Predictors of mortality in patients with acute upper gastrointestinal hemorrhage who underwent endoscopy and confirmed to have variceal hemorrhage

Gado, Ahmed; Ebeid, Basel; Abdelmohsen, Aida; Axon, Anthony

doi:10.1016/j.ajme.2014.08.002

Cited by 12 publications

(17 citation statements)

References 22 publications

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“…10 In this study, there was significant difference between the studied patients as regard blood pressure. Our findings agree with those of Gado et al, 11 and Jiménez et al 12 They found that hemodynamic instability at admission, Child class C, blood in GI tract at the index endoscopy, rebleeding within five days of endoscopy, and in-hospital complications were independent predictors of mortality.…”

Section: Discussionsupporting

confidence: 93%

“…15,16 We detected significant difference between the studied patients as regards MELD score, ROCKall score, and AIMS65 score. This finding was in agreement with Saltzman et al, 17 and Gado et al 11 This finding was in disagreement with Mohammad et al, 18 who reported the superiority of the SOFA score in mortality prediction when compared with the MELD, APACHEII, and CPT scores and concluded that independently the AIMS65 score was the simplest and most applicable scoring system for mortality prediction among cirrhosis patients suffering from acute variceal hemorrhage.…”

Section: Figsupporting

confidence: 77%

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Prognostic Factors Associated with Mortality in Cirrhotic Patients with Bleeding Varices

Eldesouky

Tawfik

Hagras

et al. 2019

IJRSMS

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Objective Bleeding gastroesophageal varices are a cause of high mortality among cirrhotic patients. Aim The aim of this study was to study prognostic factors for mortality in cirrhosis associated with variceal bleeding. Patients and Methods This prospective study was conducted on 100 cirrhotic patients admitted to the Tanta University Hospital with an acute first variceal bleeding episode. Baseline clinical, laboratory, and endoscopic findings were recorded at presentation. Results During the first 6 weeks 15 patients died, 3 following the initial bleed and 12 after an early rebleed. At 6 months, a further 21 patients had died. Statistical analysis utilizing the baseline data revealed that high early death rate was associated with number of blood units transfused, lower systolic blood pressure, thrombocytopenia, increased serum creatinine and international normalized ratio (INR). High MELD, AIMS56, acute physiology and chronic health evaluation II (APACHE II) and ROCKall scores were risk factors for mortality. Risk factors for early rebleeding included presence of diabetes mellitus, leucocytosis, high Child score, model for end-stage liver disease (MELD), AIMS56, and sepsis-associated organ failure assessment (SOFA) scores. A high Child score, presence of ascites, and associations such as hepatic encephalopathy and spontaneous bacterial peritonitis, leucocytosis, elevated alanine transaminase, aspartate transaminase, bilirubin, INR, and creatinine as well as low albumin were associated with decreased survival. Conclusion High MELD, AIMS56, APACHE II, and ROCKall scores were risk factors for mortality after acute variceal bleeding. High death rate during the first 6 weeks is associated with anemia, hypotension, thrombocytopenia, increased serum creatinine, and INR. Decreased survival at 6 months is associated with increased Child score, presence of ascites and associations such as hepatic encephalopathy and spontaneous bacterial peritonitis.

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Section: Discussionsupporting

confidence: 93%

Section: Figsupporting

confidence: 77%

Prognostic Factors Associated with Mortality in Cirrhotic Patients with Bleeding Varices

Eldesouky

Tawfik

Hagras

et al. 2019

IJRSMS

View full text Add to dashboard Cite

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“…Other studies found that 10 days and 2 weeks mortality rate were 11.5% [15] and 8% [22] respectively. Univariate analysis of clinical variables in this study showed that, hypovolemic shock, ascites, WBCs count, serum bilirubin, serum albumin, ALT, AST, CTP score and MELD score were risk factors associated with 6-week mortality.…”

Section: Discussionmentioning

confidence: 99%

Prediction of Early Rebleeding and Mortality after Acute Esophageal Variceal Hemorrhage among Yemeni Patients in Major Hospitals—Sana’a

