Abstract
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 endoscope (P - 47.29, P = 0.001) and high serum bilirubin (- 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 - 1.41, P 9/l (OR: 1.2, CI: 1.02 - 1.40, P 9/l.
Highlights
Variceal bleeding is a serious complication of liver cirrhosis and is associated with significant morbidity and mortality [1] [2]
Between April 2014 and March 2015, 160 cirrhotic patients with features of acute upper gastrointestinal bleeding suspicious for variceal hemorrhage were enrolled in the study at the major hospitals in Sana’a (77 patients in Al-Kuwait university hospital, 62 patients in Al-Thwrah Hospital and 21 patients in Al-Gumhory Teaching Hospital). 58 patients were excluded from the analysis because of hepatocellular carcinoma (HCC) (n = 9) and inability to follow them (n = 49)
The predictive factors significantly associated with rebleeding within 6 weeks period in univariate analysis were clot on varix at index endoscope (P < 0.0001), serum bilirubin (P = 0.02), CTP (P < 0.05) and Model for End-stage Liver Disease (MELD) score (P < 0.05)
Summary
Variceal bleeding is a serious complication of liver cirrhosis and is associated with significant morbidity and mortality [1] [2]. There are several factors that have been identified as predictors of mortality after esophageal variceal hemorrhage, including early rebleeding, bacterial infection, hepatic venous pressure gradient (HVPG) >20 mmHg measured shortly after admission, active bleeding at initial endoscopy, severity of initial bleeding, hematocrit level, transaminases levels, presence of portal vein thrombosis, hepatocellular carcinoma (HCC), alcoholic liver disease, serum bilirubin and albumin levels. 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).
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