS
Among 18 290 medical inpatients who underwent endoscopy, 900 (4.9%) required ICU admission or died within 48 h of endoscopy. Following risk adjustment, ICU admission or death were associated with the following procedural factors: endoscopy on the day of hospital admission (aOR 3.16 [2.38-4.21]) or 1 day after admission (aOR 1.92 [1.51-2.44]) and esophagogastroduodenoscopy (EGD) procedures; and the following patient factors: Charlson comorbidity index of two (aOR 1.38 [1.05-1.81]) or three or greater (aOR 1.84 [1.47-2.29]), older age, male sex, lower hemoglobin prior to endoscopy, increased creatinine prior to endoscopy, an admitting diagnosis of liver disease and certain medications (antiplatelet agents and corticosteroids).
CONCLUSIONS
CONCLUSIONS
ICU admission or death after endoscopy was associated with procedural factors such as EGD and timing of endoscopy, and patient factors indicative of acute illness and greater comorbidity. These findings can contribute to improved triage and monitoring for patients requiring inpatient endoscopy.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
2074-2082Subventions
Organisme : University of Toronto Department of Medicine
Organisme : St. Michael's Hospital Association Innovation Fund
Organisme : Ontario Health
Organisme : Natural Sciences and Engineering Research Council of Canada
Organisme : Green Shield Canada Foundation
Organisme : Canadian Medical Protective Agency
Organisme : CIHR
Pays : Canada
Organisme : Canadian Frailty Network
Organisme : Canadian Cancer Society
Organisme : CIHR
Pays : Canada
Informations de copyright
© 2022 Journal of Gastroenterology and Hepatology Foundation and John Wiley & Sons Australia, Ltd.
Références
Seematter-Bagnoud L, Vader JP, Wietlisbach V, Froehlich F, Gonvers JJ, Burnand B. Overuse and underuse of diagnostic upper gastrointestinal endoscopy in various clinical settings. Int. J. Qual. Health Care 1999; 11: 301-308.
Van Dam J, Brugge WR. Endoscopy of the Upper Gastrointestinal Tract. N. Engl. J. Med. 1999; 341: 1738-1748.
Hearnshaw SA, Logan RFA, Lowe D, Travis SPL, Murphy MF, Palmer KR. Acute upper gastrointestinal bleeding in the UK: patient characteristics, diagnoses and outcomes in the 2007 UK audit. Gut 2011; 60: 1327-1335.
Kim S, Kim DH, Park SY et al. Association between Charlson comorbidity index and complications of endoscopic resection of gastric neoplasms in elderly patients. BMC Gastroenterol. 2020; 20: 213.
Amornyotin S. Sedation-related complications in gastrointestinal endoscopy. World J. Gastrointest. Endosc. 2013; 5: 527-533.
Rao VL, Gupta N, Swei E et al. Predictors of mortality and endoscopic intervention in patients with upper gastrointestinal bleeding in the intensive care unit. Gastroenterol. Rep. 2020; 8: 299-305.
Verma AA, Guo Y, Kwan JL et al. Patient characteristics, resource use and outcomes associated with general internal medicine hospital care: the General Medicine Inpatient Initiative (GEMINI) retrospective cohort study. CMAJ Open 2017; 5: E842-e849.
Verma AA, Pasricha SV, Jung HY et al. Assessing the quality of clinical and administrative data extracted from hospitals: the General Medicine Inpatient Initiative (GEMINI) experience. J. Am. Med. Inform. Assoc. 2021; 28: 578-587.
Health Quality Ontario M of H and LTC. Quality-Based Procedures Clinical Handbook for GI. Endoscopy 2014.
Quan H, Li B, Couris CM et al. Updating and validating the Charlson comorbidity index and score for risk adjustment in hospital discharge abstracts using data from 6 countries. Am. J. Epidemiol. 2011; 173: 676-682.
Verma AA, Murray J, Greiner R et al. Implementing machine learning in medicine. CMAJ 2021; 193: E1351-E1357.
Pimentel MAF, Redfern OC, Malycha J et al. Detecting Deteriorating Patients in the Hospital: Development and Validation of a Novel Scoring System. Am. J. Respir. Crit. Care Med. 2021; 204: 44-52.
Ben-Menachem T, Decker GA, Early DS et al. Adverse events of upper GI endoscopy. Gastrointest. Endosc. 2012; 76: 707-718.
Palmer KR. Complications of gastrointestinal endoscopy. Gut 2007; 56: 456-457.
Rajkomar A, McCulloch CE, Fang MC. The Low Diagnostic Utility of Rechecking Hemoglobins within 24 Hours in Hospitalized Patients. Am. J. Med. 2016; 129: 1194-1197.
