Acute Variceal Bleeding in Patients with Liver Cirrhosis with and without Diabetes

Background. Acute variceal bleeding is a major cause of death in liver cirrhosis. This large scale retrospective cohort study aims to analyze the prognosis of patients with cirrhosis and acute variceal bleeding and to validate the current prognostic models. Methods. Patients with cirrhosis and acute variceal bleeding were enrolled from Jan 2019 to March 2020. The independent prognostic factors for in-hospital death were identified by logistic regression analyses. Area under curves (AUCs) was compared among Child-Pugh, cirrhosis acute gastrointestinal bleeding (CAGIB) score, and model for end-stage liver disease (MELD) and neutrophil-lymphocyte ratio (NLR) scores. Results. Overall, 379 patients with liver cirrhosis and acute variceal bleeding were consecutively evaluated. The majority of the patients were males (59.1%) and the mean age of all patients were 53.7±1.3 years (range 14-89). Hepatitis B virus (HBV) was the most common underlying cause of liver cirrhosis (54.1%). 72 (19%) patients had hepatocellular carcinoma. Multivariate logistic regression analyses showed that age, HCC, WBC, total serum bilirubin, serum creatinine, and ALT were independently associated with in-hospital death. And the odds ratios (ORs) for in-hospital death were 1.066 (95% CI 1.017-1.118, P=0.008), 7.19 (95% CI 2.077-24.893, P=0.001), 1.123 (95% CI 1.051-1.201, P=0.001), 1.014 (95% CI 1.005-1.023, P=0.003), 1.012 (95% CI 1.004-1.021, P=0.006), and 1.005 (95% CI 1.000-1.009, P=0.036), respectively. In the whole cohort with HCC patients, the AUCs of Child-Pugh, CAGIB, MELD and NLR scores were 0.842 (95% CI 0.801-0.878), 0.840 (95% CI 0.799-0.876), 0.798 (95% CI 0.754-0.838), and 0.688 (95% CI 0.639-0.735), respectively. The differences were statistically significant between Child-Pugh and NLR scores (P=0.0118), and between CAGIB and NLR scores (P=0.0354). Conclusion. Child-Pugh and CAGIB scores showed better predictive performance for prognosis of patients with cirrhosis and acute variceal bleeding than NLR scores.

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Transjugular Intrahepatic Portosystemic Shunt for Acute Variceal Bleeding in Patients with Viral Liver Cirrhosis: Predictors of Early Mortality

American Journal of Roentgenology ◽

10.2214/ajr.04.0607 ◽

2005 ◽

Vol 185 (4) ◽

pp. 885-889 ◽

Cited By ~ 21

Author(s):

Chang Jin Yoon ◽

Jin Wook Chung ◽

Jae Hyung Park

Keyword(s):

Liver Cirrhosis ◽

Transjugular Intrahepatic Portosystemic Shunt ◽

Variceal Bleeding ◽

Portosystemic Shunt ◽

Early Mortality ◽

Acute Variceal Bleeding ◽

Intrahepatic Portosystemic Shunt

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Factors Predicting Mortality of Variceal Bleeding in Liver Cirrhosis

Journal of Nepal Medical Association ◽

10.31729/jnma.3408 ◽

2018 ◽

Vol 56 (209) ◽

pp. 493-496

Author(s):

Amrendra Kumar Mandal ◽

Mukesh Sharma Paudel ◽

Sudhamshu KC ◽

Sitaram Chaudhary ◽

Bidhan Nidhi Paudel ◽

...

Keyword(s):

Liver Cirrhosis ◽

Serum Creatinine ◽

Serum Creatinine Level ◽

Creatinine Level ◽

Variceal Bleeding ◽

Meld Score ◽

High Serum ◽

Predictors Of Mortality ◽

Acute Variceal Bleeding ◽

Ctp Score

Introduction: Acute variceal bleeding in liver cirrhosis is an immediate life-threatening condition and amajor complication of portal hypertension associated with higher morbidity, mortality and hospital costs than any other causes of UGI bleeding. Therefore, early stratification and initiation of therapy based on several factors can reduce mortality associated with it. We aimed to study the predictors of mortality in acute variceal bleeding in LC. Methods: An observational prospective study was conducted in Gastroenterology and Hepatology units of Bir Hospital, Kathmandu, Nepal from April 1, 2016 to May 30, 2017. Patients were included if they had underlying liver cirrhosis and presented upper GI bleeding which were proven to be secondary to variceal bleeding. Results: Seventy-five patients with mean age of 52.5 years were available or the analysis. The M:F ratio was 2.1:1. There were 66 patients in mortality group and 9 in survivor group. The mean CTP and MELD score were 10.17±1.66 and 20.40±8.29 respectively. Among the predictors of the mortality studied, CTP score, MELD score, mean arterial pressure, Serum bilirubin, serum creatinine, need of FFP as well as PRP transfusion, presence of hepatorenal syndrome and hepatic encephalopathy were high in mortality group with statistical significance. On multivariate analysis, high CTP and high serum creatinine level were only significant predictors of mortality. Receiver operating curve for predicting accuracy of mortality was significant with higher MELD and higher CTP score. Conclusions: Strong predictors of mortality in patients with cirrhosis presenting with variceal bleeding are CTP score and high serum creatinine level.

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