POTENTIAL PREDICTORS AND OUTCOMES OF BLEEDING EVENTS AFTER ESOPHAGEAL VARICEAL LIGATION

Abstract

SESSION TITLE: Critical Care Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: October 18-21, 2020 PURPOSE: Esophageal Variceal Ligation (EVL) has been used for primary prophylaxis, acute bleeding episodes, and secondary prophylaxis of esophageal variceal hemorrhage. The most common complications of EVL are dysphagia, chest pain, intra-operative bleeding, and post-procedural bleeding from ulcer formation. The aim of our study is to identify risk factors for a bleeding event and compare outcomes in those patients who bled and those who did not bleed after EVL. METHODS: This is a retrospective cohort study. The data was gathered from the EPIC electronic medical record using Clinical Looking Glass (Emerging Health Information Technology, Yonkers, New York). We analyzed 480 EVL procedures performed in patients with cirrhosis (alcoholic, hepatitis C, hepatitis B, autoimmune, and non-alcoholic steato-hepatitis) between 2014 to 2019. RESULTS: Average age was similar between the groups that bled and the group that did not bleed (59.4 vs 59.7, p=0.92). Intubation rates were higher in the group that bled versus the group that did not bleed (42% v 6%, p<0.01). Vasopressors were more likely to be required in the group that bled versus the group that did not bleed (26% v 3%, p<0.01). The Model for End Stage Liver Disease, Sodium (MELD-Na) scores were significantly higher in the group that bled compared to the group that did not bleed (9.87 v 6.24, p<0.01). APRI (AST to Platelet Ratio Index) scores were significantly higher in the group that bled compared to the group that did not bleed (4.82 v 2.01, p=0.04). CONCLUSIONS: APRI score and MELD-Na scores can help predict bleeding events. Bleeding after EVL is a serious event associated with a higher intubation rate and greater need for vasopressors. CLINICAL IMPLICATIONS: Critical Care physicians can use APRI and MELD-Na scores to anticipate bleeding events after EVL and be better prepared for next steps in management. DISCLOSURES: No relevant relationships by Lewis Eisen, source=Web Response No relevant relationships by Galina Glazman-Kuczaj, source=Web Response No relevant relationships by Ariel Karten, source=Web Response No relevant relationships by Christa McPhee, source=Web Response No relevant relationships by Ariel Shiloh, source=Web Response