Predictors of early re-bleeding and mortality in patients with first attack of gastric variceal hemorrhage

Abstract

Background: Gastric varices (GV) bleed less frequently than esophageal varices however, gastric variceal bleeding is more severe with higher mortality and rebleeding rates. Treatment of Gastric variceal bleeding (GVB) by tissue adhesive mainly cyanoacrylate glues has been used for Gastric variceal obturation. We aimed to determine predictors of early rebleeding and mortality in patients with the first attack of GVB. Materials and methods: The study included 120 patients with a first attack of GVB.The patients subjected to thorough history, full examination, laboratory, and radiological investigations. Child Turcott Pugh score (CTP), and model of end stage liver disease (MELD) score were calculated. Upper gastrointestinal (GI) endoscopy with gastric variceal obturation (GVO) by cyanoacrylate glues were done for all included patients. Follow up during hospitalization and 6 weeks after discharge to determine early rebleeding (within 14 days) and early mortality (within 6 weeks). Results: Among 120 included patients in the study, 24 patients (20%) were presented with early rebleeding and 19 patients (15.83%) were presented with early mortality. Multi-variable logestic regression analysis showed that, Child Pugh Score was an independent prognostic factor associated with early rebleeding and early mortality. It was found that, current smoking, increased bilirubin, INR, creatinine, decreased albumin, presence of ascites, higher CTP and MELD scores are significantly more in early rebleeding and early mortality groups, while lower platelet count in early rebleeding only. Moreover, hepatic encephalopathy, and higher transaminases are more in early mortality group. There was no significant difference in gastric variceal signs between the study groups except that increase mortality in patients with more than one varix. Conclusion: Child Turcott Pugh score was an independent prognostic factor associated with early rebleeding and early mortality in patients with GVB.