Risk factors for in-hospital mortality in cirrhotic patients with oesophageal variceal bleeding

Eur J Gastroenterol Hepatol. 2012 May;24(5):551-7. doi: 10.1097/MEG.0b013e3283510448.

Abstract

Introduction: Oesophageal variceal bleeding (OVB) is a high mortality rate complication in patients with cirrhosis. The aim of this study was to assess the risk factors for in-hospital mortality (IHM) in cirrhotic patients with OVB.

Patients and methods: The study cohort included 102 patients (average age, 55.4 ± 12.6 years, 71.6% men) consecutively admitted to our hospital with OVB. All the patients underwent upper endoscopy within 12 h and octeotride or terlipressin therapy was started at admission and continued for 5 days. To calculate Model for End-Stage Liver Disease (MELD) and Child-Turcotte-Pugh scores, laboratory test data from blood samples taken within 6 h of admission were used.

Results: The IHM was 18.6% [19 patients; confidence interval (95% CI): 11.1-26.2%]. In the univariate analysis, transfusion with 2 or more units of packed red blood cells [PRBC; P=0.038; odds ratio (OR)=7.8; 95% CI: 1.2-61.3], platelets of 100/ml or less (P=0.014; OR=3.6; 95% CI: 1.2-10.3), Child-Turcotte-Pugh score of 10 or more (P=0.002; OR=4.0; 95% CI: 1.2-13.2) and MELD of 18 or more (P=0.044; OR=2.8; 95% CI: 1.1-8.1) were associated with IHM. In the multivariate analysis, transfusion with 2 or more units of PRBC (P=0.076; OR=6.7; 95% CI: 0.82-54.8), platelets of 100/ml or less (P=0.031; OR=3.4; 95% CI: 1.1-10.6) and MELD of 18 or more (P=0.048; OR=3.2; 95% CI: 1.02-10.1) remained independently associated with IHM. Applying a receiver operating characteristic analysis, the area under the curve derived from the multivariate analysis model was 0.76 (95% CI: 0.64-0.88) for IHM.

Conclusion: Cirrhotic patients with OVB and MELD of 18 or more, platelets of 100/ml or less and requiring transfusion of 2 or more units of PRBC were at an increased risk of IHM. Overall, the logistic regression model correctly predicts 82.2% of IHM patients.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Erythrocyte Transfusion
  • Esophageal and Gastric Varices / drug therapy
  • Esophageal and Gastric Varices / mortality*
  • Female
  • Gastrointestinal Agents / therapeutic use
  • Gastrointestinal Hemorrhage / drug therapy
  • Gastrointestinal Hemorrhage / mortality*
  • Hospital Mortality
  • Hospitalization
  • Humans
  • Liver Cirrhosis / mortality*
  • Lypressin / analogs & derivatives
  • Lypressin / therapeutic use
  • Male
  • Middle Aged
  • Octreotide / therapeutic use
  • Platelet Count
  • Portugal / epidemiology
  • Risk Factors
  • Severity of Illness Index
  • Terlipressin
  • Vasoconstrictor Agents / therapeutic use

Substances

  • Gastrointestinal Agents
  • Vasoconstrictor Agents
  • Lypressin
  • Terlipressin
  • Octreotide