Predictors of Early Rebleeding after Acute Bleeding from Esophageal Varices

Abstract

Purpose: Predictors for early rebleeding after an episode of acute bleeding from peptic ulcer disease are well described. These predictors are less described for patients who present with acute bleeding from esophageal varices (EV). Methods: In order to determine the predictors of 30-day rebleeding in patients with acute bleeding from EV, we performed a retrospective cohort study in a major health system (Henry Ford Health System, Detroit, Michigan). All patients who presented with acute bleeding from EV were included. Data including age, gender, ethnicity, etiology of liver cirrhosis, prior complications of liver cirrhosis (ascites, encephalopathy, prior history of EV, prior history of endoscopic band ligation, and presence of hepatocellular carcinoma), use of B blockers prior to admission, numbers of bands applied during initial endoscopy, MELD score on presentation and the number of blood products transfused during the patients' hospital stay was obtained and analyzed. Results: We identified 109 patients who presented with an acute episode of bleeding from EV. Twelve patients had an episode of rebleeding from EV within 30 days of presentation. The average time of rebleeding was 8 days. There was a significantly higher MELD score in those who had rebleeding within 30 days compared to those that did not (23.3 ± 7.6 vs. 14.9 ± 4.8) (p<0.001). Patients with a MELD score of 18 or higher had a significantly higher proportion of 30-day rebleeding compared to those with a MELD score less than 18 (30.3% vs. 2.6%) (p<0.001). Patients who received a larger number of red blood cells (RBCs), fresh frozen plasma (FFPs) or platelets (PLTs) during their hospital stay were also found to have a higher rate of 30-day rebleeding. This was particularly seen in patients who received either 6 or more units of RBCs vs. less than 6 units (22.2% vs. 5.5%) (p=0.018), patients who received 4 or more units of FFPs vs. less than 4 units (26.5% vs. 4.0%) (p=0.01), and patients who received 7 or more units of platelets vs. less than 7 units (66.7% vs. 9.4%) (p=0.032). There were not other statistically significant differences in the patients' characteristics when comparing those who had an episode of rebleeding within 30 days and those who did not. Conclusion: In patients admitted with bleeding secondary to esophageal varices, those with a MELD score ≥ 18 on admission, and those who received either ≥ 6 units of RBCs, ≥ 4 units FFPs, or ≥ 7 units PLTs have a higher rate of 30 day rebleeding.