Prognostic Factors Associated with Mortality in Cirrhotic Patients with Bleeding Varices

Abstract

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.