Predictors of morbidity and mortality after the first episode of upper gastrointestinal bleeding in liver cirrhosis

Olmo, Juan A. del; Peña, Andrés; Serra, Miguel; Wassel, A.; Benages, A; Rodrigo, José

doi:10.1016/s0168-8278(01)68827-5

Cited by 216 publications

(33 citation statements)

References 23 publications

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“…About 30%-40% of cirrhotic patients who bleed may have nonvariceal upper GI bleeding (NVUGIB), which is frequently caused by gastroduodenal ulcers (9,10). Although NVU-GIB is not uncommon among cirrhotic patients, clinical features and endoscopic findings of patients with this complication have rarely been reported (6,7,11,12). The aim of the current study was to identify the outcomes and predictors of in-hospital mortality after non-variceal bleeding among cirrhotic patients in Upper Egypt.…”

Section: Introductionmentioning

confidence: 99%

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

Morsy

Ghaliony²,

Mohammed³

2015

Turk J Gastroenterol

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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.

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Section: Introductionmentioning

confidence: 99%

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

Morsy

Ghaliony²,

Mohammed³

2015

Turk J Gastroenterol

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“…Further assessment was done including laboratory investigations and abdominal ultrasonography. The severity of bleeding was considered as: mild when pulse rate <100/min, orthostatic hypotension or cold extremities, moderate when pulse rate 100 -120 beats/min with restlessness or severe when pulse rate >120 beats/min, systolic blood pressure <60 mmHg, severe pallor or oliguria [4]. Endoscopy session was scheduled once the patient's hemodynamics permitted after an informed and written consent.…”

Section: Introductionmentioning

confidence: 99%

Management of acute esophageal variceal bleeding by endoscopic sclerotherapy in technically difficult endoscopic band ligation cases—A population based cohort study

Esmat¹,

Hamza²,

Abbas³

et al. 2013

OJGas

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Endoscopic band ligation is regarded as the main therapeutic option for acute esophageal variceal bleeding, while sclerotherapy may be used in the acute setting if ligation is technically difficult. The incidence of difficult-to-perform band ligation in acute esophageal variceal bleeding, as well as the outcome of patients subjected to injection sclerotherapy as an alternative treatment, has not been clearly investigated. Our aim is to study the outcome of patients subjected to injection sclerotherapy in the acute setting of esophageal variceal bleeding when endoscopic band ligation is technically difficult to perform. We included 151 patients with acute esophageal variceal bleeding originnating from medium or large sized varices. All patients were planned for EBL as the 1st treatment option (EBL group 61.6%), meanwhile, EIS using 5% ethanolamine oleate was reserved as the 2nd treatment option when EBL was technically difficult (EIS group 38.4%). The mean time to restore hemodynamic stability was significantly prolonged in the EIS group (11.5 ± 6.5 hrs versus 9.5 ± 5.0 hrs, p 0.05). Initial control of bleeding was significantly higher in the EBL group versus the EIS group (96.7% vs 84.5%, p 0.021). Re-bleeding was more among the EIS group (42.9% vs 24.2%, p 0.04). There were no significant differences as regarding mortality and duration of hospital stay. So, a considerable proportion of cases presenting with acute variceal bleeding will have difficulty in performing EBL. In these patients, sclerotherapy is not a waning procedure with an accepted success rate, without much additional complications and without deranging mortality.

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“…75 However, in such cases, the classic differentiation of acute tubular necrosis from HRS by an active urinary sediment with casts and urinary sodium concentration greater than 20 mmol/L may be blurred. Development of renal failure after gastrointestinal bleeding is related to an advanced stage of cirrhosis 77 and renal impairment before the bleeding is a predictor of mortality. 77 Cirrhotic patients with marked systemic arterial vasodilatation and effective underfilling are less able to tolerate intravascular volume depletion, predisposing them to development of renal failure and a poor outcome.…”

Section: Gastrointestinal Bleedingmentioning

confidence: 99%

“…Development of renal failure after gastrointestinal bleeding is related to an advanced stage of cirrhosis 77 and renal impairment before the bleeding is a predictor of mortality. 77 Cirrhotic patients with marked systemic arterial vasodilatation and effective underfilling are less able to tolerate intravascular volume depletion, predisposing them to development of renal failure and a poor outcome.…”

Section: Gastrointestinal Bleedingmentioning

confidence: 99%

New challenge of hepatorenal syndrome: Prevention and treatment

Wong¹

2001

Hepatology

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Hepatorenal syndrome (HRS) remains one of the major therapeutic challenges in hepatology today. The pathogenesis is complex, but the final common pathway seems to be that sinusoidal portal hypertension, in the presence of severe hepatic decompensation, leads to splanchnic and systemic vasodilatation and decreased effective arterial blood volume. Renal vasoconstriction increases concomitantly, renal hemodynamics worsens, and renal failure occurs. Renal failure was shown 15 years ago to be potentially reversible after liver transplantation. This potential reversibility together with increased understanding of the pathogenesis has led to successful preliminary attempts to reverse HRS nonsurgically with combinations of splanchnic vasoconstrictors and colloid volume expansion, insertion of transjugular intrahepatic portovenous shunt radiologically, and improved forms of dialysis. Recent classification of HRS into the acute onset or severe type 1 with virtually 100% mortality and the more insiduous less severe type II promises to shed more light on the pathogenesis of HRS, especially on the currently unrecognized precipitating factors. It is hoped that this classification will be included in the necessary and carefully performed clinical trials, which should lead to clearer indications for the available therapies. The challenge now is to use all this information to improve our management of cirrhotic patients to prevent occurrence of HRS in the future. (HEPATOLOGY 2001;34:1242-1251.)Progressive oliguric renal failure is a common and severe complication in patients with advanced liver disease. In a large prospective follow-up study of cirrhotic patients with ascites, development of renal failure occurred in 18% and 39% of the patients at 1 year and at 5 years, respectively, with a median survival of 1.7 weeks or a 90% mortality at 10 weeks. 1 Hepatorenal syndrome (HRS) originally referred to occurrence of renal failure following biliary surgery. 2 The definitions of HRS gradually evolved to describe the renal failure observed in patients with liver failure associated with low urinary sodium levels and absence of renal pathology. 3 A recent consensus conference further defined HRS as types I and II with the following diagnostic criteria: type I HRS is characterized by rapidly progressive renal failure with a doubling of serum creatinine to a level greater than 2.5 mg/dL or a halving of the creatinine clearance to less than 20 mL/min in less than 2 weeks; type II HRS is a more chronic form with a slowly progressive increase in serum creatinine level to greater than 1.5 mg/dL or a creatinine clearance of less than 40 mL/min 4 and has a corresponding better prognosis. Until recently, liver transplantation was the only definitive treatment for HRS. 5,6 However, even then, the reported survival rates of these HRS patients posttransplantation have been less than in transplanted patients with normal renal function, and the return of renal function to normal may be delayed for months or years. 7,8 Furthermore, liver transplanta...

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Predictors of morbidity and mortality after the first episode of upper gastrointestinal bleeding in liver cirrhosis

Cited by 216 publications

References 23 publications

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

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

Management of acute esophageal variceal bleeding by endoscopic sclerotherapy in technically difficult endoscopic band ligation cases—A population based cohort study

New challenge of hepatorenal syndrome: Prevention and treatment

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