Prognostic Factors in Liver Cirrhosis Patients with Upper Gastrointestinal Bleeding

Abstract

Introduction and aim: Upper gastrointestinal bleeding (UGB) remains one of the frequent problems in medical practice, that especially on patient with hepatic cirrhosis, has a major significance due to its determined mortality and morbidity. The aim of this study was to analyze the upper gastrointestinal bleeding in liver cirrhotic patients and to assed the different parameters as possible prognostic factors for mortality in those patients.Material and methods: We have made a retrospective study on 647 patients with liver cirrhosis patients hospitalized for UGB episode in a 5 years period in Gastroenterology and Hepatology Clinic of the Emergency Clinical County Hospital Timisoara.The liver cirrhosis diagnostic of the patients included in the study was determined by clinical exam together with paraclinical tests (laboratory and imagistic), or by histological exam.Results: The studied group included 647 hepatic cirrhosis patients, hospitalized for upper digestive hemorrhage (352 men-54.4% and 295 women -45.5%), aged between 16 and 84 years with an average age of 54.5 ± 26.1 years old. Almost 70% of the patients (n=447) had variceal hemorrhage; 83% (n=369) of these, bled because of the esophageal varices rupture and 17% (n=78) because of the gastric ones. Almost 70% of the cases had active bleeding during endoscopy and 20% had hemorrhagic shock. Death rate was 17%. We evaluated the possible predictive factors for early mortality and rebleeding in patients with variceal hemorrhage, by dividing the batch of 647 patients into 2 categories as follows: Patients without rebleeding (N=289) vs. patients who rebleed (N=158) and Survivors (N=370) vs. deceased (N=77), we tried to identify possible risk factors for prediction of rebleeding and early mortality by analyzing the following parameters: the degree ofhepatic insufficiency (Child-Pugh classification and MELD score, albumin, cholinesterase, bilirubin), the severity of bleeding (anemia, hemorrhagic shock,), endoscopic parameters (variceal grade, active bleeding at endoscopy), coagulation disorders (platelets count and INR), etiology of cirrhosis, decompensation of the underlying disease (vascular, parenchymatous).Conclusion: MELD score, serum albumin level, encephalopathy, severe anemia and rebleeding are prognostic factors for mortality and the predictive factors for rebleeding in cirrhotic patients with variceal hemorrhage are MELD score and large ascites.