Upper gastrointestinal bleeding in Egyptian patients with cirrhosis: Post‐therapeutic outcome and prognostic indicators

Abstract

Background and Aim Upper gastrointestinal bleeding (UGIB) is a serious complication of portal hypertension in cirrhotic patients. The objective of this study is to identify the risk factors for morbidity and mortality occurring after an UGIB attack. Methods A total of 1097 UGIB attacks in 690 patients with liver cirrhosis were studied. Their clinical, laboratory, and endoscopic data were reviewed. Results Mean age 53.2 ± 10.6 (20–90) years, 78% men and the main cause of liver disease was hepatitis C (94.9%). Complications occurred after 467 attacks (42.6%): hepatic encephalopathy 31.4%, spontaneous bacterial peritonitis 18%, renal impairment 13.2%, and re‐bleeding in 7.8%, while 199 patients (18.1%) died. Complications followed 78.4% of bleeding from gastric varices, 75% of post‐interventional ulcers, 10.8% of peptic ulcers, and 5.9% of telangiectasias. By univariate analysis: packed red blood cells units transfused, transaminases, Child–Pugh (CP), model of end‐stage liver disease (MELD), and albumin–bilirubin (ALBI) scores, beside the presence of hepatocellular carcinoma (HCC), previous hemorrhage in the previous 6 months, and the source of bleeding, were associated with occurrence of complications. By multivariate analysis, independent predictors of complications were CP, MELD, and ALBI scores (odds ratio, 95% confidence interval: 5.63, 3.55–8.93; 1.15, 1.11–1.19; and 2.11, 1.4–3.19, respectively) beside the presence of HCC (4.89, 2.48–9.64). Mortality predictors were packed red blood cells units transfused (1.11, 1.01–1.24), CP (5.1, 1.42–18.25) MELD (1.27, 1.21–1.32) scores, and presence of HCC (6.62, 2.93–14.95). Conclusion High CP, MELD, and ALBI scores beside the presence of HCC could predict poor outcome of UGIB. In the absence of these risk factors, early discharge could be considered if the source of bleeding is peptic ulcer or telangiectasia.

Findings of Esophagogastroduodenoscopy in Patients Suspected of Upper Gastrointestinal Bleeding Referred to the Main Endoscopy Unit at King Fahad Specialist Hospital

“…Alternatively, analysis of patients with UGIB and liver disease revealed that variceal bleeding, either esophageal or gastric, was responsible for most of the UGIB attacks (57.7%) [19][20][21]. It has been reported that about half of cirrhotic patients will develop varices due to portal hypertension and 40% of them will have variceal bleeding [22].…”

Comparing the performance of the ABC, AIMS65, GBS, and pRS scores in predicting 90-day mortality or rebleeding among emergency department patients with acute upper gastrointestinal bleeding: A prospective multicenter study

“…[1][2][3][4][5] Despite improvements in management over the past decades, acute UGIB remains a common, life-threatening condition with mortality ranging from 5% to 11%. [1][2][3][4][5] In China, there are approximately one million UGIB patients admitted to hospitals each year, with an UGIB-specific death rate estimated to be between 4%-14%. [6] JOURNAL OF TRANSLATIONAL INTERNAL MEDICINE / APR-JUN 2021 / VOL 9 | ISSUE 2…”

“…Acute upper gastrointestinal bleeding (UGIB) is a common reason for seeking care in emergency departments (ED) and being admitted to acute care hospitals worldwide, with an incidence of 80–150 per 100,000 people each year. [ 1 , 2 , 3 , 4 , 5 ] Despite improvements in management over the past decades, acute UGIB remains a common, life-threatening condition with mortality ranging from 5% to 11%. [ 1 , 2 , 3 , 4 , 5 ] In China, there are approximately one million UGIB patients admitted to hospitals each year, with an UGIB-specific death rate estimated to be between 4%–14%.…”

Immature Granulocyte Count and Percentage as New Predictors of Mortality in Patients with Upper Gastrointestinal Bleeding

“… 1 Despite improvements in diagnosis and treatment methods, its annual incidence is 50–180 per 100,000 population, the overall mortality rate is around 10%, and this rate is estimated to reach 35% in the patients with comorbidities. 1 , 2 The early diagnosis of the patients at risk for the poor outcomes can be difficult to predict in emergency situations. 3 , 4 …”