Hunaysh¹

2016

OJGas

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Background and aims: Acute variceal hemorrhage (AVH) is the most serious encountered complication of liver cirrhosis and carries high mortality rate. Several risk factors that predict early rebleeding and mortality have been studied and there is no similar study in our country, so the aim of this study was to identify the risk factors of early rebleeding and mortality after bleeding episode in cirrhotic patients in Yemen. Patients and Method: It was a prospective study of cirrhotic patients with AVH who were admitted to the main public hospitals in Sana'a between April 2014 and March 2015. Demographic information, medical histories, physical examination findings, and laboratory test results were collected. Endoscopic and pharmacologic treatment was performed. The patients were followed up since admission and up to 6 weeks for the occurrence of rebleeding and mortality after the acute attack. Univariate and multivariate analyses were performed to identify independent risk factors for rebleeding and mortality. Survival analysis was estimated using the Kaplan-Meier method. Result: A total of 102 patients were analyzed. 26 patients (25.5%) rebleeded within 6 weeks period. The predictive factors significantly associated with rebleeding within 6 weeks period in univariate analysis were clot on varix at index endo-scope (P < 0.0001), high serum bilirubin (P = 0.02), CTP score (P < 0.05) and MELD score (P < 0.05). Independent risks factors remained in multivariate analysis as significant predictors of early rebleeding were clot on varix (OR: 11.6, CI: 2.87 -47.29, P = 0.001) and high serum bilirubin (>3) (OR: 1.1, CI: 1.02 -1.19, P = 0.01). Sixteen patients died (15.7%) within 6 weeks period. Predictors of mortality with significant difference in univariate analysis were hypovolemic shock (P = 0.001), high WBCs count (P < 0.0001), low serum sodium (P = 0.04), high AST (P < 0.0001), high ALT (P = 0.02), high INR (P < 0.0001), high serum bilirubin (P < 0.0001), low serum albumin (P = 0.005), ascites (P = 0.001), A. Y. Hunaysh 215 CTP score (P < 0.0001) and MELD score (P < 0.0001). By multiple regression analysis high MELD score (≥19) (OR: 1.3, CI: 1.12 -1.41, P < 0.0001) and WBCs over 10.3 × 10 9 /l (OR: 1.2, CI: 1.02 -1.40, P < 0.05) were independent risk factors for mortality within 6 weeks period. Conclusion: Early rebleeding in cirrhotic patients with AVH was associated with clot on varix at endoscope and high serum bilirubin more than 3 mg/dl. Early mortality rate was associated with high MELD score (≥19) and WBCs over 10.3 × 10 9 /l.

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“…Today, overall 30-day mortality is 15%, the rebleeding rate is 26% and the 30-day mortality in those patients who do not rebleed is 7% (7,8). Mortality remains closely associated with failure to control bleeding or early rebleeding (6)(7)(8). As one of the most common and lethal complications of portal hypertension resulting from liver cirrhosis, esophagogastric variceal bleeding may lead to acute hemorrhage shock accompanied by other serious consequences, such as renal failure, infection and even death without timely treatment (9,10).…”

Section: Introductionmentioning

confidence: 99%

“…At the same time, there are >12 million hepatitis B patients in China and liver cancer and cirrhosis leads to the mortality of 240,000 individuals every year (5). Variceal hemorrhage (VH) is a major and life-threatening complication of chronic liver disease and is associated with significant morbidity and mortality (6). However, the overall rate of survival may be improving with advances in medical technology.…”

Section: Introductionmentioning

confidence: 99%

Sevoflurane may be more beneficial than propofol in patients receiving endoscopic variceal ligation and endoscopic variceal sclerotherapy: A randomized, double-blind study

Tang

Liu

et al. 2017

Experimental and Therapeutic Medicine

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Abstract. The aim of the present study was to evaluate the safety and efficacy of various general anesthesia regimens during endoscopic variceal ligation (EVL) and endoscopic variceal sclerotherapy (EVS). A total of 123 patients with American Society of Anesthesiologists physical status III and IV, aged 40-70 years, undergoing general anesthesia for EVL and EVS were randomly divided into two groups: Sevoflurane anesthesia (group S; n=60) and propofol anesthesia (group P; n=60). Vital signs, particularly heart rate (HR) and mean arterial pressure (MAP), were monitored. The designated time points were as follows: 5 min before induction (T0), and 1, 5, 10, 15, 20, 25 and 30 min after intubation (T1, T2, T3, T4, T5, T6 and T7, respectively). Time intervals were recorded, including recovery time and extubation time. Following surgery, the observer recorded the Ramsay sedation scale (RSS) score and the visual analogue scale (VAS) score. Adverse reactions were noted. Results demonstrated that there were significant differences in MAP between the two groups at T2, T3, T5, T6 and T7 (P<0.05). There was a significant difference in HR between the two groups at T2, T3 and T4 (P<0.05). Recovery time and extubation time in group P were significantly longer than those in group S (P<0.05; 18.38±2.25 min vs. 14.57±1.04 min and 21.70±2.70 min vs. 15.83±0.88 min, respectively). The rate of ephedrine injected was 58.3% (35/60 patients) in group P vs. 28.3% (17/60 patients) in group S (P<0.05). There was a significant difference in the RSS score between the two groups 5 min after extubation (P<0.05). VRS scores demonstrated that anesthetists and patients were significantly more satisfied with the procedure in group S than in group P (P<0.01). In conclusion, the superiority and special clinical value of inhalational anesthesia has been demonstrated during EVL and EVS attributed to stable hemodynamics and high quality of anesthesia recovery in the present study.

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Predictors of mortality in patients with acute upper gastrointestinal hemorrhage who underwent endoscopy and confirmed to have variceal hemorrhage

Cited by 12 publications

References 22 publications

Prognostic Factors Associated with Mortality in Cirrhotic Patients with Bleeding Varices

Prognostic Factors Associated with Mortality in Cirrhotic Patients with Bleeding Varices

Prediction of Early Rebleeding and Mortality after Acute Esophageal Variceal Hemorrhage among Yemeni Patients in Major Hospitals—Sana’a

Sevoflurane may be more beneficial than propofol in patients receiving endoscopic variceal ligation and endoscopic variceal sclerotherapy: A randomized, double-blind study

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