Outcomes and predictors of in-hospital mortality among cirrhotic patients with non-variceal upper gastrointestinal bleeding in upper Egypt

Abstract

Background/Aims: Variceal bleeding is one of the most frequent causes of morbidity and mortality among cirrhotic patients. Clinical endoscopic features and outcomes of cirrhotic patients with non-variceal upper gastrointestinal bleeding (NVUGIB) have been rarely reported. Our aim is to identify treatment outcomes and predictors of in-hospital mortality among cirrhotic patients with non-variceal bleeding in Upper Egypt. Materials and Methods: A prospective study of 93 cirrhotic patients with NVUGIB who were admitted to the Tropical Medicine and Gastroenterology Department, Assiut University Hospital (Assiut, Egypt) over a one-year period (November 2011 to October 2012). Clinical features, endoscopic findings, clinical outcomes, and in-hospital mortality rates were studied. Patient mortality during hospital stay was reported. Many independent risk factors of mortality were evaluated by means of univariate and multiple logistic regression analyses. Results: Of 93 patients, 65.6% were male with a mean age of 53.3 years. The most frequent cause of bleeding was duodenal ulceration (26.9%). Endoscopic treatment was needed in 45.2% of patients, rebleeding occurred in 4.3%, and the in-hospital mortality was 14%. Hypovolemic shock was the most common cause of death (46.2%). Independent risk factors of in-hospital mortality among cirrhotic patients with NVUGIB in our study were bacterial infection during hospitalization [odds ratio (OR) =0.32, 95% confidence interval (CI) =0.03-0.89], shock (OR =1.12, 95% CI =0.68-1.54), early rebleeding (OR =2.26, 95% CI =1.85-3.21), low serum albumin (OR =3.81, 95% CI =2.35-4.67), low baseline hemoglobin (OR =0.714, 95% CI =0.32-1.24), and the need for endoscopic treatment (OR =2.96, 95% CI =0.62-3.63). Conclusion: Bacterial infection during hospitalization, shock, early rebleeding, low serum albumin, low baseline hemoglobin, and the need for endoscopic treatment were independent risk factors of in-hospital mortality among cirrhotic patients with NVUGIB in Upper Egypt.

Non-variceal Causes and Outcome of Acute Upper Gastro-intestinal bleeding among Cirrhotic Patients in Tropical Medicine Intensive Care Unit

“…The occurrence of sepsis can also lead to elevation of creatinine and BUN which were also proved to be correlated to mortality. This agrees with Morsy et al [10] who said that the occurrence of infection is associated with higher mortality rate in patients with upper GI bleeding. This also agrees with Hou et al [25] who said that the use of prophylactic antibiotics help decrease the mortality rates after acute upper GI bleeding especially in patients with severely decompensated liver disease.…”

Comparison of clinical outcomes between variceal and non‐variceal gastrointestinal bleeding in patients with cirrhosis

“…Specifically, mortality in our cohort from AVB and NVB was 15.1% and 9.3%, respectively, consistent with recent studies . However, these rates are lower than those reported historically, with older studies reporting mortality of 33.5% for AVB and 15% for NVB . In addition, rebleeding rates for AVB have been demonstrated to be up to 30%, whereas in our population, we demonstrated rebleeding of 19.2% for patients with AVB.…”

Prospective Assessment of the Rockall Risk Scoring System in Egyptian Patients with Upper Gastrointestinal Bleeding

“…Twenty percent of patients in this study were shocked during presentation and this finding is similar to a study conducted by Gado et al [16] who stated that (18%) were shocked during presentation. Blood transfusion was required to (58%) of patients in the current study and this also similar to the study of De Groot et al [11] who stated that blood transfusion was required for (58%) of patients and supported with Morsy et al [13] who stated in their study that blood transfusion was required for (61%) of patients.…”

“…Regarding laboratory results, mean of Hb was 8.44 ± 2.05 g/dl that means that most of patients were anemic during presentation and this matches results of Kumar et al [17] who stated that patients presented with upper gastrointestinal bleeding were anemic with mean of Hb (8.02 ± 2.01 g/dl), and supported with De Groot et al [11] as mean of patients' Hb in their study were 6.30 ± 1.90 g/dl. As most patients included in our study were hepatic, laboratory findings of impairment of liver function were detected in the studied patients in the form of hypoalbuminemia, hyperbilirubinemia and increasing prothrombin time which is similar to the findings of Morsy et al [13].…”

“…Regarding Child-Pugh classification of hepatic patients, most hepatic patients included in this study were Child C (47%) and Child B (36%), which is similar to Morsy et al [13] who stated that most of hepatic patients in their study were Child C (75%) and B (12%), but is different than Gonzalez-Gonzalez et al [14] who stated that hepatic patients with Child C classification represent only (26%) of patients. This could be explained by the Figure 1.…”