Yen AW. Blood transfusion strategies for acute upper gastrointestinal bleeding: are we back where we started? Clin. Transl. Gastroenterol. 2018; 9: 150.
Cooper GS. Indications and Contraindications for Upper Gastrointestinal Endoscopy. Gastrointest. Endosc. Clin. N. Am. 1994; 4: 439-454.
Lau JYW, Yu Y, Tang RSY et al. Timing of Endoscopy for Acute Upper Gastrointestinal Bleeding. N. Engl. J. Med. 2020; 382: 1299-1308.
Laine L, Barkun AN, Saltzman JR, Martel M, Leontiadis GI. ACG Clinical Guideline: Upper Gastrointestinal and Ulcer Bleeding. Am. J. Gastroenterol. 2021; 116: 899-917.
Targownik LE, Murthy S, Keyvani L, Leeson S. The Role of Rapid Endoscopy for High-Risk Patients with Acute Nonvariceal Upper Gastrointestinal Bleeding. Can. J. Gastroenterol. 2007; 21: 425-429.
Kumar NL, Travis AC, Saltzman JR. Initial management and timing of endoscopy in nonvariceal upper GI bleeding. Gastrointest. Endosc. 2016; 84: 10-17.
Lim LG, Ho KY, Chan YH et al. Urgent endoscopy is associated with lower mortality in high-risk but not low-risk nonvariceal upper gastrointestinal bleeding. Endoscopy 2011; 43: 300-306.
Laursen SB, Leontiadis GI, Stanley AJ, Møller MH, Hansen JM, Schaffalitzky de Muckadell OB. Relationship between timing of endoscopy and mortality in patients with peptic ulcer bleeding: a nationwide cohort study. Gastrointest. Endosc. 2017; 85: 936-944.e3.
Bjorkman DJ, Zaman A, Fennerty MB, Lieberman D, Disario JA, Guest-Warnick G. Urgent vs. elective endoscopy for acute non-variceal upper-GI bleeding: an effectiveness study. Gastrointest. Endosc. 2004; 60: 1-8.
Laine L, Shah A. Randomized trial of urgent vs. elective colonoscopy in patients hospitalized with lower GI bleeding. Am. J. Gastroenterol. 2010; 105: 2636-2641 quiz 2642.
Niikura R, Nagata N, Shimbo T et al. Adverse Events during Bowel Preparation and Colonoscopy in Patients with Acute Lower Gastrointestinal Bleeding Compared with Elective Non-Gastrointestinal Bleeding. PLoS ONE 2015; 10: e0138000.
Oakland K, Chadwick G, East JE et al. Diagnosis and management of acute lower gastrointestinal bleeding: guidelines from the British Society of Gastroenterology. Gut 2019; 68: 776-789.
Rehman A, Iscimen R, Yilmaz M et al. Prophylactic endotracheal intubation in critically ill patients undergoing endoscopy for upper GI hemorrhage. Gastrointest. Endosc. 2009; 69: e55-e59.
Jean-Baptiste S, Messika J, Hajage D et al. Clinical impact of upper gastrointestinal endoscopy in critically ill patients with suspected bleeding. Ann. Intensive Care 2018; 8: 75-75.
Minoli G, Meucci G, Bortoli A et al. The ASGE guidelines for the appropriate use of colonoscopy in an open access system. Gastrointest. Endosc. 2000; 52: 39-44.
Zullo A, Manta R, De Francesco V, Fiorini G, Hassan C, Vaira D. Diagnostic yield of upper endoscopy according to appropriateness: A systematic review. Dig. Liver Dis. 2019; 51: 335-339.
Tee WJ, Chan G, Ahmed Z et al. Inpatient Endoscopy: Referral Appropriateness and Efficiency of Service Provision. Gut 2013; 62: A17-A18.
Mahmood S, Campbell E, Richter J. Non-bleeding Indications for Inpatient Colonoscopy: 2041. Off. J. Am. Coll. Gastroenterol. ACG 2013; 108: S619.
Soyka C, Tripathi P, Cooper G. Esophagogastroduodenoscopy Indications: Are We Following the New Guidelines?: 2235. Off. J. Am. Coll. Gastroenterol. ACG 2014; 109: S648.
de Groot NL, Bosman JH, Siersema PD, van Oijen MGH, Bredenoord AJ. RASTA study group. Admission time is associated with outcome of upper gastrointestinal bleeding: results of a multicentre prospective cohort study. Aliment. Pharmacol. Ther. 2012; 36: 477-484.